Various numbness following Cam FAI surgery


(David)

Patrick's Fabere test

Patrick's Fabere test

Hello,

I’m 50yo, male, in good health, good weight, good mobility.

I had right hip arthroscopy last July 2018 for cam FAI, cleanup and smoothing of femoral head, and labrum (no tear), basically I could not sit cross legged any more and internal hip rotation was zero and painful.

I now have numbness in my buttock, tingling in my thigh muscle and numbness which moves around knee, calf, arch and sometimes over the foot, it can change on a daily basis from nothing to very annoying.

I’m doing exercise to help L4L5 area in case it is there, doing stretching and rolling on piriformis - but if it is caused by the surgery (maybe the portals etc) I wondered what I can do?

The surgeon has been asked 3 times and just keeps saying either do more exercise or less, which has not been well received!

I’m also seeing a sport massage for trigger points in glutes etc.

Many thanks.

Dear David,
I think it true to say that after 7 months, not much further improvement is likely without intervention. As a matter of interest, has internal rotation improved, and is it less painful? Can you put your leg into the lotus position, known as Patrick's Fabere?

As a Chiropractor I would try to assess what nerve has been damaged by the surgery, and to this end, nerve conduction tests done by a neurologist would help. Is the problem in a nerve root in your back (unlikely), in the sciatic nerve as it emerges from notch in your buttock together with the piriformis, or in the femoral nerve, or one of its slips.

Then the next question is whether the sacroiliac joint has been affected, and this is likely, even before the surgery, and whether treatment of the SIJ would help.

Next would be to establish whether reflexes have been affected and by doing 'leg pain muscle testing' - which you could do at home, by entering this into the Site Search at the top of the Navigation Bar on the left of your screen.

You could also us a sharp needle to map out the exact area affected by the numbness and tingling, and whether it's sharper, duller or actually no change, just tingly.

Then are the sciatic or femoral nerve stretches positive?

If you bend forwards, backwards and to the side does it do anything unusual anywhere?

Depending on what is found from the above, your chiropractor would then decide whether he could help you, or if it's unlikely. I'm obviously uncertain, though if you could give me answers to the above, then I could perhaps give an indication.

Do you have before and after x-rays? That would help. Send them to brlewisatmwebdotcodotza Perhaps start with that and having an evaluation from a neurologist.

Good luck, I look forward to hearing further from you.

One last thing; as I understand it, that CAM deformity will regrow, particularly if you don't exercise the joint daily; I would ask the surgeon's opinion, and what exercises to do.

I hope this contributes. Precise answers to all of the above are essential if you want me to add anything further; most of it you could do yourself, except for the reflexes, stretch tests and nerve conduction tests, all of which the neurologist could provide. Perhaps print this and take it with you to him or her.

Dr B

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



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