This topic contains 11 replies, has 3 voices, and was last updated by 
Christopher Stepien June 4, 2019 at 4:53 pm.
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Christopher Stepien
57 Y.O. Active, Fit Male
Lx: right mid lateral thigh (points to spot about 8″ long along posterior VL behind ITB – used to go up to greater troch and down to knee, but has gotten smaller and 85% better with acupuncture and rolling out)
Q: pins and needles
I: 5/10
P+: sitting 30 mins –> standing, stretch while standing into hip adduction (stretching lateral side of low back and hip)
P-: getting up in morning out of bed
Dx Hypothesis:
1. L4-L5 Nerve Root Entrapment at Lumbar Spine
Exam:
SLR R – 91 deg, mod post thigh pull
SLR L – 89 deg, mod post thigh pull
SHF R – 96%, no sx, Protective tension in hamstrings
SHF L – 96%, moderate sharp pain 1″ under ASIS
QLF – 1.25″ – 2.75″ ext, flat til 4.5″ – 55% function, no sx
KHE R – 15.5″ – no sx
KHE L – 14″ – mild pull left anterior hip
SLPF – full, no sxOnset: 2 YA – no mechanism
I didn’t bother palpating Lateral femoral cutaneous nerve because it wasn’t provoked by KHE.
This seems like a straight up Degenerative – L4-L5 NR injury.
Want to make sure I’m not missing anything.
Seth Schultz, DC
It would still be valuable to palpate lateral femoral cutaneous nerve. The nerve can be stuck distal to the inguinal ligament and in turn not be provoked by KHE. His previous symptom went to the greater trochanter which would tell me the nerve isn’t entrapped to the inguinal ligament or surrounding tissue. Or at least not stuck enough to cause symptoms.
You could also tension that nerve by having him side lying with involved side up, bring him into adduction, and check if that reproduces CC.
Christopher Stepien
TY Seth.
Why can’t it be entrapped to inguinal ligament or surrounding tissue? I found an anatomical picture where there’s a posterior branch coming off it going toward GD?
Will try this test.
Seth Schultz, DC
The nerve can be entrapped there but his specific case seems like it’s less likely there and stuck more distal.
Carl Nottoli, DC
I would palpate the local tissues where he has his CC in a tensioned positioned or while in his provocative position.
Here is some anatomical drawings of the nerve variations.
https://www.researchgate.net/figure/Types-of-exits-of-the-lateral-femoral-cutaneous-nerve-from-the-pelvis-with-calculated_fig1_301646840
Christopher Stepien
Very helpful Seth and Carl. I checked at inguinal ligament, not entrapped there.
Do you have any images of where it courses under ITB? I can’t find any pictures online or in my anatomy book.
Carl Nottoli, DC
Try the link I shared in my last post 🙂
Christopher Stepien
They only have “inguinal area”, but that’s OK. I’ll work with it.
Seth Schultz, DC
Christopher Stepien
TY Seth!
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