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57 YO Male with Right Lateral Thigh Pins & Needles

Exit forum ID Forum Discussion 57 YO Male with Right Lateral Thigh Pins & Needles

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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  • #6946

    Christopher Stepien
    Participant

      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 sx

      Onset: 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.

      #6949

      Seth Schultz, DC
      Participant

        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.

        #6950

        Christopher Stepien
        Participant

          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.

          #6951

          Seth Schultz, DC
          Participant

            The nerve can be entrapped there but his specific case seems like it’s less likely there and stuck more distal.

            #6952

            Carl Nottoli, DC
            Participant

              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

              #6974

              Christopher Stepien
              Participant

                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.

                #6975

                Carl Nottoli, DC
                Participant

                  Try the link I shared in my last post 🙂

                  #6990

                  Christopher Stepien
                  Participant

                    They only have “inguinal area”, but that’s OK. I’ll work with it.

                    #6991

                    Seth Schultz, DC
                    Participant
                      #7034

                      Christopher Stepien
                      Participant

                        TY Seth!

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