This topic contains 4 replies, has 2 voices, and was last updated by Andrew Wengert May 29, 2020 at 5:08 am.
May 21, 2020 at 9:29 am #9272
Symptom location is the distribution of the anterior femoral cutaneous nerve.
Quality is sharp shooting also patient describes as “nerve pain”.
Symptom intensity is zero currently, but on average will be a 3-4, and at worst will get up to an eight. Symptom intensity is directly related to how far hip moves into provocative position.
Provocative is sitting in a chair and abducting the right leg and Walking (worse with a longer stride)
Palliative is anything that doesn’t tension that region.
SLR is 60° bilaterally with posterior knees tension increased with dorsiflexion.
SHF is full bilaterally, however, if the right leg is brought out laterally with the same supine hip flexion motion it will reproduce the chief complaint. But in the sagittal plane there is no symptom.
QLF is at 70%
Kneeling hip extension on both legs brings on Mild to moderate chief complaint but symptoms are more intense when the right leg is the trail leg. Both legs are 12 inches plus.
SLPF: 1” Right post thigh tension.
Patient is a truck driver with a history of disc injuries. This current complaint has been present for two years.
The ID tests show that my focus should be on restoring SLR and QLF, but his chief complaint appears to be more related to his provocative test of abducting the flexed hip.
All my first order history supports the diagnosis of an anterior femoral nerve entrapment. Of note I performed KFHE and he was 1” heel to butt with pad under thigh with moderate quad tension, but not the chief complaint.
Is my thinking correct at this point?
Is there a spot Where the anterior femoral cutaneous nerve contacts adductor magnus or another muscle in the region that would be tensioned with the adductor magnus treatment motion (which reproduces chief complaint)?
Attachments:You must be logged in to view attached files.May 21, 2020 at 9:53 am #9274
William Brady, DCParticipant
Great questions. You will have to palpate and trace the nerve. Most likely it is adhered with the sartorius or less likely the psoas. Palpate and then perform diagnostic passes to tension whichever structures are adhered.
Working SLR and QLF tests will be necessary for health but unlikely to directly effect the pain generator (assuming you can find adhesion).May 22, 2020 at 7:58 am #9276
Would the best patient position to find and palpate the nerve And where it is stuck be in the provocative position during the modified SHF?May 28, 2020 at 9:02 am #9278
William Brady, DCParticipant
Possibly. That provocative (hip flexion with abduction) may be compressing the nerve. I would try to palpate in that provocative but also tension the sartorius (hip extension, knee extension and internal hip rotation) to see if that is provocative and if it is to do a junction move between the sartorius and nerve.
Kind of hard to explain here in the forum. Make sense?May 29, 2020 at 5:08 am #9282
It does. Thank you Dr Brady.
I will report back after I see the patient.
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