Numbness on anterior aspect of the thigh - help

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Hi,

I need some advice on what I suspect is a nerve issue. If there is numbness and tingling on the anterior aspect of the one thigh after exercise (specifically squats and lunges) can it possible be a nerve becoming compressed between the muscles or the nerve is being overstretched?

How can I diagnose the issue and what could be possible management options?

Any advice or thoughts on this issue will be greatly appreciated.

Thanks

 

If I was suspicious of neural irritation I'd perform a cursory femoral nerve tension test (extend the hip with patient prone and knee flexed). If provocative then bring Physio into management plan.

 

This condition is known as meralgia parasthetica or an entrapment neuropathy of the lateral femoral cutaneous nerve. Wear loose fitting pants when exercising and no belts/tight waistbands. You may also want to stop the squats and lunges until the nerve becomes less inflamed.

 

Have you considered doing the Thomas test looking for a contracture of iliopsoas?

 

Thank you for your reply,

Yes I have, and there doesn't seem to be any contracture or tightness of illopsoas.

 

Thank you for your reply.

I did further research into the condition and the symptoms are the same as the ones of Meralgia parasthetica as you said. If I allow it to rest and it resolves over time, but then start exercises again afterwards, would it cause the condition to return? Also are there any specific stretching or exercises for management?

Thanks

 

But he/she said anterior thigh, not lateral thigh. Back to basics; yes the lateral femoral cutaneous nerve had its own root from the lumbar plexus - don't make me look it up, but it is about L2-3. The other two anterior nerves are a part of the femoral nerve, and have an origin somewhere in L2-4 (posterior component). The simple description given here did not indicate lateral thigh - so perhaps one ought to look at the huge lump of neurology passing through iliopsoas, for instance.

 

Thank you for your reply.

Sorry I should have been more clear, yes its the anterior thigh but the symptoms are also present on the lateral thigh. its just that whole antero-lateral part of the right thigh producing the symptoms. But the majority of the symptoms are experienced in the anterior aspect of the thigh.

 

Yes, back to basics. I've worked with orthopedic surgeons for the last 28 years and was first introduced to the diagnosis of "meralgia parasthetica" a quarter of a century ago when I asked about this anterior thigh numbness in one of my own patients to one of the orthopedists I worked with (this orthopedist used to play football with OJ Simpson on USC's football team and was blocked for OJ in the Rose Bowl.) It is fairly common condition and probably every orthopedic surgeon knows what "meralgia parasthetica" is. Unfortunately, very few podiatrists know about it.

 

Yes it certainly is nerve entrapment, as a Pod I hate to admit it, but I have numbness
in my right thigh,of which I am aware of,and have had this for many years, it was more than likely causes by lifting something awkwardly,compressing and entrapping the nerve, apart from stretching exercises, there is not a lot that can be done, in my case it causes me no trouble, just an awareness. If its a nuisance factor, the option although rarely recommended is spinal fusion.
David Crew

 

I think because there is a lot of emphasis on the conditions affecting the feet and legs below the knee in podiatry. I know with the course I am doing, in terms of nerve entrapment, we only covered those in the foot and lower leg, so I have not come across this condition either. While we cover the nerve supply of the lower limb in terms of anatomy, there isn't much mentioned about nerve conditions above the knee unless its systemic conditions that affect gait.

 

I have had a patient before that had complained of a similar condition, but did not know what the problem could be, and she also had weakness in her quadriceps, where the supervisor prescribed strengthening exercises for. But since I have now experienced the same symptoms, I know definitely that is it more than just muscle weakness and would like to be more informed about it, since we haven't been taught about this condition. That's true it is a nuisance and becomes frustrating when you can't continue doing exercise because it causes pain.

 

The diagnosis of the symptom is good. The cause of the symptom is still not diagnosed.
I am not allowed to make a diagnosis. but I would like to suggest that avoidance of muscle pull on some segment of the spine or pelvis is causing a repetitive muscle pattern in the anterior/lateral thigh to support the squat.
My suggestion is to hone your gait analysis skills by observing what additional motion or guarding is happening on the symptomatic side compared to the other.
My favorite cause is failure of the psoas minor to maintain pelvic stability due to injury at the thoracic/lumbar junction. There are many others so observe test and find the cause so you can get back to good function.

 

Dear All
Happy New Year to you all

Another name for it is the long haul flight syndrome. it occurs in those who travel from Australia to the UK.
When they go to get up to get their overhead luggage they notice the numbness.

The main cause is entrapment under the inguinal ligament at the insertion into the iliac bone
In some the nerve that an abnormal pathway and passes deep the the upper tendon of the rectus femoris on the IIS inferior iliac spine.

Just tell them what it is and it will get better

you can see the entrapments with modern ultrasound.

if they won't take no for an answer, a small infiltration of LA demonstrates the loss of numbness at this site.

occassionally it persists no matter what and a steroid injection usually fixes the problem. I prefer to use father time to heal it

sunny day been lousy weather for summer in New South Wales. only 2 days over 30C usually lucky if it only gets to 30C

Regards
Paul Conneely
www.musmed.com.au