Sharp, Tingling, Numb, Burning PAIN in Left Thigh ?? HELP!

[MonkeyMuggs]

For several weeks I've been experiencing pretty significant pain that comes and goes on the side and front (above the knee) of my right thigh. It feels likes it's nerves. It's not muscular or bone. The pain feels as though it's on the "top" or very close to the outside edge of the skin.

The pain will just all of a sudden appear (attack). Burning, Needles, Numbness. Sometimes VERY SHARP - like a knife. Keeps me awake at night. Ibuprofin and Tylenol don't seem to help much.

Has anyone else experienced this? What could it be? What do I do? I've had this before, in my right thigh as well, but much milder and it always went away. Before it was just a bother. But this hurts and is effecting my life and tennis game. Please help.

 

[ollinger]

Axiom 1 -- Sharp pain = medical evaluation.

 

[Consolation]

That's an irritated L4 nerve. Should get it checked out. It's probably nothing major but there are some bad things it could be.

 

[charliefedererer]

This is a map of the area on a leg that a "pinched nerve" of one of the nerves exiting the back, would give symptoms similar to what you are experiencing: pain, burning, needles, numbness.
(The "L" stands for Lumbar and the "S" for Sacral. The numbers refer to the level at which the nerves exit from the Lumbar or Sacral vertebrae [back bones that are stacked like building blocks, and all together make up your "backbone" or "spine". Five lumbar and five sacral "spinal nerves" exit the the small holes in the bones of your lower back.].

Your spinal cord is incredibly well protected traveling down the back encased in the bone making up your spine.

But the individual nerves come out of the side of the spine through little holes or "foramen" that exist between the vertebrae and out of the sacrum [all of the bright yellow structures in the picture below are nerves):

The trouble is that the individual holes or "foremen" are pretty small, so the nerves just barely fit through. Even a small amount of bony buildup (spinal stenosis), a bulging disc, or other cause, can "pinch" the nerve, causing pain in the area that the nerve supplies. This is how a "pinched nerve" in your back can cause the symptoms you are experiencing in the region of the leg that you describe.


But a precise diagnosis of what is going on in YOU, would of course involve seeing a doctor.

The problem you are describing is unfortunately fairly common, so seeing/talking to your primary care doctor could be a natural first step. They may want you to see another specialist, like a neurologist.

The good news is that most people respond to "conservative" treatment, but why take any chances? Get the process started with a medical exam soon.

(I do hope your pain quickly resolves and you get better soon.)

 

[Hapless]

It could indeed be a spinal nerve problem, but it could also be meralgia paresthetica, which is impingement/entrapment of the lateral femoral cutaneous nerve. It's a condition that can be seen in people police officers and/or maintenance people that wear very heavy belts pinching against their hips.

Trochanteric bursitis can present with that kind of pain, as could IT band syndrome.

Get yourself to an MD or really experienced physiotherapist who specializes in sports medicine. I can't stress this enough. Most people seen by a doctor are unhealthy and/or elderly; the normal doctor's train of thought is not used to assessing healthy athletic people. Misdiagnosis can cause you, at best, delays, and at worst, treatment advice that exacerbates your pain.

 

[MonkeyMuggs]

I really appreciate the responses and posts regarding this pain I'm experiencing in my left thigh. Especially the detailed charts from CharlieFedererer.

I've narrowed it down to almost certainly being a pinched nerve in the back along the spine, like many of you have suggested and shown. The problem and real challenge is that for the first time in my life - I do not have any medical insurance. So I've got to handle and deal with this issue as effectively and efficiently as possible. I'm also not working at this time, so funds are tight.

I went to a local clinic whereby local doctors volunteer their time/services. I saw an Orthopedic. He said the Meralgia Parasthetica was very rare and that in his entire career (35 years) he had only seen 2 cases. He would have liked/wanted to perform a Sensory Nerve Conduction Study, but this clinic did not have that equipment. In order to try to rule out or narrow the cause of my pain down, he gave me a shot of cortisone on the LATERAL FEMORAL CUTANEOUS NERVE, explaining that if my problem was in fact Meralgia Parasthetica, that the shot of cortisone should/would loosen the lateral femoral cutaneous nerve up, and that it would likely give me relief. IT DID NOT.

I also went to a Doctor of Oriental Medicine/Chinese Physician for an Accupuncture Treatment. I only went once, but it did not help. I will be seeing a friend of mine who is a Chiropractor this week.

My question is - how do you/they determine what nerve it actually is? What equipment/machines/tests are actually used or performed to determine (see) the problem? And then, if done, can they really "see" or determine where or what the precise problem (nerve/disc/bone) is? I'm a little confused as to which equipment/tests should be done/performed. Several people have mentioned that I should have or get an MRI done. The Orthopedic that I saw spoke of a Sensory Nerve Conduction Study.

If they are somehow able to determine precisely what/where the problem is..........then how do they fix it? What type of surgeries are available/performed? Since I will somehow have to pay for this out of my own pocket, I'm trying to determine the fastest and most efficient/effective method to proceed. Many doctors just perform/order tons of tests. They cast a huge net. I will most likely be unable to afford such a "shotgun" approach. I'm trying to learn what I can and narrow my problem/issue down. I would really appreciate any help/advice. The pain is such that this is not something that I'm going to be able to just live with. Its kind of crazy and funny, as it's not realistic, but the thought of "amputation" (my left leg) has crossed my mind. Appreciate, in advance, any help or experience that can be given me. The replies so far have been very helpful.

 

[Consolation]

Meralgia parasthetica is not uncommon, but unlike the text books that talk about police officers and such with big tight belts, it most commonly occurs in overweight diabetic patients due to their their pannus stretching or compressing the nerve. Ortho docs never see it because there is no orthopedic remedy for it, and thus no need to ever refer a patient to them for treatment of it. Go to a diabetic specialist, or even a primary care doc with a lot of diabetic patients on her roles and they will have seen plenty.

But that's not you're problem as the distribution and timing is wrong.

The exact nerve doesn't matter. It's is almost certainly related to an L4 impingement, but could be L3. It could also an impingement more peripheral, but that's very rare.

It's very likely something it impinging on the nerve as it leaves your vertebrae. In transient cases it can often be a strained muscle causing the problem. In that case rest and stretching can help. In more protracted cases it's more likely to be a structural problem (bone spurs, disc impingement, etc). There are also some 'bad' but rare things it could be.

Unfortunately there isn't much you can do about a structural problem without some sort of intervention (meaning surgery or micro-surgery).

It seems you've tried the rest/wait it out approach and it's still happening. If it's been going on for a while there may be findings on physical exam (subtle weakness or asymmetrical reflexes). The next step is probably imaging of some kind (MRI by far best, but most expensive, may get lucky on CT which may or may not be cheaper), which is not going to be cheap if you don't have insurance, and that's just the first step. Treatment is pricey also (if indeed it turns out to be structural).

There's no good answer here.

The only thing I would add is if you start having any noticeable weakness, or trouble controlling your bowels/urine, you need to see someone immediately.

P.S. just read last bit, you don't need to worry about amputation...

 

[Charles Norris]

This is a fairly common issue that I see atleast 10x/daily. I would seek out conservative care through a Chiropractor or PT that is certified and trained to manipulate. Make sure they have a back ground in sports rehab for obvious reasons. As noted, if symptoms get worse, you need to seek the ER immediately. However, if symptoms persist as they are now, I would try conservative care for a couple of weeks and measure your progress according to your functional deficits that you have now. It is definitely too early to spend money on an MRI, seeing you haven't even tried a chiro or PT yet. All the best.

 

[charliefedererer]

Indeed, the good news is that most causes of a "pinched nerve" do respond to conservative therapy. A fairly good discussion of this problem is available on MedicineNet.com. Here is just a small part of that discussion:

"What is a patent's prognosis for a pinched nerve?

In most cases, patients with a pinched nerve are able to recover completely without any long lasting symptoms. Most patients respond well to conservative treatment including rest, activity modification, ice, physical therapy, and medications.

Surgical operations are typically only recommended for people who do not improve with the conservative treatment or if they have worsening muscle weakness. The longer a patient has symptoms of a pinched nerve, and the worse the symptoms become, the less chance there is for a full recovery. Pain, numbness and tingling usually recovery completely with treatment. If a person develops weakness or wasting of the muscles he or she should see a doctor as soon as possible to prevent any permanent nerve damage."
- http://www.medicinenet.com/pinched_nerve/page4.htm


You might find the information from the Cleveland Clinic helpful on "What Can Physical Therapy Do For Your Back and Neck Pain" http://my.clevelandclinic.org/disor...l_therapy_do_for_your_back_and_neck_pain.aspx


An MRI is the most definitive study to look at the lower back. But as long as there is no weakness, or loss of bowel/urinary control, most patients don't need an early MRI, so that a course of conservative therapy can be instituted. It often takes several weeks for improvement to be seen.


Even in the presence of spinal stenois or a herniated disc that is seen on MRI, surgery is usually undertaken only if the pain is not responding to conservative therapy, or it weakness or loss of bowerl/urinary control occurs.

 

[rfox]

this may help

I have experienced similar pain. From the many excellent replies to MonkeyMuggs query would like to offer my experience in alleviating this pain. My pain was alleviated with a few minutes on a stair master type exercise machine temporarily [discovered quite by accident]. Another temporary relief was in lying down on my back and in pointing the ball of my outstretched left leg and stretching by pushing my foot towards the foot of the bed for a few minutes as far as it would go. Stretching the leg like this gave some immediate relief. More permanently, after a visit to a natural healer outside the country whom dug his thumbs and pressed down and behind the hip bone hard, midway on the left side, repositioning a nerve that 'slipped out of place' 'I was told during the procedure. He had done this many times with other sufferers and after this treatment no longer experienced the pain for a year until just recently where it is only a minor nuisance. The others I had gone with to get this therapy were as well relieved of this pain. As he is out of the country and relatively inaccessible [near Sofia Bulgaria] I can't give contact info. I suppose it was similar to acupressure type treatment. The pressure did cause some discomfort and moderate local pain lasting for the few minutes of the treatment. I hope someone posts a reply as to why this may have worked. If there is a bone spur or something that is aggravating the condition I will post back if a herbal supplement works I will be taking for general internal cleansing. It eats dead tissue while leaving live tissue alone. It is called serrapeptase. It is a long shot and not expecting it to do anything and not sure if a bone deposit would dissolve if indeed that is a factor. even though, the natural healer, acupressurist did offer pain relief I can live easily with any discomfort but at least now have a clue as to what is causing this. Since it has come back a little recently I did a a google search and found the topic and replies very helpful. I did see a neurologist some years ago and he looked at me like I had two heads when I described my symptoms. Not sure I would recommend that at this point unless the price is right and he has heard of this that knows a simple remedy if one is available. Since this direct pressure on nerves can be dangerous I don't know if just any accupressarist will do. It does seem the nerve in question is getting out of place just behind the left hip.

 

[rfox]

MonkeyMuggs, sorry re-read your post and see your pain is on the right side vs the left. Perhaps it is still the same but just opposite sides of the body. Also, my pain extends nearly from mid-thigh and can be traced all the way down to the left side and front of my left foot.