Henry,
Did you consider a possible peripheral entrapment. Given the anterior hip
pain and the lack of motor involvement, you might consider a lateral femoral
cutaneous entrapment. It's level (L2,3) is relatively consistent with your
prior findings, and it's referral can be through the anterolateral hip and
lateral thigh (to the knee). Consider entrapment at the ASIS around the
lateral aspect of the inguinal ligament. Some researchers have suggested
that adduction of the involved extremity can increase neural tension and
increase the symptoms. Hope it helps. Good luck.
James McMahon MPT, ATC
-----Original Message-----
From: Henry Tsao [mailto:[log in to unmask]]
Sent: Wednesday, June 06, 2001 11:29 AM
To: [log in to unmask]
Subject: Re: strange case of sciatica
To all:
Firstly thank you for your contributions and ideas. It is always good to get
another perception of the same problem, and see the different reasoning.
Interesting how people have mentioned SIJ, since it is not the first joint I
would look at thoroughly in the first session (apart from palpation, forward
flexion and Gillet's single leg standing test which were in this case all
normal). I will have a look at her SIJ next time as well. I always had
thought the SIJ referred somatically to the buttock and/or posterior leg,
but never had associated it with anterior hip pain. How does the pain refer
anteriorly (ie, neurophysiologically)??
Could it still be discal?? She is not complaining of back pain anymore, but
the disc may perhaps be still irritating the nerve. Maybe (and this crossed
my mind today) she may have nerve root/dural irritation at L2-L4 region,
which may explain for why the pain is also anterior. What are people's
thoughts on this??
The other thing I am concerned with (and people have mentioned this) is the
night pain. Unless she rolls onto that right side, this may be a redflag
requiring further investigation.
Thank you again for everyone's help, and I will keep you updated on her
progress.
Henry***
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