Cause of upper hip and lateral thigh pain

Is this the area affected? Think meralgia paresthetica.

Is this the area affected? Think meralgia paresthetica.

I have been diagnosed with a left Sacro Iliac joint problem with probably inflammation. The pain is in the back of my upper left pelvis down the side of my hip and into the lateral mid thigh area.
I have been having Chiropractic treatment for a few weeks and while it seems a little better, it has not resolved as yet.


I am doing some exercises for it and also need analgesics for the pain.

It's a fairly intense pain with a degree of a burning sensation and comes on if I sit and can be extremely bad when getting up from sitting especially over the outer hip area and into my upper thigh on the lateral side which makes it difficult to weight bear for a short time.

Sometimes it's present when walking but not so much and it's ok when lying down. I can bend over with no pain if I'm careful.

I have some leg weakness in the left leg but also the right leg although no pain in the right leg. Otherwise I have no other neurological symptoms.

My chiropractor sent me to my Family doctor to see about getting an MRI done but she said unless I had neurological symptoms I would not be accepted for referral to an Orthopedic doctor who alone can order the MRI. That's through the Public Hospital system in our Country of New Zealand.

I am concerned I may have a prolapsed disc or maybe a synovial cyst along with the Sacro Iliac problem. Can you help?

Thanks very much
Maureen

Thanks

Hello Maureen,
Leg weakness is certainly an important neurological sign; are the reflexes intact? Which muscles are affected? A page at Chiropractic Help, found using the search function in the navigation bar, called leg pain muscle testing, may be of use.

If it's the knee that's giving, and the quadriceps reflex is reduced then it's a strong indicator of a femoral nerve lesion. But bending forwards, or backwards, or to the side would then often provoke the leg pain.

If there is no weakness at the knee, then I'd be checking out a condition called meralgia paresthetica; it's what's known as a double crush syndrome, with the lateral femoral cutaneous nerve being affected both in the midlumbar spine and in the groin where it leaves the pelvis. Both the groin and lumbar spine have to be addressed to get a successful outcome. The LFCN is sensory only so wouldn't make your knee go lame.
If you have no pain at night, then this would be a strong suspicion for me; sitting with the hip flexed increases the tension in the groin under the inguinal ligament.

And a true femoral nerve lesion is usually very painful in the leg at night.

Test your own hip too. Lying down, pull each knee to the chest and then towards the opposite shoulder; is the left much stiffer and sore in the area you're complaining of?

Ask if a femoral nerve stretch has been done.

I would strongly suggest some gently lower back exercises done every morning before getting out of bed.

I hope this contributes, Maureen. Separately I'll be sending you our latest newsletter which may be pertinent.

Dr B


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