sudden onset left side pains: groin, outer hip, lower leg and foot

by Vic
(Kingston, PA, USA)

2 different views

2 different views

I. Here is my background:


56 year old male. 5'10", 260 lbs. Periodic, infrequent LBP from mid 20's on, sometimes debilitating, consistently resolved by bed-rest. Diagnosed with early-onset Parkinson's Disease at 43 years. Treated using carbidopa/levodopa/entacapone in increasing dosages for 12 years. Had elective brain surgery in 03/2016 to have a deep Brain Stimulator (DBS) implanted. Neurostimulators implanted on both sides of brain. DBS largely successful, Parkinson's medications reduced to 1/10 of pre-implant dosages.

My chronic back pain occurs infrequently, is typically short-lived, and is not part of my current medical issue.

My current complaint is of chronic pain that began one day in early June of 2012. I woke up one morning and both feet and lower legs were alarmingly swollen like elephant legs. The swelling was predominantly from the knee downward and was significantly more pronounced in my left lower leg, ankle and foot, though both sides were swollen. I could not put shoes on.

It took a few weeks for the swelling to go down. As the swelling slowly disappeared, it was replaced by (revealed) pain in several distinct locations in my leg, but only on the left side. To this day I have not experienced any similar pains at all in my right leg, only swelling there. The pains in my left hip, groin, leg, and foot have not changed significantly in either type of sensation or severity in almost 4 years.

I think I caused the initial triggering 'event' by over-exerting myself to lift a piece of furniture that I was in no condition to lift.

I have a history of over-exerting myself as evident from 1 inguinal hernia in my early twenties, one umbilical hernia in my late forties, and one lower abdominal fascia hernia repair 3 years ago that I believe was caused by this latest over-exertion event.


II. Here are my symptoms:

1. BOTH LEGS:

significant loss of strength in both legs.

an obvious reduction in circulation in both lower extremities evident by the brown spotting left in my lower legs, ankles, and feet. I assume this is dead blood from burst capillaries from the initial severe swelling event. The skin of both lower legs, ankles, and feet have an ashy look to them (think cadaver) and surface abrasions and lacerations now take months to heal. Four years after the initial event, these conditions persist.

2. LEFT LEG ONLY:

Pain seems to begin at the top of my left hip and shoots diagonally down and across my left groin area to my pubis. The pain in my groin feels as if I have a tourniquet tied around my groin (or as if I was wearing briefs that were 2 or 3 sizes too small and they were strangling my left leg at the crotch). I have even caught myself trying to run my finger between the elastic of my way–too–tight underwear and my groin to try to stretch it out only to find that I was wearing boxers, not briefs. That's how much it feels exactly like way–too–tight underwear.

These pains are accompanied by a feeling of pressure, or swelling along my left groin.

I also have the sensation of sitting on a golf ball in my lower-left buttock, below but adjacent to the ischium. I've read countless descriptions on the internet of sciatic pain that exactly match my sensation.

The pain in my hip also seems to travel superficially, down the inner front of my thigh but I notice no pain in my knee.

A different pain is felt down the left shin, ankle and my foot all the way down to the tips of my toes. This pain is a low, burning, constant pain (by constant I mean it does not "throb"). Whenever this pain is bad, I also get the sensation that a professional wrestler or someone has hold of my left foot and is twisting it continuously.

This leg pain is always accompanied by generalized burning and tingling sensations over the entire left leg and hip.

My "pains" vary in severity throughout the day from what I would call minor discomfort all the way up to severe distraction where I can no longer maintain conversations or sit in a chair, or sometimes even stand still.

These leg pains are always "there", just not always "bad". The pain down my leg and the sensation that someone is twisting my foot and the burning and tingling is what I go to bed with every night and wake up with every morning.

III. External Factors That Exacerbate the Pain

1. Being Unable to Spread Legs

The hip pain is worst whenever I am sitting in an automobile. I've noticed that since the symptoms 1st began I sit with my legs spread as far as the chair will allow. Sitting in a chair that prevents me from spreading my legs aggravates the groin pain.

2. Wearing a Belt

Wearing a belt with my trousers immediately triggers pretty severe hip and groin pain, so I no longer can wear belts.

3. Direct Correlation with Fullness of Bowel/bladder

The groin pain typically gets all my attention for a few hours after I've eaten a significant meal. This pain and swollen sensation are definitely aggravated by the fullness of my bowel. Oh, and I have no pain at all in my right hip and leg.

IV. My Plight

I pursued a medical diagnosis and treatment for 3 1/2 years. I have seen many specialists (neurologists, vascular surgeons, hip specialists, back specialists, a chiropractor, and even a sports medicine specialist). I've accumulated a library of MRI disks and test results, etc. I've had physical examinations, blood and urine tests, MRIs, EEGs, CAT scans, dopplers, x-rays, ultrasounds and several steroid cocktail injections.

I obtained no diagnosis, no treatments, and no relief, just proof that the pain would not be swayed by modern pain relievers. I also developed and a general lack of confidence in the diagnostic abilities of "modern medicine".

My final outcomes were to be referred to the Chronic Pain Management departments of two major hospitals in my area.

The first pain management group I went to injected me with steroids at L5. This had no effect. I had told them that I had previously been injected at that location with no improvement, but they said that I hadn't had THEIR steroid cocktail administered by THEIR staff -- like that would make the difference. It made no difference. I wondered how much they charged my insurance company for that entire fiasco… and then I stopped going to them and sought help elsewhere.

The last doctor I saw was the sports medicine specialist. After examination, imaging, and testing he told me he couldn't help me. I asked him what kind of doctor he would recommend I see next. He replied "a back specialist". I thanked him and told him that's where my journey had started -- three and on half years ago.

Dozens of tests, tens of thousands of dollars billed and not a single step closer to relief.

Then I took a brief hiatus and directed my attention on my upcoming brain surgery for Parkinson's. My DBS implant was a great success. It doesn't affect the progression of the disease at all but it can help me control my tremors for as much as 10 years before it gradually loses its effectiveness completely.

So now I'm all excited about possibly 10 more years before I'm relegated to the land of diapers and dementia and I'm back to trying to get some relief from this continuous pain to maximize the quality of the time I have left.

Can you help me?

I have my MRIs and reports on Google Drive. Please email me if you wish to see anything in particular.

Dear Vic,
Thank you for taking the time to write a very thorough history; in beautiful English that even the queen of England would compliment you on. It's that unusual.

Firstly, these are NOT symptoms typical of sciatica, but the femoral nerve. That's why the injection at L5 didn't help; their neurology is weak. The problem is higher in your lumbar spine.

Having said that, I haven't had the opportunity to examine you, and the large sequestered fragment at L5 doesn't look good. But at L3 and L4 you have distinct signs of stenosis too. What does the MRI report say about the body of L4?

Just to be sure, lie on your back and pull first your right knee, and then the left to your chest and then to the opposite shoulder. Place your foot on the opposite knee and drop the leg into the lotus position. Is there gross stiffness and pain in the left hip and groin?

Your belt story is interesting. The question is whether this is an impingement of the femoral nerve, or a small branch called the LFCN. The difference is that the latter is sensory only, whereas the femoral nerve itself is motor, and will affect the quadriceps muscle. Does your knee give on the steps? There's an interesting condition called meralgia paresthetica where there is pinching in both the mid to upper lumbar spine and groin, often affected by tight clothing.

I'm being something of the Devil's advocate, throwing out random thoughts, but unable to give concrete substance to them because I can't examine you.

In your lower legs you have serious signs of vascular deficiency. Are you also a smoker, or were you, and any signs of raised blood sugar? Those would be serious complications.

I don't need to tell you, I'm sure you've been told several hundred times that with a BMI of 37.3 you are morbidly obese. It's probably the underlying cause of all this stuff.

Vic, you are obviously a highly intelligent man. Apply your mind now to the question of whether you want to see sixty and, if alive, with exacerbation of all these symptoms.

The bottom line is that a complete change of lifestyle is necessary. I'd love to hear from you in five years time that you did it and are alive and well. The alternatives are too ghastly to contemplate.

Good luck, and God bless. With his help you make those changes; they are profound and won't be easy.

Dr B


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