Right-sided Thigh Pain- Runner

Abstract

Listen

Translate article

HISTORY: 41 year old active gentleman who presented with a 6 month history of new onset right sided hip and thigh pain. His initial presentation began as right knee pain that responded to an informal exercise program. A few months later he developed pain along the antero-lateral area of his right thigh, characterized as 5/10 non-radiating, burning pain. His pain was aggravated with standing and particularly worse at night causing sleep disturbance. Pain was alleviated with rest and massage. He experienced frequent low back pain with long sitting during airplane travel. No change in symptoms with valsalva maneuvers and he denied any numbness, true weakness or cardinal red flag signs. Aside from the generalized conditioning and stretching program directed by his personal trainer, he had not undergone formal physical therapy, chiropractic manipulation, acupuncture, injections or surgery. PHYSICAL EXAMINATION: Vitals signs normal. Normal lumbar lordosis and lower limb posture. Full AROM of lumbar spine and lower extremities. Non-antalgic generalized gait pattern. Sensation intact to pinprick and light touch throughout L2-S2 dermatomes. 5/5 strength lower extremities bilaterally. Single Leg squat demonstrated decreased balance on right side without full buckling of knee. Slump Sit maneuver reproduced thigh pain and was relieved with cervical extension. Reverse straight leg raise reproduced burning symptoms along right antero-lateral thigh and was made worse with neck extension. No ITB tenderness on palpation or range of motion. DIFFERENTIAL DIAGNOSIS: 1. Right L3 Radiculopathy, 2. Meralgia paresthetica 3. Right Iliotibial band syndrome TEST AND RESULTS: Prior MRI Right Hip negative Prior MRI Right Knee no evidence of meniscal injury or collateral tears MRI Lumbar Spine spondylosis and concentric annulus disc bulge at L3-L4 level compressing the thecal sac and encroaching on right L3 neuroforamen. FINAL/WORKING DIAGNOSIS: Right L3 Radiculopathy TREATMENT AND OUTCOMES: 1. Medication Management: Cymbalta 30mg po QHS with improvement of neuropathic pain. 2. Physical therapy: Mechanical Diagnosis and Therapy to centralize symptoms 3. Injections: Discussed possibility of right L3 transforaminal epidural steroid injection if symptoms recur.