Thigh Pain and Numbness - Driving

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HISTORY: A 42 y/o WM experienced left hip pain while on an 8 hour drive in which he drove the full time without a rest break. One to two hours after the drive he developed pain in his left anterior thigh with numbness and hyperesthesia along the anteromedial aspect. The patient stated there was weakness with hip flexion and reported no previous history of back, hip, or thigh pain. He denied any history of numbness in his thighs, or legs, and no history of diabetes. He had no prior surgeries, and he was not on any medications. PHYSICAL EXAMINATION: Examination revealed 9/10 pain over the anterior left thigh with numbness anteromedially to light touch. Quadricep strength was 4/5 on the left and 5/5 on the right. He did not have hip or back pain. He had full range of motion of his back and hip. A straight leg raise was normal on both sides. There was no Tinel sign over the inguinal ligament. A femoral nerve stretch test (passive hip extension with 90 degrees knee flexion in the prone position) reproduced his pain and numbness in the anterior thigh. Patellar reflex on the left was absent with a 2+reflex on the contralateral side. DIFFERENTIAL DIAGNOSIS: Lumbar Radiculopathy Femoral Neuropathy Meralgia Paresthetica Diabetic Mononeuropathy Idiopathic Mononeuropathy TEST AND RESULTS: Lumbar Radiographs: Normal Left Hip Radiograph: Normal MRI Lumbar Spine: L2-L3 left lateral disc extrusion impinging on left neuroforaminal space but not on the thecal sac. Also L3-L4 spondylosis FINAL WORKING DIAGNOSIS: Lumbar Disc Extrusion (L2-L3) and Spondylosis (L3-L4) with left femoral neuropathy TREATMENT AND OUTCOMES: Prednisone 60mg PO for 5 days Diclofenac CR 100mg once daily Physical Therapy Consult for ROM and strengthening of lumbar spine and quadriceps Physiatry Consult for Pain Management Over a one month period, patient reported 80% improvement in pain and numbness and this was no longer limiting his daily activities