Pins and needles in hip area

A 47-year-old man. Complaints pins and needles in hip area on outer front surface of right thigh. The problem has been bothering him for more than a year. In addition to hip numbness, there is pain in the left leg, especially deep and on the outer surface, discomfort in the lower back.

Objective examination: knee flexion test lying on stomach is painful, provokes symptoms, volume is limited (femoral nerve branches, rectus femoris muscle), additional hip adduction from this position on the right is impossible (external thigh skin nerve). Restriction of mobility, joint play, and pain in the lumbar spine (second and third lumbar vertebrae). Severe soreness, on palpation, in the area of inguinal ligament (place of passage of nerves). The patient was known to have impaired function, hip joint disease in childhood. Patrick's test (abduction and external rotation of the hip) - volume of movements is reduced on both sides.

Diagnosis: Roth-Bernhardt disease (synonyms: thigh external cutaneous nerve neuralgia, paresthetic meralgia, bernhardt paresthesia). Mobility disorder of the femoral nerve, external cutaneous nerve of the thigh, dysfunction of the superior lumbar spine (L2, L3).

Treatment: neurodynamic gliding techniques for the corresponding femoral nerves, mobilization in movement of the upper lumbar spinal motion segments, myofascial release of the lumbosacral area.

Results: after the first two or three sessions numbness in the hip disappeared, increased painless range of motion. Pain in the left leg reduced, but not completely gone, which could be explained by change of leg biomechanics caused by dysfunction of the hip joint (weakness of the middle gluteal muscle, hypertonus and pain of the muscle straining the vastus fascia of the hip, pain reflected there from). The patient is given recommendations and shown exercises aimed at: improving nerve gliding, stretching the shortened muscles, strengthening the weakened muscles.

Bernhardt paresthesia syndrome treatment. Conclusions.

A case illustrating the importance of normal nerve tissue mobility, lack of compression by the interface in anatomically narrow places and their normal gliding. Roth-Bernhardt's disease can be a chronic, interfering active life, untreatable problem until the transmitted nerve is released. In this case, the pins and needles went away even before the mobilization of the respective vertebrae began, only through mild functional and precisely localized clinical neurodynamic techniques.

Grigori Tafi
Osteopath, sports medicine doctor
15 years of experience in osteopathy and manual therapy. Read more...

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