Nerve impingement

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What is nerve impingement?

Nerves travel around our body, passing through different joints, muscles and bones. If any structure is swollen, the passage for the nerves to pass through narrows and compression occurs. This is called nerve impingement. Nerve impingement will usually cause tingling, numbness or shooting pain. In severe cases, dysfunction and paralysis may occur.

 

The hip is particularly vulnerable to nerve impingement as many nerves travel through the hip. The most common nerve impingements are the sciatic and lateral femoral cutaneous nerve.

One of the causes of irritation of the sciatic nerve is piriformis syndrome. The pressing on the lateral femoral cutaneous nerve is known as meralgia paraesthetica.

 

What is piriformis syndrome?

Piriformis syndrome is when the piriformis muscle in the buttock region spasms and causes pain. The spasm of the piriformis muscle can irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot. (It is similar to sciatica).

 

What is meralgia paraesthetica?

Meralgia paraesthetica is a painful, burning sensation on the outer side of the thigh, due to compression on one of the large sensory nerves in your legs—the lateral femoral cutaneous nerve (LFCN). Any swelling, trauma or pressure can narrow these openings, squeeze the nerve and cause pain.

 

Symptoms of nerve impingement

The severity of symptoms varies significantly from patient to patient. For some patients, symptoms are not constant and may come and go. Symptoms of nerve impingement in the hip may include:

  • Pain in the hip, thigh or at the back of the leg.

  • A burning sensation, tingling, or numbness in the same area.

  • Aching in the groin area.

  • Usually only one side of the body is affected.

  • The site is more sensitive to light touch than firm pressure.

 

When should I seek medical help?

There are circumstances when hip pain might be caused or accompanied by severe issues. If such symptoms are present, it is best to seek immediate medical attention to avoid further complications.

  • Inability to move your leg or hip

  • Inability to bear weight on the affected leg

  • Severe pain in the hip

  • Any signs of infection (fever, chills, redness)

  • Recent history of trauma

 

Diagnosis

To diagnose any nerve impingement, your doctor will take your case history and past medical history into account. Then they will perform a physical examination on your hip and check for sensory differences between the affected and your other leg. They will put some pressure on the nerve to reproduce the sensation.

 

Your doctor may also examine your groin area to determine if this area is causing your hip pain. Other tests which may help your doctor confirm your diagnosis include X-rays and MRIs. In some rare cases, the doctors may suggest a nerve conduction study. An X-ray will help identify any bone abnormalities that might pressure the nerve. Magnetic resonance imaging (MRI) can create better images of soft tissues and visualise any nerve compression.

 

Treatment

The goal of treatment is to reduce the pressure on the nerves. Non-surgical treatments may include: 

  • Physical therapy: The therapist will introduce exercises to improve the range of motion and flexibility of the hip muscles to reduce the pressure on the nerves. 

  • Medications: anti-inflammatory medications such as ibuprofen or naproxen to reduce the inflammation that is causing the pain.

  • Injections on the nerves by anti-inflammatory medications such as corticosteroid plus a local anaesthetic, to reduce the pain caused by compression of the nerve.

  • Refrain from doing the activities that worsen the pain.

It may take time for the burning pain to resolve. In some cases, numbness will persist despite treatment.