73-Year-Old Woman With Anterior Thigh Pain

Abstract

A 73-year-old woman presented to the Saint Marys Hospital emergency department for anterior thigh pain. This pain began 2 weeks before presentation when she noticed difficulty lifting her right leg into her car. She noticed progressive worsening of these symptoms such that she could not put on her socks and shoes. On the day of presentation, while attempting to raise her right leg into bed, she developed severe burning pain in the anterior aspect of her thigh. The severity of the pain, 10 on a 10-point scale, prompted her to seek evaluation in the emergency department. She denied trauma, change in activity level, back pain, bladder or bowel dysfunction, and saddle anesthesia. Her medical history was notable for coronary artery disease with placement of a drug-eluting stent in the distal circumflex coronary artery 6 months previously via the right radial artery, paroxysmal atrial fibrillation, diabetes mellitus with a recent glycated hemoglobin concentration of 6.0%, and chronic lower extremity lymphedema. Her medications included aspirin, clopidogrel, diltiazem, lisinopril, simvastatin, metoprolol, warfarin, and glyburide. She had no recent changes in medications, was receiving a stable warfarin dose, and her international normalized ratio (INR) was within normal limits. She denied tobacco, ethanol, and intravenous drug use. In the emergency department, radiography of the femur and lumbar spine were performed, showing no evidence of fracture.On admission, her vital signs were as follows: temperature, normal; pulse, 72 beats/min; and blood pressure, 126/68 mm Hg. Findings on cardiac and pulmonary examinations were within normal limits. Her abdomen was soft, obese, and nontender; no masses were palpable. Both lower extremities were warm and well perfused; dorsalis pedis and posterior tibial pulses were palpable. Musculoskeletal examination revealed intact internal and external rotation of her right hip. She was unable to do a straight leg raise or flexion/extension of both the hip and knee because of the severe pain. The spine and sacroiliac joints were not tender to palpation, but she did have tenderness to palpation over the greater trochanter of the right leg. She was able to perform transfers, but her ability to do so was limited by severe pain. During sensory testing, the patient noted a subjective difference in fine touch of the right vs the left anterior thigh.

An unusual double crush syndrome: femoral and sciatic neuropathy secondary to intra-abdominal firearm

“…Retroperitoneal hemorrhage can lead to femoral neuropathy femoral in two locations along the course of the femoral nerve. One location is in the iliopsoas gutter due to the rigid surrounding fascia and the other location is at the inguinal ligament [9]. Sciatic and femoral neuropathy can appear with motor and sensory deficits [4].…”