Q. What could be the cause for the pain in the left leg, and thigh?

Answered by
Dr. Atul Prakash
and medically reviewed by Dr.Nithila A
This is a premium question & answer published on Aug 27, 2019 and last reviewed on: Sep 16, 2020

Hello doctor,

I have attached lumbar spine MRI. I had sciatica for three months with severe pain in the left leg when I walk and stand. Better when I lean forward or sit. Pain is in the left leg, thigh, and upper thigh under groin. Numbness and tingling down leg calf to the foot. I have pain in the right thigh as well when walking or arching, but not nearly as much. When I stand up straight or lie down pain, numbness, tingling is present.

I have to sleep in a fetal position with legs curled up. I cannot arch my back without pain. I did swimming regularly until the pain started. I exercise in the water now. Could swimming have caused this? I also have numbness in my right inguinal area above the pelvis. Can this be related? I am respectfully requesting a detailed report on my MRI.

1. What is causing my pain?

2. Is this stenosis or bulging disc? What are my options?

3. Will epidural injections help or is surgery an only option?

4. Will this resolve on its own? This condition is adversely affecting my life. Can I stretch the painful areas? In other words, can I arch my back to stretch even though it hurts, or can I do stretching that will not hurt, like lifting the leg to the chest? Kindly help.

#

Hello,

Welcome to icliniq.com.

From your symptoms, it sounded like LC stenosis but having looked at your MRI, and it is evident that there are disc bulges prolapse at multiple levels on the left side leading to your remaining sided symptom. L4/5 and L5/S1 showed lateral canal stenosis and possibly a far lateral bulge leading exiting nerve irritation.

Yes, you should benefit from a directed nerve root injection at the two levels on the left side. What I cannot explain is the upper thigh pain. No swimming per se should not a disc bulge or a prolapse unless you have done something getting in or out of the pool. Arching your backward is not recommended as this will not help relieve the pressure may make it worse. I hope this helps.

Thank you doctor,

I am not sure that I have entirely understood your evaluation. Where are the disc bulges? Are they at L4 and L5? Is stenosis caused by the disc bulging or is there a narrowing of the canal? I do not understand the fact far lateral bulge leading exiting nerve irritation. What does that mean? I have severe pain in the left thigh and right thigh. I have pain in the upper left leg. Can you elaborate? Is this a condition that will resolve without surgery? Are there any other details from the MRI that would be helpful to me?

#

Hello,

Welcome back to icliniq.com.

There appears to be no gross bony central canal stenosis. There are disc bulges seen on the axial cuts (at the level of the disc) at L5/S1 (FSE axial T2 instance 24/25) only on the left side. This the dark looking bulge that is seen encroaching the canal and pushing the nerves posteriorly at L5/S1 and appears to be abutting the exiting nerve outside the spinal canal as this bulge is located more lateral. At cuts 13 to 14 /25 Axial FSE XL, there are bulges found laterally unlike 23 to 24/25 where it is paracentral. The saggital cuts are clearly showing that in T2 Saggital cuts instance 7 to 8/11.

As there is a mismatch between the symptoms and clinical picture, I will recommend it directed nerve root injections to help with symptoms as well as act as a diagnostic tool for surgery if required. Also, you should be on Pregabalin 75 mg twice a day to help work three nerve pain.


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