Is this a hernia

[chewymix]

Hi

~ 5yrs ago i experienced what i can only describe as a burning sensation in my left inguinal area, from around the inguinal ring and downwards. There was no 'injury' that made this happen as far as i am aware i just woke up like it. I let it lie for a couple of weeks and the burning faded to be left with a 'discomfort' of something not right down there. Sometimes i felt as though i could press on a spot on the inguinal ring and cause an acute pain. I went to family doc who did some tests but came back blank - Went for an MRI on lower back and again all clear. Had facet joint injections which again did nothing. Has physio to try and mobilise the inguinal ligament on the left and generally free things up but no improvement. This was over 5 years ago and the symptons were/are

virtually no pain on waking
pain is minimal if just lounging around
if sitting on a chair ie upright then get pretty bad pain in left inguinal area but spread to high hamstring/glute area
sitting position can sometimes cause left inguinal/scrotal/adductor numbness which indicates to me genitofemoral involvement? Moving resolves this numbness.

Recently i woke and 'stretched' in bed ie just woke the muscles up sort of thing and felt a definate 'pop' from my right inguinal area. Over the last month or so this area has started to feel very similar to the left.

I have seen sports MD's and not got that far, have tried inguinal and genitofemoral nerve blocks but i think they 'missed' - They were thinking of sending me to a hernia guy but now i am presenting with right sided symptons they want to reassess -

Sorry this is not 'easy' but anyone got any clues? Sitting is a killer after few hours (its never comfortable) and after this time i'd like to get it resolved.

thanks

[jerryhesch]

Well described problem, thank for the clarity with which you osed the question. since around 2004 the issues of contralateral nerve damage after a unilateral insult to a nerve has been demontrated in the research literature. It is much more common than one would think to hae symptoms start on one side of the body and in time to develop mirror/contralateral signs and symptoms and even degeneration of axons! Perhaps this should be considered as somewhat preliminary, albeit of significant interest, and certainly matches anecdotal "evidence". The unanswered question, after correcting the primary problem does one get some regeeneration on the opposite side? Do contralateral signs and symptoms reduce or go after addressing the original problem, I believe that they do reduce.
You definetely must get cleared by a hernia specialist and I sugest both the standing screen and the supine screen and screen for the more rare "non-hernia" tear of abdominal tendons, which occurs above or below the inguinal canal, whereas the typical inguinal hernia occurs within the canal. Also get screen for less common femoral and obturator. All of the proximal innervation can cause confusing pain referral, so one must screen the entire region, especially in chronic cases such as yours.
You certainly could have a traumatic (or other insult such as viral) neuropathy but would also consider the ilioinguinal and iliohypogastric, lesser considerations the accessory obturator and femoral portion of genitofemoral. I developed an intra-inguinal sensory evaluation and published it in a brief letter to the editor in J Manual & manip ther. I am happy to speak with you, my email is jerryhesch@cox.net
best of luck, keep usposted
jerry hesch

[zaofer2000]

Did you assess pelvis position (ilium anterior, posterior, upslip....)?

[jerryhesch]

In terms of evaluating pelvic structural dysfunction, the most common pattern that adds additional stress to the aformentioned nerves is a pattern I have described as pelvic side-glide (distinctly different from a "lateral shift"). It can be subtle enough to be missed upon visual examination, so one needs to do a passive test, taking up the slack and the imparting a passive force. Most common is a lack of side glide going left to right. You push with open palms directly on the lateral pelvis with client supine. Treatment is sidelying with pillows under the lateral pelvis with the restricted direction on top.
In spite of the above, in spite of descriptions of SI dysfunction (and pelvic biomechanical dysfunction) having a correlate with aforementioned symptoms, once they are more than mild, the likelyhood of the symptoms being provoked by SI/pelvis is very small indeed. Much more likely is the co-existense of both problems.
Jerry Hesch
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[chewymix]

i have had my pelvis assesed by many people and although being told it was 'twisted' and subsequently corrected by an osteopath the underlying condition remains.

For me the fact that apart from the pain on sitting in the hamstring attachment area, which from research seems to be a common complain of occult type hernias, tells me this could be a hernia is the fact that in certain positions the left inguinal area goes numb. In my mind surely that means something is pressing on it with enough 'force' that surely is more than misaligned structures.

I have a feeling i will never know for sure until i accept to go under the knife, although if that then reveals nothing structually wrong then that would have been a very bad move!

thanks

[jerryhesch]

Corrected pelvic twist may be true, but there is a much greater complexity to pelvic and seperately; SI joint mechanics than is described in the ancient Osteopathic paradigm, but I will not elaborate here.
There could be several factors in play here and a very thorough eval is in order-the kind that are hands-on and take about an hour and a half.
I still would argue that a biomechanical problem enhanced by certain positions could in fact reduce blood flow to the aforementioned nerves, enhancing the pre-exisitng peripheral neuropathy. A competent surgeon can do an eval and discern if you have a typical or an atypical hernia or a peripheral neuropathy. Going under the knife should be preceded by proper diagnosis.
Unfortunately symptoms such as hamstring tendon painin sitting also correlates with other problems.
Has anyone done a thorough sensory evaluation including provocation of agormentioned nerve? An internal inguianl sensory evaluation as I have described elsewhere?
I cannot post much more but would be happy to spedak directly with you. I developed the test I describe, self-diagnosed and then got the proper treatment very successful, NOT a hernia.
Best of luck, I do know emirically (31 years) what you areexperienceing.
Jerry Hesch
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[neurospast]

burning sensation in inguinal area, on stretch a pop, sitting upright aggravates, MRI scan area clean, facet joint injections no results. Hernia results so far negative. This what I understand to be the facts.
Why did you let the facet joints be injected?
injections for nerve blocks so far no results? What made you think this was the cause?
I would like to know; History of back problems? now or prior to first symptoms? Do other things aside of sitting upright aggravate the symptoms? Has your hip been checked? Has anyone suggested a bursitis? Or an active triggerpoint? Or a labrial tear?
I need to know more before I can speculate on your problem.

[nasde]

not sure how technical to word this answer cause not sure if you're a medical or health professional, or just very well versed in anatomy!

I think you may have a psoas muscle/pelvis problem. it's origins/pathway coincides with the nerve that supplies the sensation for the testicals (genitofemoral?) and it's known to also cause numbness/altered sensation in the front of thigh.

You may have an associated stiffness/reciprocal stiffening in the hip/gluteal muscles as your body compensates for this muscle strain in the front of your hip.

Doesn't sound particularly like a hernia to me. would recommend a proper assessment by physio and treatment directed at the above mentioned area.

Good luck!

[neurospast]

brilliant reply

[chewymix]

Can anyone recommend a good sports physio in London that could assess this please? I've seen some and not been overely impresses so could do with some recommendations.

thanks