Acetabular Paralabral Cyst: An Unusual Cause of Lower Extremity Pain and Paresthesia.

The patient was a 41-year-old woman with an 8-month history of insidious sharp right groin pain and paresthesia radiating distally to the medial lower leg and foot with sitting and any activity involving hip extension. She denied any clicking in her hip. She was previously diagnosed by her internal medicine physician with a femoral hernia. However, surgical correction of hernia, as well as nonsteroidal anti-inflammatory medication, did not alleviate symptoms. Therefore, she was referred for a collaborative consultation with an orthopaedic surgeon and a physical therapist. Orthopaedic surgeon/physical therapist clinical examination found limited right hip flexion (100°), internal rotation (10°), and extension (0°); a positive impingement test2,3; reproduction of paresthesia along the saphenous nerve distribution of the distal medial thigh, anteromedial knee, and distal medial leg with nerve tension testing1; and a negative lumbar spine examination. These were suggestive of potential labral tear, femoroacetabular impingement, and saphenous neuropathy. Magnetic resonance imaging of the right hip revealed an anterior labral tear with an associated moderate-sized, multilobulated paralabral cyst compressing the medial femoral neurovascular bundle (FIGURES 1 and 2). Mixed cam-pincer femoroacetabular impingement morphology was also present. The patient initially optMICHAEL P. REIMAN, PT, DPT, OCS, SCS, ATC, FAAOMPT, CSCS, Department of Orthopaedic Surgery, Duke University, Durham, NC. THOMAS W. HASH, 2ND, MD, Department of Radiology, Duke University, Durham, NC. RICHARD C. MATHER, 3RD, MD, Department of Orthopaedic Surgery, Duke University, Durham, NC. Acetabular Paralabral Cyst: An Unusual Cause of Lower Extremity Pain and Paresthesia