Bilateral Iatrogenic Femoral Neuropathy

Bono, Valeria; Bella, Vincenzo La; Spataro, Rossella

doi:10.3988/jcn.2015.11.4.398

Cited by 5 publications

(6 citation statements)

References 4 publications

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“…[1][2][3][4] Entrapment neuropathy due to neuropraxia takes place on the basis of the ischemia and mechanical cases. [5][6][7][8][9] Many peripheral nerves are susceptible to entrapment syndrome, most of which as a consequence of their position in relation to other anatomical structures such as muscles, ligaments, or retinacula. 10,11 Examples in the upper limb are the median nerve in carpal tunnel syndrome, or ulnar nerve entrapment of the elbow.…”

Section: Introductionmentioning

confidence: 99%

“…10,11 Examples in the upper limb are the median nerve in carpal tunnel syndrome, or ulnar nerve entrapment of the elbow. 5,11,13 In the lower limb, the peripheral nerve entrapments include the sciatic nerve passing through piriformis or dividing around the superior gemellus muscle and the lateral cutaneous nerve of the thigh passing through the inguinal ligament, meralgia paresthetica. 2,4,11,12,[14][15][16][17][18] The femoral nerve (FN) descends in a groove between psoas and iliacus muscles, deep to the iliac fascia, passing under the inguinal ligament and it enters the thigh where it gives its terminal branches.…”

Section: Introductionmentioning

confidence: 99%

“…2,4,11,12,[14][15][16][17][18] The femoral nerve (FN) descends in a groove between psoas and iliacus muscles, deep to the iliac fascia, passing under the inguinal ligament and it enters the thigh where it gives its terminal branches. 5,19,20 Compression to the FN has mostly been described as being due to bleeding disorders, when an iliac haematoma compresses it at three possible levels: against the inguinal ligament; at its lumbar roots; or in the space between the psoas and iliacus muscles where the overlying fascia is thicker. [20][21][22][23][24] The principal symptoms are thigh weakness along with the anterior thigh and medial leg numbness.…”

Section: Introductionmentioning

confidence: 99%

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Macroscopic observations of muscular bundles of accessory iliopsoas muscle as the cause of femoral nerve compression

Unat

Şirintürk

Çağımnı

et al. 2019

Journal of Orthopaedics

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Compression of the femoral nerve (FN) to the iliac fossa has been reported as a consequence of several pathologies as well as due to the aberrant muscles. The purpose of this research was to investigate the patterns of the accessory muscles of iliopsoas muscles and the relationship of the FN in fifty semi pelvis. Accessory muscular slips from iliacus and psoas, piercing or covering the FN, were found in 19 specimens (7.9%). Based on the macroscopic structure, the muscle was categorized into two types. Pattern 1 as the more frequent variation, was sheet muscular type covering the FN (17 specimens, 89.5%). Pattern 2, the less frequent variation was found on a muscular slip covering the FN (2 specimens, 10.5%). Iliac and psoas muscles and their variants on both types were defined. Appraising the relation between the muscle and the nerves, each disposition of the patterns may be a potential risk for nerve entrapment. The knowledge about the possible variations of the iliopsoas muscle complex and the FN may also give surgeons confidence during pelvic surgery. Recognition of these variations in normal anatomy may be useful to the clinicians when treating patients with refractory leg pain.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Macroscopic observations of muscular bundles of accessory iliopsoas muscle as the cause of femoral nerve compression

Unat

Şirintürk

Çağımnı

et al. 2019

Journal of Orthopaedics

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“…(a) Stretching and/or prolonged compression of the nerve caused by the self-retaining retractors that can directly compress the nerve against the pelvic sidewall (b) Compression of the iliac vessels causing direct ischemia of the nerve (c) Prolonged compression of the femoral nerves under the inguinal ligament, or (d) Excessive stretching due to excessive abduction and external rotation of the hips during lithotomy positioning [2][3][4][5][6] In addition to the above iatrogenic causes, there are reports of rare cases of bilateral femoral nerve compression and ischemia due to iliopsoas hematomas [7][8][9][10] and iliopsoas swelling secondary to rhabdomyolysis [11,12]. ere are also individual reports of bilateral femoral neuropathy due to vasculitis in the context of disseminated intravascular coagulopathy [13] and due to blunt force trauma [14].…”

Section: Discussionmentioning

confidence: 99%

Bilateral Femoral Neuropathy: A Rare Complication of Drug Overdose due to Prolonged Posturing in Lithotomy Position

Tsiptsios

Daud

Tsamakis

et al. 2020

Case Reports in Neurological Medicine

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Background. Bilateral femoral neuropathy is an uncommon complication of various surgical and nonsurgical procedures, such as pelvic/abdominal surgery or vaginal delivery. Case Report. We report a case of a 41-year-old male who was found unresponsive against the wall in a “lithotomy-type” position with both knees flexed at approximately 90 degrees and both hips flexed and externally rotated at approximately 90 and 60 degrees, respectively, 24–48 hours after a drug overdose (combination of dihydrocodeine, paracetamol, diazepam, and amitriptyline). During his recovery, he complained of severe bilateral proximal lower limb weakness and bilateral distal lower limb pain and allodynia. His symptoms were initially attributed to critical illness myopathy/neuropathy (CIMN). However, thorough clinical and neurophysiological evaluation revealed that his symptoms were due to severe bilateral femoral neuropathies. Conclusions. To our knowledge, this is the first reported case of bilateral femoral nerve palsy due to prolonged posturing in a “lithotomy-type” position in the context of a drug overdose.

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“…The documented ethnic and demographic variations in course and branching pattern [8] and its intimate relationship with the pelvis, hip joint and proximal femur places it at risk of injury through dislocations, fractures, direct blows or surgery. Femoral neuropathy results in ipsilateral hip flexion and knee extension deficits and hypoesthesia impairment on the anteromedial aspect of the thigh [9] and patella areflexia.…”

Section: Introductionmentioning

confidence: 99%

Surgical anatomy of the femoral nerve in formalin prefixed cadavers in an adult Kenya population

Alex¹,

Ayumba²,

El-badawi³

2022

Int. J. Orthop. Sci.

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Background: Ethnic variations involving femoral nerve have been described in literature. This nerve is the largest branch of the lumbar plexus. It innervates the hip flexors, knee extensors, and sensory function to medial and anterior aspects of the thigh. Risks of insults to nerve can be non-iatrogenic (trauma), and iatrogenic (approaches to the acetabulum, pelvis and proximal femur). The study aimed at providing precise description of variant anatomy of nerve, hence will help surgeons avoid iatrogenic insults. Methods: An anatomic descriptive cross-sectional study design involving fifty six (56), formalin prefixed adult cadaveric specimens. The length of the femoral nerve in relation to the inguinal ligament and its bony attachments, and the patterns of distribution of main branches in the regions were defined. Results: Males-35 (Left=17, Right=18); Females-21(Left=7, Right=14). Femoral nerve location: 53.02 mm (SD 14.59) from the ipsilateral anterior superior iliac spine (ASIS). Nerve trunk in relation to inguinal ligament measured: 47.85mm (SD 13.719) from the psoas muscle proximally and branched 29.32 mm (SD 14.239) distally. Innervations and branches: quadriceps in all specimens (Posterior); Sartorius muscles (Anterior), with noted variability in individual muscles. Branching pattern variations: 6 limbs (10.71%) at ligament level, 2(3.57%) limbs more proximal, while one nerve was split by a slip from the psoas muscle and then united 25.88mm proximal to ligament. The variations in sex were not statistically significant (p> 0.05). Conclusion:The anatomical course, length and branches of the femoral nerve in relation to inguinal ligament concur to great extent with described anatomic studies with some noted variability. Surgeons should be aware of the anatomic variations of femoral nerve and be cautious when operating in the zones traversed by the nerve.

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Bilateral Iatrogenic Femoral Neuropathy

Cited by 5 publications

References 4 publications

Macroscopic observations of muscular bundles of accessory iliopsoas muscle as the cause of femoral nerve compression

Macroscopic observations of muscular bundles of accessory iliopsoas muscle as the cause of femoral nerve compression

Bilateral Femoral Neuropathy: A Rare Complication of Drug Overdose due to Prolonged Posturing in Lithotomy Position

Surgical anatomy of the femoral nerve in formalin prefixed cadavers in an adult Kenya population

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