The sensory innervation of the hip joint - an anatomical study

Abstract

Typically obturator nerve blockade is used to relieve hip pain. It sometimes only has a minor effect in resolving symptoms. This clinical observation led us to examine comprehensively the sensory nerve innervation of formalin-fixed hip joint capsules. Following macroscopic preparation, the area of the hip joint capsule was inspected with the aid of an operating microscope. We discovered a separation between the anterior and posterior sensory innervation of the hip joint capsule. The anteromedial innervation was determined by the articular branches of the obturator n. Additionally, the anterior hip joint capsule was innervated by sensory articular branches from the femoral n. In the posterior part we found articular branches from the sciatic n., which in addition to the articular branches from the nerves to the quadratus femoris m., innervate the postero-medial section of the hip joint capsule. Moreover, articular branches of the superior gluteal n. were found, which innervate the posterolateral section of the hip joint capsule. This anatomical study demonstrates that the obturator n. block is insufficient for the treatment of hip pain. Further investigations will determine if these nn. can be reached percutaneously. Effective neural blockade of the hip joint must include the femoral n., the sciatic n. and the superior gluteal n.

Postoperative analgesia for hip arthroscopy: combined L1 and L2 paravertebral blocks

“…The mechanism whereby L1/L2 block provides analgesia of the hip joint is less clear, as the nerve supply to the hip joint is complex, is often variable, and has been a source of debate. An elegant anatomical study by Birnbaum et al [6] showed that the anterior and posterior parts of the joint capsule have different sensory innervations. The anterior part of the joint capsule is innervated by articular branches of the femoral nerve, and the anteromedial part is innervated by articular branches of the obturator nerve.…”

Neuropathic pain in patients with osteoarthritis of hip joint

“…Historically, the mechanism of OA pain has been considered to be of nociceptive origin, but our study identified 5.9% of our hip OA patients as likely to have NP. Regarding the mechanism of NP in hip OA, we have formulated the hypothesis that NP occurs in association with damage to nerves innervating subchondral bone [22], ligamentum capitis femoris [23], capsule [23][24][25]27], the soft tissues of the fossa acetabuli [24], labrum [26] or synovial membrane [27]. Torrance et al [28] reported the results of an epidemiological survey in the UK using S-LANSS [29], the selfcompleted version of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale [30].…”

CT-guided obturator nerve block for diagnosis and treatment of painful conditions of the hip

“…Thus, overall good agreement existed concerning the assessment of the treatment effect, and the clinical examination by and large confirmed the findings reported by the patients. The effect of pain relief was graded from 0 ( = no pain relief) to 1 = mild pain relief; 2 = good pain relief 3 = excellent pain relief (no more pain) Pain during the block was graded from 0 = no pain/discomfort to 1 = mild pain/discomfort; 2 = some pain; 3 = significant pain a On the day of the block b During the time indicated in the right column Table 4 Clinical assessment after treatment according to the Merle d'AubignØ score [12]. See Table 2 …”

“…Lacking effect of pain relief despite correctly placed blocks may be explained by the fact that innervation of the hip varies [11, 12,16] or by the fact that (depending on the type of osteoarthritic changes) a slightly different position of the femoral head within the joint may not lead to reduced pain in an individual case.…”

“…It innervates them, as well as the pectineus and the gracilis muscles, and gives off branches to the skin of the medial thigh. The posterior ramus follows the external obturator muscle, innervates the adductor brevis and magnus muscles and gives off sensory branches to the anteromedial capsule of the hip joint [6,9,10,11,12].…”