1
|
Valenzuela-Fuenzalida JJ, Inostroza-Wegner A, Osorio-Muñoz F, Milos-Brandenberg D, Santana-Machuca A, Nova Baeza P, Donoso MO, Bruna-Mejias A, Iwanaga J, Sanchis-Gimeno J, Gutierrez-Espinoza H. The Association between Anatomical Variants of Musculoskeletal Structures and Nerve Compressions of the Lower Limb: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2024; 14:695. [PMID: 38611609 PMCID: PMC11011940 DOI: 10.3390/diagnostics14070695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/14/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Objective: The aim of this study was to describe the main anatomical variants and morphofunctional alterations in the lower limb that compress surrounding nervous structures in the gluteal region, thigh region, and leg and foot region. Methods: We searched the Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception up to October 2023. An assurance tool for anatomical studies (AQUA) was used to evaluate methodological quality, and the Joanna Briggs Institute assessment tool for case reports was also used. Forest plots were generated to assess the prevalence of variants of the gluteal region, thigh, and leg. Results: According to the forest plot of the gluteal region, the prevalence was 0.18 (0.14-0.23), with a heterogeneity of 93.52%. For the thigh region, the forest plot presented a prevalence of 0.10 (0.03-0.17) and a heterogeneity of 91.18%. The forest plot of the leg region was based on seven studies, which presented a prevalence of 0.01 (0.01-0.01) and a heterogeneity of 96.18%. Conclusions: This review and meta-analysis showed that, in studies that analyzed nerve compressions, the prevalence was low in the thigh and leg regions, while in the gluteal region, it was slightly higher. This is mainly due to the PM region and its different variants. We believe that it is important to analyze all the variant regions defined in this study and that surgeons treating the lower limb should be attentive to these possible scenarios so that they can anticipate possible surgical situations and thus avoid surgical complications.
Collapse
Affiliation(s)
- Juan José Valenzuela-Fuenzalida
- Department of Morphology and Function, Faculty of Health Sciences, Universidad De Las Américas, Santiago 7500000, Chile; (J.J.V.-F.); (A.S.-M.)
- Departament de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8320000, Chile; (A.I.-W.); (F.O.-M.); (P.N.B.); (M.O.D.); (A.B.-M.)
| | - Alfredo Inostroza-Wegner
- Departament de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8320000, Chile; (A.I.-W.); (F.O.-M.); (P.N.B.); (M.O.D.); (A.B.-M.)
| | - Francisca Osorio-Muñoz
- Departament de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8320000, Chile; (A.I.-W.); (F.O.-M.); (P.N.B.); (M.O.D.); (A.B.-M.)
| | - Daniel Milos-Brandenberg
- Escuela de Medicina, Facultad Ciencias de la Salud, Universidad del Alba, Santiago 8320000, Chile;
| | - Andres Santana-Machuca
- Department of Morphology and Function, Faculty of Health Sciences, Universidad De Las Américas, Santiago 7500000, Chile; (J.J.V.-F.); (A.S.-M.)
| | - Pablo Nova Baeza
- Departament de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8320000, Chile; (A.I.-W.); (F.O.-M.); (P.N.B.); (M.O.D.); (A.B.-M.)
| | - Mathias Orellana Donoso
- Departament de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8320000, Chile; (A.I.-W.); (F.O.-M.); (P.N.B.); (M.O.D.); (A.B.-M.)
- Escuela de Medicina, Universidad Finis Terrae, Santiago 7501015, Chile
| | - Alejandro Bruna-Mejias
- Departament de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8320000, Chile; (A.I.-W.); (F.O.-M.); (P.N.B.); (M.O.D.); (A.B.-M.)
| | - Joe Iwanaga
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan;
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA 70112, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA 70112, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Juan Sanchis-Gimeno
- GIAVAL Research Group, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, 46001 Valencia, Spain;
| | | |
Collapse
|
2
|
Chalk C, Namiranian D. Meralgia paresthetica. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:195-201. [PMID: 38697741 DOI: 10.1016/b978-0-323-90108-6.00013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Meralgia paresthetica is a common but probably underrecognized syndrome caused by dysfunction of the lateral femoral cutaneous nerve. The diagnosis is based on the patient's description of sensory disturbance, often painful, on the anterolateral aspect of the thigh, with normal strength and reflexes. Sensory nerve conduction studies and somatosensory evoked potentials may be used to support the diagnosis, but both have technical limitations, with low specificity and sensitivity. Risk factors for meralgia paresthetica include obesity, tight clothing, and diabetes mellitus. Some cases are complications of hip or lumbar spine surgery. Most cases are self-limited, but a small proportion of patients remain with refractory and disabling symptoms. Treatment options include medications for neuropathic pain, neurolysis, neurectomy, and radioablation, but controlled trials to compare efficacy are lacking.
Collapse
Affiliation(s)
- Colin Chalk
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.
| | - Dina Namiranian
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| |
Collapse
|
3
|
Pedrosa M, Martins B, Araújo R. It's in the game: A review of neurological lesions associated with sports. J Neurol Sci 2023; 455:122803. [PMID: 37995461 DOI: 10.1016/j.jns.2023.122803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/24/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION The practice of sports may lead to neurological injuries. While relatively uncommon (overall incidence of approximately 2.5%), and mostly benign and transient, some conditions may be life-threatening and permanent. Thus, both clinical neurologists and sports physicians should be aware of their existence and relevance. We aimed to review all sports-related neurological injuries and illnesses reported in the literature. METHODS Following SANRA guidelines, we performed a narrative review and searched PubMed and Scopus databases. Relevant sports were selected based on their recognition as an Olympic sport by the International Olympic Committee. Chronic traumatic encephalopathy (CTE) and other neurodegenerative disorders were not included. RESULTS A total of 292 studies were included concerning 33 different sports. The most reported neurological injury was damage to the peripheral nervous system. Traumatic injuries have also been extensively reported, including cerebral haemorrhage and arterial dissections. Non-traumatic life-threatening events are infrequent but may also occur, e.g. posterior reversible encephalopathy syndrome, cerebral venous thrombosis, and arterial dissections. Some conditions were predominantly reported in specific sports, e.g. yips in baseball and golf, raising the possibility of a common pathophysiology. Spinal cord infarction due to fibrocartilaginous embolism was reported in several sports associated with minor trauma. CONCLUSION Sports-related neurological injuries are increasingly receiving more social and medical attention and are an important cause of morbidity and mortality. This review may serve as a guide to physicians managing these challenging situations.
Collapse
Affiliation(s)
| | - Bárbara Martins
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Rui Araújo
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
4
|
de Ruiter GCW, Oosterhuis JWA, Vissers TFH, Kloet A. Unusual causes for meralgia paresthetica: systematic review of the literature and single center experience. Neurosurg Rev 2023; 46:107. [PMID: 37148363 PMCID: PMC10162905 DOI: 10.1007/s10143-023-02023-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/06/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
Meralgia paresthetica is often idiopathic, but sometimes symptoms may be caused by traumatic injury to the lateral femoral cutaneous nerve (LFCN) or compression of this nerve by a mass lesion. In this article the literature is reviewed on unusual causes for meralgia paresthetica, including different types of traumatic injury and compression of the LFCN by mass lesions. In addition, the experience from our center with the surgical treatment of unusual causes of meralgia paresthetica is presented. A PubMed search was performed on unusual causes for meralgia paresthetica. Specific attention was paid to factors that may have predisposed to LFCN injury and clues that may have pointed at a mass lesion. Moreover, our own database on all surgically treated cases of meralgia paresthetica between April 2014 and September 2022 was reviewed to identify unusual causes for meralgia paresthetica. A total of 66 articles was identified that reported results on unusual causes for meralgia paresthetica: 37 on traumatic injuries of the LFCN and 29 on compression of the LFCN by mass lesions. Most frequent cause of traumatic injury in the literature was iatrogenic, including different procedures around the anterior superior iliac spine, intra-abdominal procedures and positioning for surgery. In our own surgical database of 187 cases, there were 14 cases of traumatic LFCN injury and 4 cases in which symptoms were related to a mass lesion. It is important to consider traumatic causes or compression by a mass lesion in patients that present with meralgia paresthetica.
Collapse
Affiliation(s)
- G C W de Ruiter
- Department of Neurosurgery, Haaglanden Medical Center, Lijnbaan 32, 2501, CK, The Hague, The Netherlands.
| | - J W A Oosterhuis
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Th F H Vissers
- Medical Library, Haaglanden Medical Center, The Hague, The Netherlands
| | - A Kloet
- Department of Neurosurgery, Haaglanden Medical Center, Lijnbaan 32, 2501, CK, The Hague, The Netherlands
| |
Collapse
|
5
|
Abd-Elsayed A, Gyorfi MJ, Ha SP. Lateral Femoral Cutaneous Nerve Radiofrequency Ablation for Long-term Control of Refractory Meralgia Paresthetica. PAIN MEDICINE 2020; 21:1433-1436. [PMID: 32022852 DOI: 10.1093/pm/pnz372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Meralgia paresthetica is a term used to describe a clinical pain syndrome related to the compression or irritation of the lateral femoral cutaneous nerve (LFCN). The LFCN is a pure sensory nerve that is susceptible to compression injury. The most common compression locations are: as it courses from the lumbosacral plexus, through the abdominal cavity, under the inguinal ligament, and into the subcutaneous tissue of the thigh. METHODS This case series is a retrospective single-center review of six patients with medically intractable meralgia paresthetica who were treated with radiofrequency ablation. To be considered for radiofrequency ablation, the patient must have been unsuccessful with medical management alone for more than two months and have a clinical diagnosis of meralgia paresthetica. Temporary relief of pain of 50% or greater was considered a positive result. Average pain scores were measured pre- and postprocedure, along with one-, two-, three-, and six-month intervals postoperation. RESULTS All patients demonstrated immediate relief in self-reported pain scores, averaging a 75.5% reduction in pain. At the one-, two-, three-, and six-month follow-ups, patients averaged a reduction of 60.0%, 58.0%, 51.4%, and 40.5%, respectively. Both the postop and one-month follow-up pain scores were lower, statistically significantly so (P < 0.05), whereas the two-, three-, and six-month follow-ups were not statistically different from pretreatment scores. CONCLUSIONS Although our study was small, radiofrequency ablation showed a clear reduction in average pain scores in a subset of patients who had failed standard medical therapy with a reduction in pain at one-month follow-up with relief of symptoms sometimes lasting longer than 12 months.
Collapse
Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Michael J Gyorfi
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sung P Ha
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| |
Collapse
|
6
|
Cheatham SW, Kolber MJ, Salamh PA. Meralgia paresthetica: a review of the literature. Int J Sports Phys Ther 2013; 8:883-893. [PMID: 24377074 PMCID: PMC3867081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND AND PURPOSE Meralgia Paresthetica (MP) is a nerve entrapment which may cause pain, paresthesias, and sensory loss within the distribution of the lateral cutaneous nerve of the thigh. When the differential diagnosis of lateral or anterolateral thigh pain is inconclusive, MP should be considered as a potential source. MP produces similar signs and symptoms as those associated with more common diagnoses such as lumbar spine pathology. This clinical commentary will review the most relevant literature on MP with an emphasis on recognition and management of this condition. DESCRIPTION OF TOPIC WITH RELATED EVIDENCE The authors reviewed the most relevant published literature on MP from 1970 to 2013 located using the databases PubMed, CINAHL, and Proquest. DISCUSSION/RELATION TO CLINICAL PRACTICE MP still remains a diagnostic challenge since it can mimic other common diagnoses. Understanding the current literature surrounding the diagnosis and treatment of MP is essential for clinicians practicing in the outpatient environment. The consensus on the most effective non-surgical and surgical interventions is still limited, as is the research on physical therapy interventions for this condition. Perhaps the lack of research and global consensus represents a knowledge deficit that makes MP a challenge to diagnose and successfully treat. Future collaborative studies are needed to improve the clinical diagnostics and understanding of interventions for this pathology. LEVEL OF EVIDENCE 5.
Collapse
Affiliation(s)
| | | | - Paul A. Salamh
- Southeastern Orthopedics Physical Therapy, Raleigh, NC, USA
| |
Collapse
|
7
|
Lindenblatt N, Giovanoli P. Compression of the lateral femoral cutaneous nerve by a fibrous sartorius strand in a professional female soccer player. EUROPEAN JOURNAL OF PLASTIC SURGERY 2013. [DOI: 10.1007/s00238-013-0838-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
8
|
Robb A, Sajko S. Conservative management of posterior interosseous neuropathy in an elite baseball pitcher's return to play: a case report and review of the literature. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2009; 53:300-10. [PMID: 20037695 PMCID: PMC2796949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This report documents retrospectively a case of Posterior Interosseous Neuropathy (PIN) occurring in an elite baseball pitcher experiencing a deep ache in the radial aspect of the forearm and altered sensation in the dorsum of the hand on the throwing arm during his pitching motion. The initial clinical goal was to control for inflammation to the nerve and muscle with active rest, microcurrent therapy, low-level laser therapy, and cessation of throwing. Minimizing mechanosensitivity at the common extensor region of the right elbow and PIN, was achieved by employing the use of myofascial release and augmented soft tissue mobilization techniques. Neurodynamic mobilization technique was also administered to improve neural function. Implementation of a sport specific protocol for the purposes of maintaining throwing mechanics and overall conditioning was utilized. Successful resolution of symptomatology and return to pre-injury status was achieved in 5 weeks. A review of literature and an evidence-based discussion for the differential diagnoses, clinical examination, diagnosis, management and rehabilitation of PIN is presented.
Collapse
Affiliation(s)
- Andrew Robb
- Division of Graduate Studies, Sports Sciences, Canadian Memorial Chiropractic College. Tel: 416.482.2340.
| | | |
Collapse
|