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Gupta AK, Gupta S, Kanojia RK, Nirala R, Sharma D, Kulshrestha S. Surgical course of lateral femoral cutaneous nerve during anterior exposure of paediatric hips: an observational study. J Pediatr Orthop B 2024; 33:1-8. [PMID: 36943687 DOI: 10.1097/bpb.0000000000001079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Anterior approach to the hip joint is commonly used for paediatric hip disorders. Lateral femoral cutaneous nerve (LFCN) is always exposed and dissected in this approach before deep dissection is carried out. The course of this nerve has been described in adults but there is a lack of literature regarding this in the paediatric age group. This study aimed to find the surgical anatomy of LFCN in children during the anterior approach to the hip. A total of 51 paediatric hip surgeries were done in 45 children for various hip disorders. The anterior exposure was done by the Somerville approach (Bikini incision). During surgical exposure, LFCN was exposed and its relationship to anterior superior iliac spine (ASIS), inguinal ligament and sartorius muscle was observed. In most of the cases (45/51) it was found as a single trunk below the inguinal ligament and medial to the ASIS. In one hip, multiple branches of the nerve were found just below the inguinal ligament. In four hip exposures, the nerve was not found in the surgical field and in one case nerve was accidentally cut during surgery as it was lying adherent to ASIS. There was no significant correlation between the observational parameters of the nerve with anthropometric variables. Nerve was mostly seen in area 5-25 mm medial to ASIS and 10-50 mm below the ASIS in 80% of our surgical exposures where the nerve was isolated. We observed that once LFCN is dissected, the injury during further surgical procedures can be prevented.
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Affiliation(s)
- Anand Kumar Gupta
- Department of Orthopedics, Lady Hardinge Medical College, New Delhi, India
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Park HW, Ji KS, Kim JH, Kim LN, Ha KW. Ultrasonographic identification of lateral femoral cutaneous nerve anatomical variation in persistent meralgia paresthetica: A case report. World J Clin Cases 2023; 11:7699-7705. [DOI: 10.12998/wjcc.v11.i31.7699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Meralgia paresthetica (MP) is an entrapment mononeuropathy of the lateral femoral cutaneous nerve (LFCN). Although structural abnormalities in nerve tissues can be confirmed using ultrasonography, this is not routinely performed.
CASE SUMMARY Herein, we present the case of a 52-year-old woman who developed MP after laparoscopic gynecological surgery. The patient was referred to our clinic from an obstetrics and gynecology clinic with symptoms of numbness and a tingling sensation in the left anterolateral thigh, which developed after surgery performed 5 mo earlier. Tests were performed to assess the disease status and determine the underlying causes. Ultrasonographic examination revealed an anatomical variation, where the left LFCN was entrapped within the inguinal ligament. This case suggests that performing ultrasonographic examination before and after surgery in the lithotomy position could help prevent MP.
CONCLUSION This case demonstrates the value of ultrasonography in detecting anatomical variation and diagnosing persistent MP. Ultrasonography should be considered an adjunct to electromyography for optimal MP management. Further, this case would help other clinicians determine patient prognosis and decide on targeted treatment strategies.
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Affiliation(s)
- Hyeong-Woo Park
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul 02500, South Korea
| | - Kyung-Suk Ji
- Department of Obstetrics and Gynecology, Sahmyook Medical Center, Seoul 02500, South Korea
| | - Jun-Hyung Kim
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul 02500, South Korea
| | - Li-Na Kim
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul 02500, South Korea
| | - Kang-Wook Ha
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul 02500, South Korea
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Anatomical Analysis of the Lateral Femoral Cutaneous Nerve and Its Passage beneath the Inguinal Ligament. Plast Reconstr Surg 2022; 149:1147-1151. [PMID: 35271552 DOI: 10.1097/prs.0000000000009034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Meralgia paraesthetica is a mononeuropathy of the lateral femoral cutaneous nerve. According to the literature, the nerve travels beneath the inguinal ligament 1.3 to 5.1 cm medial to the anterior superior iliac spine. Compression at this site may cause pain and paresthesia. The aim of this study was to provide more accurate measurements to improve the diagnostic and surgical management of meralgia paraesthetica. METHODS The lateral femoral cutaneous nerve was dissected bilaterally in 50 Thiel-embalmed human cadavers. Measurements were performed with a standard caliper at the superior and inferior margins of the inguinal ligament. The distance from the inner lamina of the anterior superior iliac spine to the medial margin of the lateral femoral cutaneous nerve was measured. Data were collected and statistical analysis was performed with R. RESULTS Ninety-three lateral femoral cutaneous nerves of 50 cadavers were dissected. In 6 percent of cadavers, the lateral femoral cutaneous nerve could not be found. The mean distance from the inner lamina of the anterior superior iliac spine to the lateral femoral cutaneous nerve's medial border was 2.1 ± 1.3 cm (range, 0.2 to 6.4 cm; 95 percent CI, 1.8 to 2.4 cm) at the superior margin of the inguinal ligament and 1.9 ± 1.4 cm (range, 0.2 to 3.0 cm; 95 percent CI, 1.6 to 2.2 cm) at the inferior border of the inguinal ligament. CONCLUSION This anatomical study shows that the majority of the lateral femoral cutaneous nerve passes beneath the inguinal ligament in a very narrow area of 0.6 cm.
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Schwarz AM, Hohenberger GM, Grechenig P, Kerner A, Gänsslen A, Staresinic M, Bakota B. The 2-2-2-20-20 concept for supraacetabular schanz screw insertion without additional radiography. Injury 2021; 52 Suppl 5:S58-S62. [PMID: 32736822 DOI: 10.1016/j.injury.2020.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/18/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Application of supraacetabular Schanz screws is usually performed under image intensifier guidance. The aim of this study was to perform it without imaging, with the hypothesis that, respecting anatomical landmarks, pre- and intraoperative fluoroscopy can be avoided. MATERIAL & METHODS Insertion of the supra-acetabular Schanz screws was performed by two trauma surgery residents in a study sample of 14 human adult cadavers which had been embalmed by use of Thiel`s method. With cadavers placed in supine position, the anterior superior iliac spine (ASIS) was palpated. Starting from this landmark, 2 cm were measured in a distal and 2 cm in the medial direction. At this point, a 2 cm long oblique skin incision was performed. Through this approach, 150 mm Schanz screws were drilled bilaterally into the supra-acetabular corridor with an angulation of 20° to distal as well as 20° to medial. Following screw application, combined obturator oblique-outlet views (COOO) were taken bilaterally in each specimen by use of an Arcadis© Orbic 3D C-arm to prove the screw position. Six of the specimens underwent a 3D-CT-scan. Images were evaluated concerning correct screw positioning by a further traumatologist. Skin and subcutaneous tissues were removed in the ilioinguinal region and possible lesions to the lateral femoral cutaneous nerve (LFCN) or to the joint capsule were evaluated. RESULTS The sample consisted of eight pelves from female and six pelves from male cadavers. During radiographic evaluation of the COOO-scans (14 specimens) and the 3D-scans (6 specimens), the Schanz screws were placed inside the supra-acetabular corridor in all specimens (14/14). During dissections, no intracapsular screw placements or LFCN lesions were found. CONCLUSION According to the described anatomical data, we defined a 2-2-2-20-20 concept, starting with a 2 cm skin incision 2 cm distal and 2 cm medial to the ASIS with a drill angulation of 20° inferior and 20° lateral orientation. Using this technique, all Schanz screws could be sufficiently inserted without intraprocedural x-ray imaging.
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Affiliation(s)
- A M Schwarz
- AUVA - Trauma Hospital (UKH) Styria
- Graz, Göstinger Straße 24, 8020, Graz, Austria.
| | - G M Hohenberger
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - P Grechenig
- Division of Macroscopic and Clinical Anatomy, Medical University of Graz, Harrachgasse 21, 8010, Graz, Austria
| | - A Kerner
- Division of Macroscopic and Clinical Anatomy, Medical University of Graz, Harrachgasse 21, 8010, Graz, Austria
| | - A Gänsslen
- Clinic for Trauma Surgery, Orthopaedics and Hand Surgery, Klinikum Wolfsburg, Sauerbruchstraße 7, 38440, Wolfsburg, Germany
| | - M Staresinic
- General and Sports Trauma Department,University Hospital Merkur Zagreb, Zajceva 19, 10000, Zagreb, Croatia
| | - B Bakota
- Trauma and Orthopaedics department, Medical University Hospital LKH Graz, Austria
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Nielsen TD, Moriggl B, Barckman J, Jensen JM, Kølsen-Petersen JA, Søballe K, Børglum J, Bendtsen TF. Cutaneous anaesthesia of hip surgery incisions with iliohypogastric and subcostal nerve blockade: A randomised trial. Acta Anaesthesiol Scand 2019; 63:101-110. [PMID: 30109702 DOI: 10.1111/aas.13221] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/27/2018] [Accepted: 06/22/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cutaneous nerve blockade may improve analgesia after hip surgery. Anaesthesia after the lateral femoral cutaneous (LFC) nerve block is too distal for complete coverage of most hip surgery incisions, which requires additional anaesthesia of the adjacent, proximal area. The transversalis fascia plane (TFP) block potentially anaesthetises the iliohypogastric and subcostal nerves. The primary aim of the present study was to investigate, if the TFP block provides cutaneous anaesthesia adjacent to the LFC nerve block. METHODS Active vs placebo TFP blocks were compared in a paired randomised controlled trial (RCT) in 20 volunteers, who all had bilateral LFC nerve blocks. The day preceding the RCT, the area anaesthetised by a novel selective ultrasound guided subcostal nerve block was identified bilaterally in order to assess the contribution of the subcostal nerve to the area anaesthesia by the TFP block. RESULTS Anaesthesia of the lateral hip region after TFP block was 80%. The cutaneous anaesthesia after active TFP block was in continuity with the LFC nerve block in 65%. Combined TFP and LFC nerve blockade significantly increased the coverage of hip surgery incisions compared to LFC nerve block alone. The success rate of blocking the subcostal nerve was 50% with the TFP block. CONCLUSION The TFP block anaesthetises the skin proximal to the LFC nerve block by anaesthetising the iliohypogastric and subcostal nerves. TFP block as a supplement to LFC nerve block improves the coverage of the proximal surgical incisions used for hip surgery.
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Affiliation(s)
- Thomas D. Nielsen
- Department of Anaesthesiology; Aarhus University Hospital; Aarhus Denmark
| | - Bernhard Moriggl
- Division of Clinical and Functional Anatomy; Department of Anatomy, Histology and Embryology; Medical University of Innsbruck; Innsbruck Austria
| | - Jeppe Barckman
- Department of Orthopaedic Surgery; Aarhus University Hospital; Aarhus Denmark
| | - Jan Mick Jensen
- Department of Anaesthesiology; Aarhus University Hospital; Aarhus Denmark
| | | | - Kjeld Søballe
- Department of Orthopaedic Surgery; Aarhus University Hospital; Aarhus Denmark
| | - Jens Børglum
- Department of Anaesthesiology; Zealand University Hospital; University of Copenhagen; Roskilde Denmark
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Kokubo R, Kim K, Morimoto D, Isu T, Iwamoto N, Kitamura T, Morita A. Anatomic Variation in Patient with Lateral Femoral Cutaneous Nerve Entrapment Neuropathy. World Neurosurg 2018; 115:274-276. [PMID: 29729473 DOI: 10.1016/j.wneu.2018.04.159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND We report a surgical case of entrapment neuropathy of lateral femoral cutaneous nerve (LFCN) with anatomical variation. CASE DESCRIPTION This 53-year-old man had a 10-year history of paresthesia and pain in the right anterolateral thigh exacerbated by prolonged standing and walking. His symptoms improved completely but transiently by LFCN block. The diagnosis was LFCN entrapment. Because additional treatment with drugs and repeat LFCN block was ineffective, we performed surgical decompression under local anesthesia. A nerve stimulator located the LFCN 4.5 cm medial to the anterior superior iliac spine. It formed a sharp curve and was embedded in connective tissue. Proximal dissection showed it to run parallel to the femoral nerve at the level of the inguinal ligament. The inguinal ligament was partially released to complete dissection/release. Postoperatively, his symptoms improved and the numeric rating scale fell from 8 to 1. CONCLUSION We report a rare anatomical variation in the course of the LFCN.
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Affiliation(s)
- Rinko Kokubo
- Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai, Chiba, Japan.
| | - Kyongsong Kim
- Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai, Chiba, Japan
| | - Daijiro Morimoto
- Department of Neurosurgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Toyohiko Isu
- Department of Neurosurgery, Kushiro Rosai Hospital, Kushiro, Hokkaido, Japan
| | - Naotaka Iwamoto
- Department of Neurosurgery, Teikyo University Hospital, Itabashi-ku, Tokyo, Japan
| | - Takao Kitamura
- Department of Neurosurgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Akio Morita
- Department of Neurosurgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
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Palamar D, Terlemez R, Akgun K. Ultrasound-Guided Diagnosis and Injection of the Lateral Femoral Cutaneous Nerve with an Anatomical Variation. Pain Pract 2017; 17:1105-1108. [PMID: 28112483 DOI: 10.1111/papr.12559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/21/2016] [Accepted: 12/10/2016] [Indexed: 01/03/2023]
Abstract
Meralgia paresthetica (MP) is an entrapment neuropathy of the lateral femoral cutaneous nerve (LFCN). There are many variations in the course of the LFCN. A 55-year-old woman presented with pain and tingling sensations on the anterolateral aspect of her left thigh. Physical examination revealed hypoesthesia of the proximal anterolateral thigh on the left side. During the electrodiagnostic study, sensory nerve action potential of the LFCN could not be obtained on both sides. Through those clinical and electrophysiological findings, we prediagnosed the case as MP and planned to perform diagnostic nerve block. For the injection to perform, ultrasonography was used. During the ultrasonographic evaluation, the left LFCN was visualized lateral to the anterior superior iliac spine (ASIS). Then ultrasound-guided nerve block with 2 cc lidocaine 2% for diagnostic purpose was performed in this region. Immediately after the injection, the patient's complaints relieved completely, and hence the patient was diagnosed as having MP with an LFCN anatomical variation. Two months later her complaints persisted, and ultrasound-guided LFCN injection with 2 mL of lidocaine 2% + 1 cc of betametazone was performed. One month after the second injection, her complaints were relieved markedly and she resumed her daily activities. In conclusion, the course of the LFCN is quite variable. We present a relatively rare anatomical variation of the LFCN, crossing lateral to the ASIS, diagnosed with ultrasonography. Ultrasonography can be performed to visualize the LFCN, especially a nerve with an anatomical variation.
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Affiliation(s)
- Deniz Palamar
- Department of Physical Medicine and Rehabilitation, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Rana Terlemez
- Department of Physical Medicine and Rehabilitation, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Kenan Akgun
- Department of Physical Medicine and Rehabilitation, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Wadhwa V, Scott KM, Rozen S, Starr AJ, Chhabra A. CT-guided Perineural Injections for Chronic Pelvic Pain. Radiographics 2016; 36:1408-25. [DOI: 10.1148/rg.2016150263] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tomaszewski KA, Popieluszko P, Henry BM, Roy J, Sanna B, Kijek MR, Walocha JA. The surgical anatomy of the lateral femoral cutaneous nerve in the inguinal region: a meta-analysis. Hernia 2016; 20:649-57. [PMID: 27115766 PMCID: PMC5023748 DOI: 10.1007/s10029-016-1493-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/13/2016] [Indexed: 02/06/2023]
Abstract
Purpose Several variations in the anatomy and injury of the lateral femoral cutaneous nerve (LFCN) have been studied since 1885. The aim of our study was to analyze the available data on the LFCN and find a true prevalence to help in the planning and execution of surgical procedures in the area of the pelvis, namely inguinal hernia repair. Methods A search of the major medical databases was performed for LFCN anatomy. The anatomical data were collected and analyzed. Results Twenty-four studies (n = 1,720) were included. The most common pattern of the LFCN exiting the pelvis was medial to the Sartorius as a single branch. When it exited in this pattern, it did so on average 1.90 cm medial to the anterior superior iliac spine (ASIS). Conclusions The LFCN and its variations are important to consider especially during inguinal hernia repair, abdominoplasty, and iliac bone grafting. We suggest maintaining a distance of 3 cm or more from the ASIS when operating to prevent injury to the LFCN. Electronic supplementary material The online version of this article (doi:10.1007/s10029-016-1493-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K A Tomaszewski
- International Evidence-Based Anatomy Working Group, Krakow, Poland.
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland.
| | - P Popieluszko
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
| | - B M Henry
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
| | - J Roy
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
| | - B Sanna
- Faculty of Medicine and Surgery, University of Cagliari, Sardinia, Italy
| | - M R Kijek
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
| | - J A Walocha
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
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Rudin D, Manestar M, Ullrich O, Erhardt J, Grob K. The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint. J Bone Joint Surg Am 2016; 98:561-7. [PMID: 27053584 DOI: 10.2106/jbjs.15.01022] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Injury to the lateral femoral cutaneous nerve (LFCN) is a risk during the operative anterior approach to the hip joint. Although several anatomical studies have described the proximal course of the nerve in relation to the anterior superior iliac spine (ASIS) and the inguinal ligament, the distal course of the LFCN in the proximal aspect of the thigh has not been sufficiently studied. The aim of this cadaveric study was to examine the branching pattern of the nerve, with special consideration to the anterior approach to the hip joint. METHODS Twenty-eight cadaveric hemipelves from 18 donors (10 paired and 8 unpaired specimens) were dissected. The LFCN branches were localized proximal to the inguinal ligament and traced distally into the area of the proximal aspect of the thigh. Distribution patterns of the nerve with respect to its relationship to the ASIS and the internervous plane of the anterior approach to the hip joint were recorded. RESULTS We found 3 different branching patterns of the LFCN: sartorius-type (in 36% of the specimens), characterized by a dominant anterior nerve branch coursing along the lateral border of the sartorius muscle with no, or only a thin, posterior branch; posterior-type (in 32%), characterized by a strong posterior nerve branch; and fan-type (in 32%), characterized by multiple spreading nerve branches of equal thickness. In 50% of the specimens, the LFCN divided into ≥2 branches superior to the inguinal ligament. Sixty-two percent of the LFCN branches entered the proximal aspect of the thigh medial to the ASIS; 27%, above; and 11%, lateral to the ASIS. The LFCN consistently coursed within the deep layer of the subcutaneous fat tissue. CONCLUSIONS Injury to branches of the LFCN cannot be avoided in approximately one-third of surgical dissections that use the anterior approach to the hip joint. To protect the anterior branch of the LFCN, the skin incision should be as lateral as possible. The posterior branch of the LFCN is most vulnerable in the proximal aspect of the anterior approach to the hip joint, where it can be expected to course within the deep layer of the subcutaneous tissue.
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Affiliation(s)
- Diana Rudin
- Department of Orthopaedic Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Mirjana Manestar
- Department of Anatomy, University of Zurich Irchel, Zurich, Switzerland
| | - Oliver Ullrich
- Department of Anatomy, University of Zurich Irchel, Zurich, Switzerland
| | - Johannes Erhardt
- Department of Orthopaedic Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Karl Grob
- Department of Orthopaedic Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
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3-Tesla High-Field Magnetic Resonance Neurography for Guiding Nerve Blocks and Its Role in Pain Management. Magn Reson Imaging Clin N Am 2015; 23:533-45. [DOI: 10.1016/j.mric.2015.05.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Park BJ, Joeng ES, Choi JK, Kang S, Yoon JS, Yang SN. Ultrasound-guided lateral femoral cutaneous nerve conduction study. Ann Rehabil Med 2015; 39:47-51. [PMID: 25750871 PMCID: PMC4351494 DOI: 10.5535/arm.2015.39.1.47] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 08/29/2014] [Indexed: 11/17/2022] Open
Abstract
Objective To verify the utility of the lateral femoral cutaneous nerve (LFCN) ultrasound-guided conduction technique compared to that of the conventional nerve conduction technique. Methods Fifty-eight legs of 29 healthy participants (18 males and 11 females; mean age, 42.7±14.9 years) were recruited. The conventional technique was performed bilaterally. The LFCN was localized by ultrasound. Cross-sectional area (CSA) of the LFCN and the distance between the anterior superior iliac spine (ASIS) and the LFCN was measured. The nerve conduction study was repeated with the corrected cathode location. Sensory nerve action potential (SNAP) amplitudes of the LFCN were recorded and compared between the ultrasound-guided and conventional techniques. Results Mean body mass index of the participants was 23.7±3.5 kg/m2, CSA was 4.2±1.9 mm2, and the distance between the ASIS and LFCN was 5.6±1.7 mm. The mean amplitude values were 6.07±0.52 µV and 6.66±0.54 µV using the conventional and ultrasound-guided techniques, respectively. The SNAP amplitude of the LFCN using the ultrasound-guided technique was significantly larger than that recorded using the conventional technique. Conclusion Correcting the stimulation position using the ultrasound-guided technique helped obtain increased SNAP amplitude.
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Affiliation(s)
- Bum Jun Park
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Eui Soo Joeng
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Jun Kyu Choi
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Seok Kang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Seung Nam Yang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
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Fritz J, Chhabra A, Wang KC, Carrino JA. Magnetic resonance neurography-guided nerve blocks for the diagnosis and treatment of chronic pelvic pain syndrome. Neuroimaging Clin N Am 2013; 24:211-34. [PMID: 24210321 DOI: 10.1016/j.nic.2013.03.028] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Magnetic resonance (MR) neurography - guided nerve blocks and injections describe a techniques for selective percutaneous drug delivery, in which limited MR neurography and interventional MR imaging are used jointly to map and target specific pelvic nerves or muscles, navigate needles to the target, visualize the injected drug and detect spread to confounding structures. The procedures described, specifically include nerve blocks of the obturator nerve, lateral femoral cutaneous nerve, pudendal nerve, posterior femoral cutaneous nerve, sciatic nerve, ganglion impar, sacral spinal nerve, and injection into the piriformis muscle.
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Affiliation(s)
- Jan Fritz
- Musculoskeletal Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, 600 N Wolfe Street, Baltimore, MD 21287, USA.
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Zhu J, Zhao Y, Liu F, Huang Y, Shao J, Hu B. Ultrasound of the lateral femoral cutaneous nerve in asymptomatic adults. BMC Musculoskelet Disord 2012; 13:227. [PMID: 23171132 PMCID: PMC3552899 DOI: 10.1186/1471-2474-13-227] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 11/19/2012] [Indexed: 11/10/2022] Open
Abstract
Background To define the sites where the lateral femoral cutaneous nerve (LFCN) is more easily visualized and to describe the anatomical variations of the LFCN. Methods A total of 240 LFCNs in 120 volunteers were evaluated with 18 MHz ultrasound; the intermuscular space between the tensor fasciae latae muscle and the sartorius was used as an initial sonographic landmark. The time taken to identify the nerve was recorded. The number of nerve branches at the level of the inguinal ligament (IL) and the relationship between the LFCN and the IL was assessed. The nerve cross-sectional area (CSA) of the LFCN and the distance between the LFCN and the anterior superior iliac spine was measured. Results Each nerve was identified using ultrasound in all participants. The mean time for identifying the nerve was 7s for unilateral LFCNs. The nerve passed under the IL in 198 cases, whereas in 44 cases, it passed through to the IL. The LFCN consisted of 1–4 branches just after its passage under or through the IL. The CSA of the LFCN was 1.04±0.44 mm2, and the mean distance between the LFCN and the anterior superior iliac spine was 15.6 ± 4.2 mm. Conclusions It is easier to identify the LFCN if the intermuscular space between the tensor fasciae latae muscle and the sartorius is used as an initial sonographic landmark. The anatomical variation of the LFCN can be viewed with high-frequency ultrasound.
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Affiliation(s)
- Jiaan Zhu
- Department of Ultrasound, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, 600 Yishan Rd, Shanghai 200233, China.
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Bhardwaj N, Lloyd DM. Laparoscopic relief of meralgia paraesthetica. Ann R Coll Surg Engl 2011. [PMID: 21929929 DOI: 10.1308/003588411x592130h] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- N Bhardwaj
- Department of Surgery, Leicester General Hospital, Leicester, UK.
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Affiliation(s)
- N Bhardwaj
- Department of Surgery Leicester General Hospital, Leicester, UK
| | - DM Lloyd
- Department of Surgery Leicester General Hospital, Leicester, UK
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Choi HJ, Choi SK, Kim TS, Lim YJ. Pulsed radiofrequency neuromodulation treatment on the lateral femoral cutaneous nerve for the treatment of meralgia paresthetica. J Korean Neurosurg Soc 2011; 50:151-3. [PMID: 22053239 DOI: 10.3340/jkns.2011.50.2.151] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 04/24/2011] [Accepted: 08/16/2011] [Indexed: 11/27/2022] Open
Abstract
We describe a rare case of pulsed radiofrequency treatment for pain relief associated with meralgia paresthetica. A 58-year-old female presented with pain in the left anterior lateral thigh. An imaging study revealed no acute lesions compared with a previous imaging study, and diagnosis of meralgia paresthetica was made. She received temporary pain relief with lateral femoral cutaneous nerve blocks twice. We performed pulsed radiofrequency treatment, and the pain declined to 25% of the maximal pain intensity. At 4 months after the procedure, the pain intensity did not aggravate without medication. Pulsed radiofrequency neuromodulation treatment on the lateral femoral cutaneous nerve may offer an effective, low risk treatment in patients with meralgia paresthetica who are refractory to conservative medical treatment.
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Affiliation(s)
- Hyuk Jai Choi
- Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Korea
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Anatomical variation of the lateral femoral cutaneous nerve: A case report and review of the literature. J Plast Reconstr Aesthet Surg 2011; 64:961-2. [DOI: 10.1016/j.bjps.2010.11.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 11/25/2010] [Indexed: 11/22/2022]
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Ray B, D'Souza A, Kumar B, Marx C, Ghosh B, Gupta NK, Marx A. Variations in the course and microanatomical study of the lateral femoral cutaneous nerve and its clinical importance. Clin Anat 2010; 23:978-84. [DOI: 10.1002/ca.21043] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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