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Shirodkar K, Iyengar KP, Mehta J, Azzopardi CA, Botchu R. Right-sided meralgia paresthetica from lateral femoral cutaneous nerve neuroma. J Ultrasound 2024:10.1007/s40477-024-00883-y. [PMID: 38573474 DOI: 10.1007/s40477-024-00883-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 02/15/2024] [Indexed: 04/05/2024] Open
Abstract
Meralgia Paresthetica (MP) causes outer thigh discomfort, numbness, and tingling. Compression or injury to the Lateral Femoral Cutaneous Nerve (LFCN), which gives sensory innervation to outer aspect of the thigh. It frequently gets impinged beneath the inguinal ligament resulting in in sensory impairment in the distribution of LFCN. Compression of the LFCN is a frequent cause of MP, whereas LFCN neuromas is a rare cause. This case report describes a unique case of Meralgia Paresthetica produced by a LFCN neuroma and enhances our knowledge of Meralgia Paresthetica.
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Affiliation(s)
- K Shirodkar
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - K P Iyengar
- Department of Orthopedics, Southport and Ormskirk Hospital NHS Trust, Southport, UK
| | - J Mehta
- Department of Spinal Surgery, Royal Orthopedic Hospital, Birmingham, UK
| | - C A Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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Kanayama T, Nakase J, Yoshimizu R, Ishida Y, Yanatori Y, Arima Y, Takemoto N. Periarticular cocktail injection is more useful than nerve blocks for pain management after anterior cruciate ligament reconstruction. Asia Pac J Sports Med Arthrosc Rehabil Technol 2024; 36:45-49. [PMID: 38584974 PMCID: PMC10995970 DOI: 10.1016/j.asmart.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/12/2024] [Accepted: 03/17/2024] [Indexed: 04/09/2024] Open
Abstract
Background Anterior cruciate ligament (ACL) reconstruction is commonly associated with moderate-to-severe postoperative pain. Notably, various pain control strategies, a femoral nerve block (FNB) with a lateral femoral cutaneous nerve block (LFCNB), adductor canal block (ACB) with LFCNB, or periarticular cocktail injection (PI), have been investigated. However, no studies compare the effects of FNB with LFCNB, ACB with LFCNB, and PI for pain control after ACL reconstruction. This study aimed to evaluate the impact of FNB with LFCNB, ACB with LFCNB, and PI for pain relief in the early postoperative period after ACL reconstruction. Methods This retrospective controlled clinical trial enrolled 299 patients who underwent primary ACL reconstruction at our hospital between April 2016 and October 2022. We categorized these cases into groups based on the use of PI (PI group), FNB with LFCNB (FNB group), and ACB with LFCNB (ACB group) for pain management. We selected 40 cases each, with matched age, sex, and body mass index (BMI) from each group, resulting in 120 cases for analysis. In the FNB and ACB groups, 0.75% ropivacaine 15 ml was injected under ultrasound guidance preoperatively. In the PI group, a mixture of 0.75% ropivacaine 20 ml, normal saline 20 ml, and dexamethasone 6.6 mg was injected half at the start of surgery and the rest just before wound closure. Patient demographics (age, sex, height, body weight, and BMI) and surgical data (the requirement for meniscal repair, operative time, and tourniquet inflation time) were analyzed. After ACL reconstruction, patients' numerical rating scale pain scores (NRS) (0-10) were recorded at 30 min and 4, 8, 12, 24, 48, and 72 h postoperatively. NRS were then compared among the three groups using analysis of variance. In addition, within each group, these data were compared between the NRS ≥7 and NRS ≤6 groups using a t-test. Results There were no significant differences in patient demographics and surgical data. Pain scores were significantly higher in the PI group than in the FCB and ACB groups 30 min postoperatively, but they were lower at 12, 24, 48, and 72 h postoperatively. In the FNB group, there were no significant differences in the demographic and surgical data by NRS pain score. In the ACB group, the number of men was significantly higher in the NRS ≥7 group than in the NRS ≤6 group (p = 0.015). In the PI group, tourniquet inflation time was significantly longer in the NRS ≥7 group than in the NRS ≤6 group (p = 0.008). Conclusions Following ACL reconstruction using a hamstring autograft, periarticular cocktail significantly reduced early postoperative pain compared with nerve block combinations.
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Affiliation(s)
- Tomoyuki Kanayama
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Junsuke Nakase
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Rikuto Yoshimizu
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yoshihiro Ishida
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yusuke Yanatori
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yu Arima
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Naoki Takemoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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Panuwannakorn M, Jiravichitchai T, Lertthammakiat S, Jaovisidha S, Sirachainan N, Chuansumrit A. Iliopsoas haemorrhage complicated by femoral neuropathy in patients with haemophilia: a case series report. Int J Hematol 2023; 117:293-306. [PMID: 36151351 DOI: 10.1007/s12185-022-03456-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The study aimed to determine the incidence of femoral neuropathy in patients with haemophilia exhibiting iliopsoas haemorrhage. METHODS Patients with iliopsoas haemorrhage confirmed by ultrasonography or CT scan were studied retrospectively. RESULTS A total of 44 episodes of iliopsoas haemorrhage occurred in 20 patients with haemophilia (A17, B3). Most episodes in patients without inhibitors (14/16 = 87.5%) were adequately treated followed by prophylaxis. However, 11 of 28 episodes (39.3%) in patients with inhibitors were adequately treated and no prophylaxis was provided. An appropriate rehabilitation programme was arranged during hospitalisation and follow-up. Femoral neuropathy was observed in 28 of 44 episodes, while 16 episodes of persistent femoral neuropathy from previous bleeding were excluded. As a result, 11 of 28 episodes (39.3%) of femoral neuropathy were similarly found amongst patients with and without inhibitors. The mean time of onset and resolution of femoral neuropathy were 3.7 (1.8) and 23.4 (20.5) days after the onset of iliopsoas haemorrhage, respectively. Patients receiving inadequate and delayed replacement had a significantly higher rate of femoral neuropathy than those who received adequate and prompt replacement. CONCLUSION Femoral neuropathy following iliopsoas haemorrhage was common in haemophilia patients with and without inhibitors.
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Affiliation(s)
- Monratta Panuwannakorn
- Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tachit Jiravichitchai
- Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Surapong Lertthammakiat
- Department of Paediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suphaneewan Jaovisidha
- Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nongnuch Sirachainan
- Department of Paediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ampaiwan Chuansumrit
- Department of Paediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Gooneratne T, Wijeyaratne M. Iatrogenic Deep Femoral Artery Pseudoaneurysm Causing Quadriceps Paralysis: An Indication for Open Surgery in an Endovascular Era. Vasc Specialist Int 2021; 37:25. [PMID: 34349045 PMCID: PMC8339415 DOI: 10.5758/vsi.210027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/24/2021] [Accepted: 06/27/2021] [Indexed: 11/20/2022] Open
Abstract
Contemporary management of iatrogenic pseudoaneurysms is mostly performed using non-surgical techniques. Herein, we present a rare case of deep femoral artery (DFA) pseudoaneurysm with compression neuropathy, which required open repair. A 67-year-old female patient presented with increasing pain in the right groin, sensory neuropathy of the anteromedial thigh and upper leg, and quadriceps paralysis 4 days after coronary angiography via femoral puncture. Computed tomography angiography revealed a pseudoaneurysm of the DFA. The disabling compressive neuropathy warranted urgent open decompression rather than thrombin injection or endovascular therapy. Timely open evacuation of the hematoma, release of compression on the femoral nerve, and postoperative physiotherapy resulted in complete recovery of quadriceps power. The patient was pain free within 12 weeks and able to ambulate independently. This case report highlights the role of prompt open surgery for pseudoaneurysms with compression neuropathy.
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Affiliation(s)
- Thushan Gooneratne
- Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Mandika Wijeyaratne
- Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Jang AY, Oh YJ, Lee SI, Lim OK, Suh SY. Femoral neuropathy following venoarterial-extracorporeal membrane oxygenation therapy: a case report. BMC Cardiovasc Disord 2020; 20:393. [PMID: 32854617 PMCID: PMC7457300 DOI: 10.1186/s12872-020-01675-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 08/19/2020] [Indexed: 11/10/2022] Open
Abstract
Background Although life-threatening complications of extracorporeal membrane oxygenation (ECMO) are well described, non-life threatening complications are less known. Herein, we report a case of femoral neuropathy (FN) due to nerve compression caused by cannula compression and deep vein thrombosis (DVT) after successful ECMO therapy, which seriously undermined one’s quality of life. Case presentation A 70-year old male presented to the emergency department for chest pain. The patient had cardiac arrest before percutaneous coronary intervention (PCI) and was inserted with ECMO. Although he was successfully weaned from ECMO 4 days after PCI, he consistently complained swelling, abnormal sensation, and weakness in his right lower extremity, where the cannulas were inserted. Imaging studies showed deep vein thrombosis (DVT) in his right leg, which was further treated with anticoagulants. Symptoms, however, remained after the regression of DVT. Nerve conduction study revealed femoral neuropathy, which may have been caused by ECMO cannula compression and tissue swelling. Conclusion The current case proposes that non-life threatening complications of ECMO therapy can seriously affect quality of life. Venous drainage distant from the arterial cannula may prevent such complications.
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Affiliation(s)
- Albert Youngwoo Jang
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, 1198 Guwol-dong, Namdong-gu, 405-760, Incheon, Republic of Korea
| | - Young Jun Oh
- Intensive Care Unit, Department of Nursing, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Seok In Lee
- Department of Thoracic Cardiovascular Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Oh Kyung Lim
- Department of Physical & Rehabilitation Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Soon Yong Suh
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, 1198 Guwol-dong, Namdong-gu, 405-760, Incheon, Republic of Korea.
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Ayyildiz A, Dogu B, Ciftci S, Yilmaz F, Kuran B. Idiopathic Lumbosacral Neuropathy Syndrome: Case Report. Sisli Etfal Hastan Tip Bul 2020; 54:384-7. [PMID: 33312041 DOI: 10.14744/SEMB.2019.45143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 04/27/2019] [Indexed: 11/20/2022]
Abstract
Idiopathic lumbosacral plexitis or lumbosacral radiculoplexus neuropathy is a disease characterized by nerve damage in lumbar and/or sacral plexus without trauma, mass effect or diabetic complications. A 47-year-old male patient with right groin pain and loss of right leg muscle strength is presented in this case report. Neuropathy was detected in the L4 nerve root by electromyography and magnetic resonance neurrographic imaging. The underlying cause was investigated; however, it is linked to the idiopathic outcome. Idiopathic lumbosacral neuropathy is a lumbosacral plexus disease in which no underlying pathology plays a role in causing severe pain and muscle weakness. Patients should be avoided urgently operation because of the sudden onset symptoms.
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Sahu KK, Mishra AK, Zhang P. Femoral Neuropathy: A Rare Presentation of Retroperitoneal Hematoma with Review of Literature. Indian J Hematol Blood Transfus 2020; 36:174-177. [PMID: 32158101 DOI: 10.1007/s12288-019-01126-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 04/20/2019] [Indexed: 11/30/2022] Open
Abstract
Hematomas in close compartments and in pelvic gutters are always challenging to treat and diagnose. A young female on apixaban for recently diagnosed pulmonary thromboembolism (PE) presented to us for the complaints of right sided lower limb weakness. Neurological examination was positive for the right femoral nerve distribution deficit. Computed tomography (CECT) showed large right sided iliopsoas hematoma. Anticoagulation was stopped and was given blood transfusions with which she improved without need of any surgical evacuation. We hereby aim to enrich the understanding of our readers regarding this topic with a review of our experience and other recent publications in medical literature. It is important for the internists to be aware of varied and atypical presentations of retroperitoneal hematoma (RPH) especially following surgical/orthopaedic procedures or in association with anticoagulants and antiplatelets.
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Affiliation(s)
- Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA 01608 USA
| | - Ajay Kumar Mishra
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA 01608 USA
| | - Peng Zhang
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA 01608 USA
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Hynes JP, Downey RE, Hughes N, O'Keane CJ, Kavanagh E. Subperiosteal hematoma of the iliac wing presenting with leg weakness in a young adult footballer. Radiol Case Rep 2020; 15:424-426. [PMID: 32082463 PMCID: PMC7021541 DOI: 10.1016/j.radcr.2020.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/08/2020] [Accepted: 01/08/2020] [Indexed: 11/18/2022] Open
Abstract
We present the case of a 17 year old football player with a 2 week history of left leg weakness and difficulty weight-bearing. Magnetic resonance imaging revealed a well-circumscribed lesion deep to the left iliacus muscle. The patient proceeded to computed tomography-guided biopsy. The likely diagnosis was that of a subperiosteal haematoma of the iliac wing, which was exerting mass effect upon the left femoral nerve resulting in leg pain and weakness. Imaging was repeated at an interval of 1 month, at which time the lesion had almost entirely resolved. Subperiosteal haematoma of the iliac bone is a rare entity but should be considered as a potential diagnosis in young adults, particularly where there is a history of trauma or recent sports injury.
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Affiliation(s)
- John P Hynes
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Richard E Downey
- National Orthopaedic Hospital of Ireland, Cappagh, Dublin, Ireland
| | - Nicola Hughes
- National Orthopaedic Hospital of Ireland, Cappagh, Dublin, Ireland
| | - Conor J O'Keane
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eoin Kavanagh
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland.,National Orthopaedic Hospital of Ireland, Cappagh, Dublin, Ireland
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Ferrando Lacarte I, Clemente Sarasa C, Domingo Sanchez MD, Cánovas Pareja C. [ Femoral neuropathy: Haematoma in iliac muscle and a lumbar vertebral fracture]. Rev Esp Geriatr Gerontol 2019; 55:120-122. [PMID: 31353128 DOI: 10.1016/j.regg.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/10/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
Abstract
75-year-old patient with a history of acenocumarol anticoagulated atrial fibrillation, which shows pain, functional impotence and right lower limb paresthesias after fall. Studies evidenc evertebral fracture L5 and haematoma on right iliac muscle, proceeding to surgical drainage, suspension of acenocumarol, and onset of apixaban. After treatment persisted femoral neuropathy, which not allowed complete functional recovery. DISCUSSION: Femoral neuropathy as possible cause of compressive hematoma over iliopsoas muscle or secundary to lumbar canal stenosis and contact with L4 root. In both of the misit posible to observe weakness of proximal lower limb musculature. Haematoma was suspected due to lower back pain, flank mass and hypovolemia. Handlingis based on the severity of the symptomatology, from conservative to surgical drainage to reduce sequelae and bleeding complications. Apixaban has shown a higher safety profile. Stabilization of lumbar fracture allowed partial functional recovery.
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Abstract
Entrapment neuropathies in the lower limbs are a common neurologic problem and may present in any medical setting. Accurate identification and management of these nerve palsies can prevent pain, sensory loss, incoordination, and muscle weakness that may significantly affect a patient's functional mobility. In this article, the authors focus on the cause, signs and symptoms, diagnosis, and treatment of select entrapment neuropathies of the lower extremity, including palsies of the common peroneal, lateral femoral cutaneous, femoral, and posterior tibial nerves.
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Affiliation(s)
- Michael P Bowley
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, WACC 739B, Boston, MA 02114, USA.
| | - Christopher T Doughty
- Department of Neurology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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Khanna V, Ashraf M, Sambandam SN. Spontaneous Retroperitoneal Hematoma Presenting as Femoral Neuropathy in a Patient on Low Molecular Weight Heparin Therapy. J Orthop Case Rep 2018; 8:55-57. [PMID: 30584517 PMCID: PMC6298708 DOI: 10.13107/jocr.2250-0685.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Retroperitoneal hemorrhage has been sparsely reported with warfarin therapy. In this paper, we describe a case of spontaneous retroperitoneal hematoma causing femoral neuropathy following treatment with low molecular weight heparin. Case Report A 65-year-old gentleman had presented with acute onset left-sided thigh pain, paraesthesia, and weakness along with lower backache. On deeper introspection, our patient had, in the recent past, been thrombolyzed for pulmonary embolism. The clinical examination led us to suspect an acute lumbar pathology, and he was investigated on those lines. Imaging studies, however, revealed a massive retroperitoneal hemorrhage which was the cause of femoral neuropathy. In this case report, the presentation of this rare association has been discussed with special emphasis on clinical premonition in the background of anticoagulant therapy. Watchful and medical treatment yielded successful recovery at follow-up. Conclusion Cautious clinical assessment is needed in patients taking anticoagulant therapy. The presentation of a femoral neuropathy is often intriguing. Management options include careful observation and emergency decompression in cases of worsening neurological status.
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Affiliation(s)
- Vishesh Khanna
- Department of Orthopaedics, Arthroplasty Fellow, Sunshine Hospital, Secunderabad, Telangana, India
| | - Munis Ashraf
- Department of Orthopaedics, K.G Hospital and Postgraduate Medical Institute, Coimbatore, Tamil Nadu, India
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Yoo J, Lim KB, Lee HJ, Kim J, You EC, Kang J. Femoral Neuropathy Secondary to Autosomal Dominant Polycystic Kidney Disease: A Case Report. Ann Rehabil Med 2018; 42:488-493. [PMID: 29961749 PMCID: PMC6058580 DOI: 10.5535/arm.2018.42.3.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 09/05/2017] [Indexed: 11/22/2022] Open
Abstract
Compressive femoral neuropathy is a disabling condition accompanied by difficulty in hip flexion and knee extension. It may result from retroperitoneal hematoma or bleeding, or from complications associated with pelvic,
hip surgery, and renal transplants. A 55-year-old female with autosomal dominant polycystic kidney disease presented with proximal muscle weakness in lower extremities. The patient experienced recurrent renal cyst infection, with aggravated weakness during each event. Electromyography and nerve conduction study revealed
bilateral femoral neuropathy. Computed tomography and magnetic resonance images were added to further identify the cause. As a result, a diagnosis of femoral neuropathy caused by enlarged polycystic kidney was made.
Cyst infection was managed with antibiotics. Renal function was maintained by frequent regular hemodialysis. While avoiding activities that may increase abdominal pressure, rehabilitation exercises were provided. Motor
strength in hip flexion and knee extension improved, and was confirmed via electrodiagnostic studies.
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Affiliation(s)
- Jeehyun Yoo
- Department of Physical Medicine and Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Kil-Byung Lim
- Department of Physical Medicine and Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Hong-Jae Lee
- Department of Physical Medicine and Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jiyong Kim
- Department of Physical Medicine and Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Eun-Cheol You
- Department of Physical Medicine and Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Joongmo Kang
- Department of Physical Medicine and Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea
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Abstract
BACKGROUND Femoral nerve injury is not a common complication of the abdominopelvic surgical procedures. OBJECTIVE To present a case of femoral neuropathy after nephrectomy. METHODS Case report. RESULTS A 71-year-old female patient with a right-sided congenital hip dysplasia developed numbness, tingling and burning pain in the right thigh and muscle weakness in the right hip after the nephrectomy surgery. Neurological examination and electrodiagnostic test revealed a femoral nerve injury. Prognosis of the femoral neuropathy was good. The quadriceps muscle weakness improved within six months. CONCLUSION Postoperative femoral neuropathy is an unexpected complication after total nephrectomy surgery. The prognosis is relatively good and early physical therapy can produce rapid recovery.
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Affiliation(s)
- Bilge Kesikburun
- Department of Physical Medicine and Rehabilitation, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Emel Ekşioğlu
- Department of Physical Medicine and Rehabilitation, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Ece Ünlü Akyüz
- Department of Physical Medicine and Rehabilitation, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Fuat Demirel
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Aytül Çakcı
- Department of Physical Medicine and Rehabilitation, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Colsa Gutiérrez P, Viadero Cervera R, Morales-García D, Ingelmo Setién A. Intraoperative peripheral nerve injury in colorectal surgery. An update. Cir Esp 2015; 94:125-36. [PMID: 26008880 DOI: 10.1016/j.ciresp.2015.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 02/04/2015] [Accepted: 03/08/2015] [Indexed: 12/15/2022]
Abstract
Intraoperative peripheral nerve injury during colorectal surgery procedures is a potentially serious complication that is often underestimated. The Trendelenburg position, use of inappropriately padded armboards and excessive shoulder abduction may encourage the development of brachial plexopathy during laparoscopic procedures. In open colorectal surgery, nerve injuries are less common. It usually involves the femoral plexus associated with lithotomy position and self-retaining retractor systems. Although in most cases the recovery is mostly complete, treatment consists of physical therapy to prevent muscular atrophy, protection of hypoesthesic skin areas and analgesics for neuropathic pain. The aim of the present study is to review the incidence, prevention and management of intraoperative peripheral nerve injury.
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Affiliation(s)
- Pablo Colsa Gutiérrez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Sierrallana , Torrelavega, Cantabria, España.
| | | | - Dieter Morales-García
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - Alfredo Ingelmo Setién
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Sierrallana , Torrelavega, Cantabria, España
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Abstract
Femoral neuropathy may be associated with various etiologies and can cause severe walking disability. We present the case of a 25-year-old woman who underwent surgical repair for a patella fracture and complained of lower extremity pain, paresthesia, and weakness postoperatively. Electromyography and magnetic resonance imaging (MRI) revealed partial peripheral neuropathy of the left femoral nerve associated with the patella fracture. To our knowledge, this is the first reported case of femoral neuropathy associated with a patella fracture.
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Affiliation(s)
- Sang Hyoung Lee
- Department of Orthopaedic Surgery, Dongguk University Hospital, Ilsan, Korea
| | - Tong Joo Lee
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Korea
| | - Min Su Woo
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Korea
| | - Dae Gyu Kwon
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Korea
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Yi TI, Yoon TH, Kim JS, Lee GE, Kim BR. Femoral neuropathy and meralgia paresthetica secondary to an iliacus hematoma. Ann Rehabil Med 2012; 36:273-7. [PMID: 22639754 PMCID: PMC3358686 DOI: 10.5535/arm.2012.36.2.273] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 04/19/2011] [Indexed: 11/05/2022] Open
Abstract
Compressive femoral and lateral femoral cutaneous neuropathies from an iliacus hematoma are unusual presentation. We report a case of a 16-year-old boy who developed right femoral and lateral femoral cutaneous neuropathies as a complication of traumatic ipsilateral iliacus hematoma formation. The patient complained of numbness in the right thigh and calf as well as right leg weakness, and pain in the right inguinal area. Nerve conduction study and needle electromyography identified the neuropathies. After the electrodiagnostic studies, the pelvic bone MRI revealed a large, 9×5×4.5 cm right iliacus hematoma. As a result, diagnosis of a right iliacus hematoma compressing the femoral and lateral femoral cutaneous nerves was made, and the patient underwent an operation to remove the hematoma. Symptoms and neurological signs showed notable improvement after surgical decompression. Subsequent follow-up electrodiagnostic studies after 11 weeks demonstrated regeneration evidence.
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Affiliation(s)
- Tae Im Yi
- Department of Rehabilitation Medicine, Daejin Medical Center Bundang Jesaeng General Hospital, Seongnam 463-774, Korea
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17
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Kong WK, Cho KT, Lee HJ, Choi JS. Femoral Neuropathy due to Iliacus Muscle Hematoma in a Patient on Warfarin Therapy. J Korean Neurosurg Soc 2012; 51:51-3. [PMID: 22396845 PMCID: PMC3291708 DOI: 10.3340/jkns.2012.51.1.51] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 06/28/2011] [Accepted: 01/11/2012] [Indexed: 11/27/2022] Open
Abstract
Spontaneous hematomas of the iliacus muscle are rare lesions and these are seen in individuals receiving anticoagulation therapy or patients with blood dyscrasias such as hemophilia. It can cause femoral neuropathy and resultant pain and paralysis. Although there is no clear consensus for the treatment of femoral neuropathy from iliacus muscle hematomas, delays in the surgical evacuation of hematoma for decompression of the femoral nerve can lead to a prolonged or permanent disability. We report here on a rare case of a spontaneous iliacus muscle hematoma that caused femoral neuropathy in a patient who was taking warfarin for occlusive vascular disease and we discuss the treatment.
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Affiliation(s)
- Woo Keun Kong
- Department of Neurosurgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
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Abstract
Epidural analgesia is frequently used for the management of labor pain in parturients. The neurologic complications of epidural analgesia are rare, but they are catastrophic when they occur. We report here on a case of bilateral femoral neuropathy in a vaginal delivery patient with epidural analgesia. The patient complained of weakness of both thighs and numbness around both knees. Neurologic examination and electromyographic study revealed that they occurred due to the delivery itself. The patient had not fully recovered at eight weeks after delivery. The declining incidence of postpartum femoral neuropathy may reflect a reduced duration of labor in accordance with modern obstetric practice, and particularly the more frequent use of Caesarean delivery. The exact etiology of postpartum femoral neuropathy is unknown, and the possible factors are direct compression of nerves that are proximal within the pelvis by either the fetal head or birthing instruments, or this malady is the result of pressure induced ischemia at the level of the inguinal ligament when the pregnant woman is in the lithotomy position.
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Affiliation(s)
- Seung Pyo Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Byung Mo Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Wonsik Ahn
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea.
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