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Femoral Nerve Pain

Femoral Nerve Pain

Femoral nerve pain, also known as femoral nerve dysfunction, is a disorder that occurs as a result of damage to the femoral nerve, resulting in loss of sensation and movement in the legs. This happens when the femoral nerve is compressed as it passes under the inguinal region, anterior to the iliopsoas muscle.

In most cases, femoral neuropathy goes away without requiring any treatment. If symptoms don’t improve, medications and physical therapy may become necessary.

An athlete holding their knee with femoral nerve pain

Symptoms of Femoral Nerve pain:

The symptoms of femoral nerve pain depend on the extent of damage to the femoral nerve. Typical symptoms include the following:

  • Pain over the front of the thigh
  • Loss of power of knee extension and hip flexion
  • Lower extremity muscle weakness
  • Numbness, pain, burning, or tingling sensation in the medial aspect of the lower leg and anteromedial thigh
  • Loss of muscle bulk of quadriceps
  • Difficulty going up and downstairs
  • Groin pain
  • Stiffness in your hip joint
  • Loss of knee jerk
  • Atrophy of thigh muscles

What Causes Femoral Nerve pain?

Being the largest nerve of the lumbar plexus, the femoral nerve controls the muscles that move the hip and straighten the leg. The nerve enters the femoral triangle after passing underneath the inguinal ligament. It is responsible for providing sensation to the part of the lower leg and front of the thigh. Because of the location, damage to the femoral nerve is rare.

The most common iatrogenic causes of femoral nerve pain include:

  • A direct injury
  • Retroperitoneal haematoma because of anticoagulant medications
  • Prolonged pressure on the femoral nerve
  • Femoral nerve block
  • Vascular procedures, such as arterial bypass and femoral artery catheterisation
  • Femoral nerve compression or entrapment due to lumbar spine pathology (L2-L4), in the adductor canal or iliacus compartment and may also involve the saphenous branch
  • Musculotendinous entrapment
  • Prolonged lithotomy position (lying on your back with your legs flexed).
  • Hip and pelvic surgeries like hysterectomy
  • A pelvic fracture

Damage to the femoral nerve can also be a result of rare non-iatrogenic causes:

  • Infection
  • Trauma
  • Radiation injury
  • Tight or heavy waist belts
  • A broken pelvic bone
  • Injury to the spine can narrow the gap where the nerve exits the spinal cord, causing pinching of the femoral nerve.
  • Alcoholism
  • Diabetes mellitus

Diabetes mellitus may cause compression to the femoral nerve due to fluctuations in blood sugar. Nerve damage affecting the hands, feet, arms, and legs is called peripheral neuropathy as typically involves important peripheral nerve. This is a matter of debate whether femoral neuropathy is a form of diabetic amyotrophy or truly a peripheral neuropathy.

How Is Femoral Nerve pain diagnosed?

The diagnosis and treatment of femoral nerve pain depend on the symptoms you experience. The doctor will ask about the patient’s medical history, including any past surgeries and lifestyle risk factors.

1. Initial Tests:

Your doctor will perform a comprehensive physical examination to diagnose the cause of femoral nerve pain. The doctor will also test specific muscles to look for weakness, i.e smaller and weak quadriceps muscles on the front of the thigh. They will also ask you about the changes in your foreleg and at the front of your thigh. Monitoring of knee reflexes will also be carried out. The objective of initial tests is to find out whether the symptoms involve only the femoral nerve or other nerves also contribute.

The following additional tests can also be performed to further confirm the diagnosis:

2. Electromyography (EMG):

EMG records your muscles’ health and electrical activity and ensures that the nerves that control the muscles are active. EMG is performed to determine whether the response of muscles to stimulation is appropriate or not. As nerves control and stimulate your muscles, any abnormality can be revealed by EMG.

3. Magnetic Resonance Imaging (MRI):

MRI scans detect the presence of any tumors, masses, or cancerous growths that could cause prolonged compression of the femoral nerve. An MRI scan can detect abnormalities of the body’s internal structures by using magnetic fields to generate detailed images of them.

4. CT Scan:

A CT scan can also detect abnormal vascular or bone growths. The CT scan produces different images of the body’s structures that are being scanned by combining computer technology and x-rays.

5. Nerve Conduction Velocity (NCV) Tests:

NCV tests measure the speed of electrical signals moving through a nerve. When electrical signals travel through the nerves in a slow time, it indicates damage to the nerve being checked. Typically, the NCV test is performed at the same time as EMG.

What is meralgia paresthetica?

Meralgia paresthetica, is a type of specific femoral nerve dysfunction that impacts your lateral femoral cutaneous nerve. This particular branch of the femoral nerve gives feeling and sensation to your thigh’s skin.

Treatment Options for Femoral Nerve pain:

The treatment options depend on the underlying cause of femoral nerve pain. The two widely used treatment options include medications and physical therapy.

1. Medications:

Medications for femoral nerve pain include corticosteroid injections to reduce swelling and inflammation in your leg. Painful and uncomfortable symptoms can be relieved by prescribed or over-the-counter pain medications.

In a few cases, healthcare providers may recommend a nerve block, a local anaesthetic to reduce femoral nerve pain by “turning off” or “interrupting” the pain signals that pass through the femoral nerve.

2. Physical therapy for femoral nerve pain:

Physical therapy exercises help strengthen your leg muscles again, reduce pain, and improve mobility. Some common physical therapy exercises include kneeling hip flexor stretch, hip rotation, and hip abduction. Your physical therapist also recommends you wear a knee brace to aid you in walking and preventing knee buckling.

3. Surgery:

If the cause of femoral nerve pain is a tumour or growth, surgery might be recommended to relieve pressure on the nerve. Femoral decompression is also performed to reduce compression on the femoral nerve and improve the flow of blood to the upper thigh [5].

It generally takes several months to fully recover from femoral nerve pain. Six months are required to experience full resolution.

4. Prolozone Therapy:

Prolozone Therapy is a natural injection that helps to address the root cause of femoral nerve pain. More information can be found on the Prolozone page of this website located on the home page.

Possible Complications:

If left untreated, femoral nerve pain may lead to permanent damage or death of the femoral nerve. Sustained injuries are another option in people with femoral nerve pain that may go unnoticed due to loss of sensation. The risk of falls is another complication due to muscle weakness.

Preventing Femoral Nerve pain:

Modifying the following lifestyle habits may also reduce the symptoms of femoral neuropathy:

  • Losing weight if obesity or diabetes mellitus contribute to femoral nerve pain
  • Keeping your blood sugar in control.
  • Avoiding sitting for extended periods to reduce pressure on the femoral nerve
  • Avoiding tight clothing
  • Exercising regularly to strengthen leg muscles

The Bottom Line:

Femoral nerve pain is a disorder characterised by damage to the femoral nerve, resulting in pain, weakness, numbness, and paralysis of the legs. Femoral neuropathy can occur as a result of surgical procedures, direct injury, or any health conditions like diabetes mellitus. Treating femoral neuropathy and adopting certain lifestyle modifications is essential to prevent you from any complications.

References

  1. Ganu S, Mehta Y. Femoral compressive neuropathy from iliopsoas haematoma complicating dengue hemorrhagic fever. Asian Pac J Trop Med 2013;6:419–20. https://doi.org/https://doi.org/10.1016/S1995-7645(13)60052-8.
  2. Campbell, A. A., Eckhauser, F. E., Belzberg, A., & Campbell, J. N. (2010). Obturator nerve transfer as an option for femoral nerve repair: case report. Neurosurgery66(6 Suppl Operative), 375. https://doi.org/10.1227/01.NEU.0000369649.31232.B0
  3. Moore AE, Stringer MD. Iatrogenic femoral nerve injury: a systematic review. Surg Radiol Anat 2011;33:649–58. https://doi.org/10.1007/s00276-011-0791-0.
  4. Yi TI, Yoon TH, Kim JS, Lee GE, Kim BR. Femoral Neuropathy and Meralgia Paresthetica Secondary to an IliacusHematoma. Ann Rehabil Med 2012;36:273–7. https://doi.org/10.5535/arm.2012.36.2.273.
  5. Diabetic Neuropathy | NIDDK n.d. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies
  6. Minoo Hadjari Hollis. What are the signs and symptoms of femoral nerve entrapment? n.d. https://www.medscape.com/answers/2225774-32344/what-are-the-signs-and-symptoms-of-femoral-nerve-entrapment

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