Entrapment Neuropathies of The Lower Extremities

Meral Bayramoğlu

Entrapment Neuropathies of The Lower Extremities

Year 2017, Issue: 4, 185 - 191, 01.12.2017

Meral Bayramoğlu

Abstract

Peripheral nerves of the lower extremities might be compressed on their course where the anatomic configuration puts them in a vulnerable position. Neuropathic states can also be the result of any kind of trauma which directly injures the nerves or leads to a state of inflammation around the nerves. A wide variety of etiologies, as well as clinical presentations, may lead to diagnostic challenges for the clinician. The main symptom of a peripheral neuropathy is paresthesia. This could be accompanied by pain and numbness depending on the severity of the compression. The lumbosacral plexus, which arises from the ventral rami of the L1-S3 roots, serves the lower extremities. There are particular anatomic sites where the nerves are more vulnerable. A clear identification of the anatomic course, and motor and sensory distribution of each nerve arising from the lumbosacral plexus, is critical in localizing the injury and planning the optimal treatment. Electrodiagnostic studies help localize the site of the lesion, give a clue about the severity and potential recovery, and help differentiate any plexopathy and/or radiculopathy. Imaging studies, mostly magnetic imaging, can be ordered to help confirm the entrapment or exclude other pathologies. Most, but not all, of the cases can be treated by conservative measures. Common entrapments of the lower extremities, namely, meralgia paresthetica, femoral, obturator, sciatic, peroneal and tibial neuropathies will be discussed in this review

Keywords

neuropathy, lower extremity, entrapment

References

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9. Parsonnet V, Karasakalides A, Gielchinsky I, Hochberg M, Hussain SM. Meralgia paresthtetica after coronary bypass surgery. J Thorac Cardiovasc Surg 1991;101:219–21.
10. Abarbanel JM, Berginer VM, Osimani A, Solomom H, Charuzi I. Neurologic complications after gastric restriction surgery for morbid obesity. Neurology 1987;37:196–200.
11. Grace DM. Meralgia paresthetica after gastroplasty for morbid obesity. Can J Surg 1987;30:64–5.
12. Macgregor AM, Thoburn EK. Meralgia paresthetica following bariatric surgery. Obes Surg 1999;9:364–8. doi: 10.1381/096089299765552945
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ALT EKSTREMİTELERİN TUZAK NÖROPATİLERİ

Year 2017, Issue: 4, 185 - 191, 01.12.2017

Meral Bayramoğlu

Abstract

Alt ekstremite periferik sinirleri, traseleri boyunca anatomik olarak duyarlı bulundukları bölgelerde sıkışabilir. Siniri direkt olarak etkileyen herhangi bir travma veya sinir çevresindeki bir inflamatuar durum da nöropatiye neden olabilir. Hem etyolojinin, hem de klinik semptom ve bulguların çok çeşitli olabilmesi, klinisyenin tanıda zorluklarla karşılaşmasına neden olabilir. Bir periferik nöropatinin ana semptomu parestezidir; buna sıkışma şiddetinin derecesine bağlı olarak ağrı ve hissizlik eşlik edebilir. Alt ekstremitelerin innervasyonu L1-S3 köklerinin anterior ramuslarından oluşan lumbosakral pleksus tarafından sağlanır. Sinirlerin zedelenmeye daha duyarlı olduğu belirli anatomik bölgeler vardır. Hasar bölgesini saptamak ve uygun tedaviyi planlamak için lumbosakral pleksustan çıkan her sinirin motor ve duyu dağılımının net olarak ayırt edilmesi önemlidir. Lezyon bölgesinin saptanması, lezyonun şiddeti ve iyileşme potansiyeli ile ilgili ipuçları vermesi, pleksopati/radikülopati ayrımının yapılabilmesi açısından elektrodiagnostik çalışmalar oldukça faydalıdır. Görüntüleme yöntemlerinden özellikle manyetik rezonans görüntüleme, tuzak nöropatisi tanısının desteklenmesi veya diğer patolojilerin ekarte edilmesi için istenebilir. Tuzak nöropatilerin hepsi değilse de çoğu konservatif olarak tedavi edilebilmektedir. Bu derlemede alt ekstremitelerde sıkça görülen nöropatiler olan meralgia parestetika, femoral, obturator, siyatik, peroneal ve tibial nöropatilerden bahsedilecektir

Keywords

Nöropati, alt ekstremite, tuzak

References

1. Harney D, Patijn J. Meralgia paresthetica: diagnosis and management strategies. Pain Med 2007;8:669–77. doi: 10.1111/j.1526-4637.2006.00227.x
2. Grossman MG, Ducey SA, Nadler SS, Levy AS. Meralgia paresthetica: diagnosis and treatment. J Am Acad Orthop Surg 2001;9:336–44.
3. Boyce JR. Meralgia paresthetica and tight trousers. JAMA 1984;251:1553.
4. Moucharafieh R, Wehbe J, Maalouf G. Meralgia paresthetica: a result of tight new trendy low cut trousers (‘taille basse’). Int J Surg 2008;6:164–8. doi: 10.1016/j.ijsu.2007.04.003
5. Shapiro BE, Preston DC. Entrapment and compressive neuropathies. Med Clin North Am 2009;93:285–315. doi: 10.1016/j.mcna.2008.09.009
6. Yamout B, Tayyim A, Farhat W. Meralgia paresthetica as a complication of laparoscopic cholecystectomy. Clin Neurol Neurosurg 1994;96:143–4.
7. Hutchins FL Jr, Huggins J, Delaney ML. Laparoscopic myomectomy –an unusual cause of meralgia paresthetica. J Am Assoc Gynecol Laparosc 1998;5:309–11.
8. Antunes PE, Antunes MJ. Meralgia paresthetica after aortic valve surgery. J Heart Valve Dis 1997;6:589–90.
9. Parsonnet V, Karasakalides A, Gielchinsky I, Hochberg M, Hussain SM. Meralgia paresthtetica after coronary bypass surgery. J Thorac Cardiovasc Surg 1991;101:219–21.
10. Abarbanel JM, Berginer VM, Osimani A, Solomom H, Charuzi I. Neurologic complications after gastric restriction surgery for morbid obesity. Neurology 1987;37:196–200.
11. Grace DM. Meralgia paresthetica after gastroplasty for morbid obesity. Can J Surg 1987;30:64–5.
12. Macgregor AM, Thoburn EK. Meralgia paresthetica following bariatric surgery. Obes Surg 1999;9:364–8. doi: 10.1381/096089299765552945
13. Seid AS, Amos E. Entrapment neuropathy in laparoscopic herniorraphy. Surg Endosc 1994;8:1050–3.
14. Sampath P, Yeo CJ, Capmbell JN. Nerve injury associated with laparoscopic inguinal herniorraphy. Surgery 1995;118:829–33.
15. Aszmann OC, Dellon ES, Dellon AL. Anatomical course of the lateral femoral cutaneous nerve and its susceptibility to compression and injury. Plast Reconstr Surg 1997;100:600–4.
16. Williams PH, Trzil KP. Management of meralgia paresthetica. J Neurosurg 1991;74:76–80. doi: 10.3171/jns.1991.74.1.0076
17. Dibenedetto LM, Lei Q, Gilroy AM, Hermey DC, Marks SC Jr, Page DW. Variations in the inferior pelvic pathway of the lateral femoral cutaneous nerve: implications for laparoscopic hernia repair. Clin Anat 1996;9:232– 6. doi: 10.1002/(SICI)1098-2353(1996)9:43.0.CO;2-G 18. Sürücü HS, Tanyeli E, Sargon MF, Karahan ST. An anatomic study of the lateral femoral cutaneous nerve. Surg Radiol Anat 1997;19:307–10.
19. Dias Filho LC, Valença MM, Guimarães Filho FA, Medeiros RC, Silva RA, Morais MG, et al. Lateral femoral cutaneous neuralgia: an anatomical insight. Clin Anat 2003;16:309–16. doi: 10.1002/ca.10106
20. Grothaus MC, Holt M, Mekhail AO, Ebraheim NA, Yeasting RA. Lateral femoral cutaneous nerve: an anatomic study. Clin Orthop Relat Res 2005;(437):164–8.
21. Ropars M, Morandi X, Huten D, Thomazeau H, Berton E, Darnault P. Anatomical study of the lateral femoral cutaneous nerve with special reference to minimally invasive anterior approach for total hip replacement. Surg Radiol Anat 2009;31:199–204. doi: 10.1007/ s00276-008-0433-3
22. Massey EW. Sensory mononeuropathies. Semin Neurol 1998;18:177–83. doi: 10.1055/s-2008-1040871
23. Puig L, Alegre M, de Moragas JM. Treatment of meralgia paraesthetica with topical capsaicin. Dermatology 1995;191:73–4.
24. Hurdle MF, Weingarten TN, Crisostomo RA, Psimos C, Smith J. Ultrasoundguided blockade of the lateral femoral cutaneous nerve: technical description and review of 10 cases. Arch Phys Med Rehabil 2007;88:1362– 4. doi: 10.1016/j.apmr.2007.07.013
25. Kim DH, Murovic JA, Tiel RL, Kline DG. Intrapelvic and thigh level femoral nerve lesions: management and outcomes in 119 surgically treated cases. J Neurosurg 2004;100:989–96. doi: 10.3171/jns.2004.100.6.0989
26. Lange B, Langer C, Markus PM, Becker H. Paralysis of the femoral nerve following totally extraperitoneal laparoscopic inguinal hernia repair. Surg Endosc 2003;17:1157. doi: 10.1007/s00464-002-4270-x
27. Naroji S, Belin LJ, Maltenfort MG, Vaccaro AR, Schwartz D, Harrop JS, et al. Vulnerability of the femoral nerve during complex anterior and posterior spinal surgery. J Spinal Cord Med 2009;32:432–5.
28. Papastefanou SL, Stevens K, Mullholland RC. Femoral nerve palsy. An unusual complication of anterior lumbar interbody fusion. Spine (Phila Pa 1976) 1994;19:2842–4.
29. Boontje AH, Haaxma R. Femoral neuropathy as a complication of aortic surgery. J Cardiovasc Surg (Torino) 1987;28:286–9.
30. Gruson KI, Moed BR. Injury of the femoral nerve associated with acetabular fracture. J Bone Joint Surg Am 2003;85-A:428–31.
31. Laurent LE. Femoral nerve compression syndrome with paresis of the quadriceps muscle caused by radiotherapy for malignant tumors. A report of four cases. Acta Orthop Scand 1975;46:804–8.
32. Baxi A, Kaushal M, Kadi P, Baxi DA. Femoral Neuropathy: A curse of vaginal hysterectomy. Journal of Gynecologic Surgery 2010;26:171–4. doi: 10.1089=gyn.2009.0056
33. Bohrer JC, Walters MD, Park A, Polston D, Barber MD. Pelvic nerve injury following gynecologic surgery: A prospective cohort study. Am J Obstet Gynocol 2009;201:531–7. doi: 10.1016/j.ajog.2009.07.023
34. Tosun A, İnal E, Keleş I, Tulmaç M, Tosun Ö, Aydın G, et al. Conservative treatment of femoral neuropathy following retroperitoneal hemorrhage: a case report and review of the literature. Blood Coagul Fibrinolysis 2014;25:769–72. doi: 10.1097/MBC.0000000000000110
35. Ducic I, Delton L, Larson EE. Treatment concepts for idiopathic and iatrogenic femoral nerve mononeuropathy. Ann Plast Surg 2005;55:397–401.
36. Mingo-Robinet J, Castaneda-Cabrero C, Alvares V, Alonso-Cortes JML, Monge-Casres E. Tourniquet-related iatrogenic femoral nerve palsy after knee surgery: Case report and review of the literature. Case Reports in Orthopedics 2013;1–4. doi: 10.1155/2013/368290
37. Narouze ZN, Zakari A, Vydyanathan A. Ultrasound-guided placement of permanent percutaneous femoral nerve stimulator leads for the treatment of intractable femoral neuropathy. Pain Physician 2009;12:E305–8.
38. Garvin KL, Backstein D, Pellegrini VD Jr, Kim RH, Lewallen DG. Dealing with complications. J Bone Joint Surg Am 2009;91 Suppl 5:18–21. doi: 10.2106/JBJS.I.00347
39. Parmer SS, Carpenter JP, Fairman RM, Velazquez OC, Mitchell ME. Femoral neuropathy following retroperitoneal hemorrhage: case series and review of the literature. Ann Vasc Surg 2006;20:536–40. doi: 10.1007/ s10016-006-9059-2
40. Mochida H, Kikuchi S. Injury to infrapatellar branch of saphenous nerve in arthroscopic knee surgery. Clin Orthop Relat Res 1995;(320):88–94.
41. Tennent TD, Birch NC, Holmes MJ, Birch R, Goddard NJ. Knee pain and the infrapatellar branch of the saphenous nerve. J R Soc Med 1998;91:573–5.
42. Bertram C, Porsch M, Hackenbroch MH, Terhaag D. Saphenous neuralgia after arthroscopically assisted anterior cruciate ligament reconstruction with a semitendinosus and gracilis tendon graft. Arthroscopy 2000;16:763–6. doi: 10.1053/jars.2000.4820
43. Lippitt AB. Neuropathy of the saphenous nerve as a cause of knee pain. Bull Hosp Jt Dis 1993;52:31–3.
44. Schwartzman RJ, Maleki J. Postinjury neuropathic pain syndromes. Med Clin North Am 1999;83:597–626.
45. Pendergrass PT, Moore JH. Saphenous neuropathy following medial knee trauma. J Orthop Sports Phys Ther 2004;34:328–34. doi: 10.2519/ jospt.2004.1269
46. Busis NA. Femoral and obturator neuropathies. Neurol Clin 1999;17:633–53.
47. Bradshaw C, McCrory P, Bell S, Brukner P. Obturator neuropathy: a cause of chronic groin pain in athletes. Am J Sports Med 1997;25:402–8. doi: 10.1177/036354659702500322
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Primary Language	English
Journal Section	Collection
Authors	Meral Bayramoğlu
Publication Date	December 1, 2017
Published in Issue	Year 2017Issue: 4

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EndNote	Bayramoğlu M (December 1, 2017) Entrapment Neuropathies of The Lower Extremities. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 4 185–191.

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