Femoral Mononeuropathy Clinical Presentation

  • Author: Wayne E Anderson, DO; Chief Editor: Nicholas Lorenzo, MD   more...
 
Updated: Jan 12, 2012
 

History

Patients with femoral neuropathy complain of difficulty with stairs and frequent falling secondary to "knee buckling." This weakness is typically of acute or subacute onset. This contrasts with a myopathic process in which the weakness is subacute to chronic in onset and bilateral in nature.

Acute, severe pain in the groin, thigh, and/or lower abdomen may occur if the neuropathy is associated with a retroperitoneal hematoma.[14] Otherwise, the associated pain is usually mild and located near the inguinal ligament.

Patients may complain of medial leg and calf numbness. Sensory symptoms in saphenous nerve distribution are rare with injury to the main trunk of the femoral nerve.

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Physical Examination

Weakness of the quadriceps muscle and decreased patellar reflex are the most striking examination findings. If the neuropathy is advanced and chronic, wasting of the quadriceps may be noted. If a retroperitoneal hematoma is present, hip extension may cause pain.

In some patients, the iliopsoas muscle is involved. In such cases, the lesion must be above the inguinal ligament, as the motor branch to this muscle comes off before the inguinal ligament.

In isolated femoral neuropathies, the thigh adductors are normal. Although the thigh adductors share common lumbar roots with the muscles innervated by the femoral nerve, they are innervated by the obturator nerve along with the sciatic nerve and therefore are spared. Sensory deficits consist of numbness of the medial thigh and the anteromedial calf.

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Contributor Information and Disclosures
Author

Wayne E Anderson, DO  Assistant Professor of Internal Medicine/Neurology, College of Osteopathic Medicine of the Pacific Western University of Health Sciences; Clinical Faculty in Family Medicine, Touro University College of Osteopathic Medicine; Clinical Instructor, Departments of Neurology and Pain Management, California Pacific Medical Center

Wayne E Anderson, DO is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Society of Law, Medicine & Ethics, California Medical Association, and San Francisco Medical Society

Disclosure: Cephalon Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; King Honoraria Speaking and teaching; Forest Honoraria Speaking and teaching

Chief Editor

Nicholas Lorenzo, MD  Consulting Staff, Neurology Specialists and Consultants

Nicholas Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and American College of Physician Executives

Disclosure: Nothing to disclose.

Additional Contributors

Neil A Busis, MD Chief, Division of Neurology, Department of Medicine, Head, Clinical Neurophysiology Laboratory, University of Pittsburgh Medical Center-Shadyside

Neil A Busis, MD is a member of the following medical societies: American Academy of Neurology and American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Elizabeth A Sekul , MD Associate Professor of Pediatrics and Neurology, Medical College of Georgia

Elizabeth A Sekul, MD is a member of the following medical societies: American Academy of Neurology; American Association of Neuromuscular and Electrodiagnostic Medicine; and Child Neurology Society

Disclosure: Nothing to disclose.

Aashit K Shah, MD Associate Professor of Neurology, Wayne State University; Program Director, Clinical Neurophysiology Fellowship, Department of Neurology, Detroit Medical Center

Aashit K Shah, MD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, and American Epilepsy Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

References

  1. Phang IS, Biant LC, Jones TS. Neurostenalgia of the femoral nerve: a treatable cause of intractable hip pain in a young adult. J Arthroplasty. Apr 2010;25(3):498.e15-7. [Medline].

  2. Olesen LL. Femoral neuropathy secondary to anticoagulation. J Intern Med. Oct 1989;226(4):279-80. [Medline].

  3. Colak M, Canbaz H, Ayan I, Karabacak T, Kuyurtar F. Intrapelvic mass causing femoral compression neuropathy in a patient with Gaucher disease: a case report. Eklem Hastalik Cerrahisi. 2009;20(3):169-73. [Medline].

  4. al Hakim M, Katirji B. Femoral mononeuropathy induced by the lithotomy position: a report of 5 cases with a review of literature. Muscle Nerve. Sep 1993;16(9):891-5. [Medline].

  5. Peirce C, O'Brien C, O'Herlihy C. Postpartum femoral neuropathy following spontaneous vaginal delivery. J Obstet Gynaecol. Feb 2010;30(2):203-4. [Medline].

  6. Wong CA. Nerve injuries after neuraxial anaesthesia and their medicolegal implications. Best Pract Res Clin Obstet Gynaecol. Jan 4 2010;[Medline].

  7. Kurt S, Kaplan Y, Karaer H, Erkorkmaz U. Femoral nerve involvement in diabetics. Eur J Neurol. Mar 2009;16(3):375-9. [Medline].

  8. Krendel DA, Zacharias A, Younger DS. Autoimmune diabetic neuropathy. Neurol Clin. Nov 1997;15(4):959-71. [Medline].

  9. Llewelyn JG, Thomas PK, King RH. Epineurial microvasculitis in proximal diabetic neuropathy. J Neurol. Mar 1998;245(3):159-65. [Medline].

  10. Collins MP, Periquet-Collins I. Nonsystemic vasculitic neuropathy: update on diagnosis, classification, pathogenesis, and treatment. Front Neurol Neurosci. 2009;26:26-66. [Medline].

  11. 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(4):432-5. [Medline].

  12. Azuelos A, Coro L, Alexandre A. Femoral nerve entrapment. Acta Neurochir Suppl. 2005;92:61-2. [Medline].

  13. Farrell CM, Springer BD, Haidukewych GJ, Morrey BF. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am. Dec 2005;87(12):2619-25. [Medline].

  14. 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. Jul 2006;20(4):536-40. [Medline].

 
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