Femoral Mononeuropathy Treatment & Management

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

Approach Considerations

Treatment is dependent on the etiology of the lesion. As previously stated, most patients with a femoral mononeuropathy can be treated conservatively with physical therapy, avoidance of excessive hip abduction and external rotation, and knee bracing to prevent buckling of the knee. In cases of painful femoral neuropathy, neuropathic pain medications may provide benefit.

In patients with femoral neuropathy associated with positional compression or retraction compression during surgery or delivery, recovery typically occurs over 3-4 months.

When the cause of the neuropathy is a retroperitoneal hematoma, evacuation of the hematoma may be indicated, but this is controversial.[14] In patients on anticoagulation therapy, anticoagulant agents must be stopped until the hematoma has resolved. Outcomes for these patients are worse than for those with a hematoma due to trauma.

If the compression is due to a tumor, then therapy, either surgery or chemotherapy, is directed at the neoplasm. When the neuropathy is due to diabetes or vasculitic causes, immunosuppressive therapy may be warranted.[10]

Surgical decompression

Surgical decompression of the nerve sometimes is performed for neuropathies resulting from hematomas or mass lesions. Femoral decompression is indicated in cases of intractable pain associated with femoral nerve compression.[1] Occasionally, surgical exploration for other reasons (eg, penetrating wounds, fascia bands) is indicated.

Consultations

Consultation with an electrodiagnostic laboratory (EMG/nerve conduction velocity [NCV] studies) may help to determine the location, severity, and potential permanency of the lesion.

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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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