Femoral Mononeuropathy Treatment & Management
- Author: Wayne E Anderson, DO, FAHS, FAAN; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE more...
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. 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.
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. Occasionally, surgical exploration for other reasons (eg, penetrating wounds, fascia bands) is indicated.
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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