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Postpartum femoral neuropathy has a reported incidence of less than 1% and its total recovery time extends up to 6 months to a year. A multidisciplinary approach is vital to rule out permanent disability and to assure a correct diagnosis and earlier rehabilitation. We report a case of a 37‐year‐old puerperal woman with a history of intrapartum epidural analgesia, who presented post‐labor unilateral lower‐limb motor weakness and sensory loss, with functional compromise on independent gait. A multidisciplinary team consisting of an anesthesiologist, a physiatrist, a neurologist, and an obstetrician was then established. In the initial physiatry and neurology assessment, the patient reported pain (numerical rating scale 7/10) over the inguinal ligament, lower limb hypoesthesia, and muscle weakness. Femoral neuropathy was suspected. Magnetic resonance imaging ruled out potential complications related to the anesthetic procedure. The patient was then enrolled in a supervised rehabilitation program and, 3 weeks later, electrodiagnostic studies confirmed the initial suspicion. Two months later, the patient had regained lower‐limb active range of motion and no pain nor paresthesia was reported. Our case report describes how an early multimodal rehabilitation program within a multidisciplinary framework allows for sooner neuromotor function improvement and activities of daily living independence. Synopsis: Postpartum femoral neuropathy total recovery time extends up to 6 months. A timely rehabilitation program within a multidisciplinary framework has shown earlier neuromotor function improvement. [ABSTRACT FROM AUTHOR]

Objective: To determine the normal values of the newly described distal stimulated medial femoral cutaneous (MFC) nerve conduction study in a healthy population using a wide range of ages and body mass index (BMI) values. Materials and Methods: Distal stimulated MFC nerve conduction studies were performed bilaterally in 144 healthy volunteers with no peripheral nerve diseases affecting the lower extremities according to clinical and electrophysiological evaluations. The volunteers were divided into three groups according to their age: 18–39.9 years (age 1), 40–59.9 years (age 2), and 60 years and above (age 3). They were also grouped according to their BMI: 24.9 or less (BMI 1), 25–29.9 (BMI 2), and 30 or more (BMI 3). Results: The mean MFC amplitude was 5.7 μV on both sides, the mean peak latency was 2.8 ms on both sides, and the mean conduction velocity was 61.5 m/s on the right and 61.9 m/s on the left. The MFC amplitudes obtained on the right and left sides were similar, and the mean amplitude difference between sides was 10.1 +- 9.1% (0–56.6). A negative correlation was identified between MFC amplitude and age and BMI. Conclusion: This study revealed that the newly described distal stimulated MFC sensory nerve conduction study is repeatable and easily applicable.

Objective: To determine the normal values of the newly described distal stimulated medial femoral cutaneous (MFC) nerve conduction study in a healthy population using a wide range of ages and body mass index (BMI) values. Materials and Methods: Distal stimulated MFC nerve conduction studies were performed bilaterally in 144 healthy volunteers with no peripheral nerve diseases affecting the lower extremities according to clinical and electrophysiological evaluations. The volunteers were divided into three groups according to their age: 18-39.9 years (age 1), 40-59.9 years (age 2), and 60 years and above (age 3). They were also grouped according to their BMI: 24.9 or less (BMI 1), 25-29.9 (BMI 2), and 30 or more (BMI 3). Results: The mean MFC amplitude was 5.7 pV on both sides, the mean peak latency was 2.8 ms on both sides, and the mean conduction velocity was 61.5 m/s on the right and 61.9 m/s on the left. The MFC amplitudes obtained on the right and left sides were similar, and the mean amplitude difference between sides was 10.1 ± 9.1% (0-56.6). A negative correlation was identified between MFC amplitude and age and BMI. Conclusion: This study revealed that the newly described distal stimulated MFC sensory nerve conduction study is repeatable and easily applicable. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to determine the incidence of femoral neuropathy in patients with haemophilia exhibiting iliopsoas haemorrhage. Methods: Patients with iliopsoas haemorrhage confirmed by ultrasonography or CT scan were studied retrospectively. Results: A total of 44 episodes of iliopsoas haemorrhage occurred in 20 patients with haemophilia (A17, B3). Most episodes in patients without inhibitors (14/16 = 87.5%) were adequately treated followed by prophylaxis. However, 11 of 28 episodes (39.3%) in patients with inhibitors were adequately treated and no prophylaxis was provided. An appropriate rehabilitation programme was arranged during hospitalisation and follow-up. Femoral neuropathy was observed in 28 of 44 episodes, while 16 episodes of persistent femoral neuropathy from previous bleeding were excluded. As a result, 11 of 28 episodes (39.3%) of femoral neuropathy were similarly found amongst patients with and without inhibitors. The mean time of onset and resolution of femoral neuropathy were 3.7 (1.8) and 23.4 (20.5) days after the onset of iliopsoas haemorrhage, respectively. Patients receiving inadequate and delayed replacement had a significantly higher rate of femoral neuropathy than those who received adequate and prompt replacement. Conclusion: Femoral neuropathy following iliopsoas haemorrhage was common in haemophilia patients with and without inhibitors. [ABSTRACT FROM AUTHOR]

Purpose: As a first step towards developing a core outcome set (COS) for lateral femoral cutaneous neuropathy, the goal of the current study was to perform a systematic review of the literature to identify outcome measures that have been previously reported in studies on lateral femoral cutaneous neuropathy., Methods: A systematic review of the literature from 2000-2024 was performed utilizing PubMed and Medical Subject Headings (MeSH). Identified articles were screened according to study inclusion/exclusion criteria. Outcome measures reported in each included study were recorded and categorized into motor, sensory, pain, patient-reported outcomes, psychological, electrodiagnostic outcomes, imaging outcomes, and other outcomes. Descriptive statistics were performed., Results: A total of 80 articles were initially identified, and 10 articles met criteria for inclusion and underwent analysis. The most common outcome domain was patient-reported outcomes, which were reported in 7 (70%) studies. However, the specific patient-reported outcomes were very heterogeneous. A pain outcome was reported in 6 (60%) studies. Motor, psychological, imaging, and electrodiagnostic outcomes were not reported in any study. Across the included studies, 14 unique outcomes were reported., Conclusions: We have identified the outcome measures that have previously been utilized in studies on lateral femoral cutaneous neuropathy. Patient-reported and pain outcomes were most commonly used across the included studies., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

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BACKGROUND: The extreme lateral interbody fusion approach (XLIF) is a surgical technique introduced two decades ago for spinal fusions. However, little has been published on the particular complications associated with this surgical technique and the rehabilitation. The purpose of this report is to describe a case of post-operative complication of retroperitoneal hematoma following XLIF with subsequent femoral neuropathy and the physical therapy intervention approach applying the repetitions in reserve (RIR) concept. CASE PRESENTATION: A 60-year-old female presented with severe right hip flexor and quadriceps weakness from a retroperitoneal hematoma following a right-sided XLIF procedure for severe right L4-5 radiculopathy. Post-surgical physical therapy treatment and 6-month outcomes are described. OUTCOME AND FOLLOW-UP: By postoperative week 12, the patient obtained a knee brace that eliminated her falls due to quadriceps weakness. At 6 months post-operatively, she demonstrated significantly improved quadriceps and hip flexor strength (from 1/5 and 2+/5, respectively, to 3+/5), and improved lower extremity functional scale score, from 30 to 58. She was also able to complete a 6-minute walk test and ambulated 128 m. DISCUSSION: Significant improvement in motor function and functional outcomes was noted by post-operative month six. The role of physical therapy was to focus on the timing of muscle reactivation using electrical stimulation and progressive resistance exercises using the RIR concept as nerve function returned. [ABSTRACT FROM AUTHOR]

Abstract Background Although life-threatening complications of extracorporeal membrane oxygenation (ECMO) are well described, non-life threatening complications are less known. Herein, we report a case of femoral neuropathy (FN) due to nerve compression caused by cannula compression and deep vein thrombosis (DVT) after successful ECMO therapy, which seriously undermined one’s quality of life. Case presentation A 70-year old male presented to the emergency department for chest pain. The patient had cardiac arrest before percutaneous coronary intervention (PCI) and was inserted with ECMO. Although he was successfully weaned from ECMO 4 days after PCI, he consistently complained swelling, abnormal sensation, and weakness in his right lower extremity, where the cannulas were inserted. Imaging studies showed deep vein thrombosis (DVT) in his right leg, which was further treated with anticoagulants. Symptoms, however, remained after the regression of DVT. Nerve conduction study revealed femoral neuropathy, which may have been caused by ECMO cannula compression and tissue swelling. Conclusion The current case proposes that non-life threatening complications of ECMO therapy can seriously affect quality of life. Venous drainage distant from the arterial cannula may prevent such complications.

Introduction: The purpose of this study was to evaluate YouTube videos on meralgia paresthetica (MP) for reliability, quality, and differences between quality levels., Methods: We analyzed 59 videos related to MP. We evaluated several video characteristics, including views, likes, dislikes, duration, and speaker profile. We used view ratio, like ratio, Video Power Index (VPI), Global Quality Scale (GQS), JAMA criteria, and modified DISCERN (mDISCERN) to assess viewer engagement, popularity, educational quality, and reliability., Results: The videos received a total of 4,009,141 views (average 67,951.54), with 25.4% focused on exercise training and 23.7% focused on disease information. Mean scores were mDISCERN 2.4, GQS 2.8, and JAMA 2.1. Physician-led videos had higher mDISCERN scores, while allied health worker-led videos had more views, likes, dislikes, view ratios, and VPI. Poor and high-quality videos differed in views, likes, view ratio, VPI, and duration. Positive correlations existed among mDISCERN, JAMA, and GQS scores, with video duration positively correlated with GQS., Conclusion: The content of YouTube videos discussing diseases significantly influences viewer engagement and popularity. To enhance the availability of valuable content on YouTube, which lacks a peer review process, medical professionals must contribute high-quality educational materials tailored to their target audience., (© 2024. The Author(s) under exclusive licence to Belgian Neurological Society.)

Contemporary management of iatrogenic pseudoaneurysms is mostly performed using non-surgical techniques. Herein, we present a rare case of deep femoral artery (DFA) pseudoaneurysm with compression neuropathy, which required open repair. A 67-year-old female patient presented with increasing pain in the right groin, sensory neuropathy of the anteromedial thigh and upper leg, and quadriceps paralysis 4 days after coronary angiography via femoral puncture. Computed tomography angiography revealed a pseudoaneurysm of the DFA. The disabling compressive neuropathy warranted urgent open decompression rather than thrombin injection or endovascular therapy. Timely open evacuation of the hematoma, release of compression on the femoral nerve, and postoperative physiotherapy resulted in complete recovery of quadriceps power. The patient was pain free within 12 weeks and able to ambulate independently. This case report highlights the role of prompt open surgery for pseudoaneurysms with compression neuropathy.

Background: Anterior cruciate ligament (ACL) reconstruction is commonly associated with moderate-to-severe postoperative pain. Notably, various pain control strategies, a femoral nerve block (FNB) with a lateral femoral cutaneous nerve block (LFCNB), adductor canal block (ACB) with LFCNB, or periarticular cocktail injection (PI), have been investigated. However, no studies compare the effects of FNB with LFCNB, ACB with LFCNB, and PI for pain control after ACL reconstruction. This study aimed to evaluate the impact of FNB with LFCNB, ACB with LFCNB, and PI for pain relief in the early postoperative period after ACL reconstruction., Methods: This retrospective controlled clinical trial enrolled 299 patients who underwent primary ACL reconstruction at our hospital between April 2016 and October 2022. We categorized these cases into groups based on the use of PI (PI group), FNB with LFCNB (FNB group), and ACB with LFCNB (ACB group) for pain management. We selected 40 cases each, with matched age, sex, and body mass index (BMI) from each group, resulting in 120 cases for analysis. In the FNB and ACB groups, 0.75% ropivacaine 15 ml was injected under ultrasound guidance preoperatively. In the PI group, a mixture of 0.75% ropivacaine 20 ml, normal saline 20 ml, and dexamethasone 6.6 mg was injected half at the start of surgery and the rest just before wound closure. Patient demographics (age, sex, height, body weight, and BMI) and surgical data (the requirement for meniscal repair, operative time, and tourniquet inflation time) were analyzed. After ACL reconstruction, patients' numerical rating scale pain scores (NRS) (0-10) were recorded at 30 min and 4, 8, 12, 24, 48, and 72 h postoperatively. NRS were then compared among the three groups using analysis of variance. In addition, within each group, these data were compared between the NRS ≥7 and NRS ≤6 groups using a t -test., Results: There were no significant differences in patient demographics and surgical data. Pain scores were significantly higher in the PI group than in the FCB and ACB groups 30 min postoperatively, but they were lower at 12, 24, 48, and 72 h postoperatively. In the FNB group, there were no significant differences in the demographic and surgical data by NRS pain score. In the ACB group, the number of men was significantly higher in the NRS ≥7 group than in the NRS ≤6 group (p = 0.015). In the PI group, tourniquet inflation time was significantly longer in the NRS ≥7 group than in the NRS ≤6 group (p = 0.008)., Conclusions: Following ACL reconstruction using a hamstring autograft, periarticular cocktail significantly reduced early postoperative pain compared with nerve block combinations., Competing Interests: The authors did not receive support from any organization for the submitted work. The authors have no conflicts of interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript., (© 2024 Asia Pacific Knee, Arthroscopy and Sports Medicine Society. Published by Elsevier (Singapore) Pte Ltd.)

Compressive femoral neuropathy is a disabling condition accompanied by difficulty in hip flexion and knee extension. It may result from retroperitoneal hematoma or bleeding, or from complications associated with pelvic, hip surgery, and renal transplants. A 55-year-old female with autosomal dominant polycystic kidney disease presented with proximal muscle weakness in lower extremities. The patient experienced recurrent renal cyst infection, with aggravated weakness during each event. Electromyography and nerve conduction study revealed bilateral femoral neuropathy. Computed tomography and magnetic resonance images were added to further identify the cause. As a result, a diagnosis of femoral neuropathy caused by enlarged polycystic kidney was made. Cyst infection was managed with antibiotics. Renal function was maintained by frequent regular hemodialysis. While avoiding activities that may increase abdominal pressure, rehabilitation exercises were provided. Motor strength in hip flexion and knee extension improved, and was confirmed via electrodiagnostic studies.

Warfarin is a widely used drug in patients with a high risk of thromboembolism in cardiovascular diseases. Serious complications can be encountered as a result of high side effect profile and narrow therapeutic window. Iliopsoas hematoma and secondary femoral neuropathy are among the complications that may be encountered. The patient was admitted to the hematology clinic because of warfarin intoxication. Paresis was observed in the right lower extremity during follow-up. Iliopsoas hematoma was detected in the imaging study and electrophysiological study revealed femoral nerve neuropathy. After the diagnosis, conservative treatment and rehabilitation program was initiated immediately. In this article, a case of femoral nerve neuropathy following iliopsoas hematoma due to warfarin intoxication was presented.

Hematomas in close compartments and in pelvic gutters are always challenging to treat and diagnose. A young female on apixaban for recently diagnosed pulmonary thromboembolism (PE) presented to us for the complaints of right sided lower limb weakness. Neurological examination was positive for the right femoral nerve distribution deficit. Computed tomography (CECT) showed large right sided iliopsoas hematoma. Anticoagulation was stopped and was given blood transfusions with which she improved without need of any surgical evacuation. We hereby aim to enrich the understanding of our readers regarding this topic with a review of our experience and other recent publications in medical literature. It is important for the internists to be aware of varied and atypical presentations of retroperitoneal hematoma (RPH) especially following surgical/orthopaedic procedures or in association with anticoagulants and antiplatelets. [ABSTRACT FROM AUTHOR]

Background: The Pavlik harness has been used for approximately a century to treat developmental dysplasia of the hip (DDH). Femoral nerve palsy is a documented complication of Pavlik harness use, with an incidence ranging from 2.5% to 11.2%. Rare reports of brachial plexus palsy have also been documented. The primary purpose of the current study was to evaluate the incidence of various nerve palsies in patients undergoing Pavlik harness treatment for DDH. Secondary aims were to identify patient demographic or hip characteristics associated with nerve palsy., Methods: We performed a retrospective review of patients diagnosed with DDH and treated with a Pavlik harness from February 1, 2016, to April 1, 2023, at a single tertiary care orthopaedic hospital. Hip laterality, use of a subsequent rigid abduction orthosis, birth order, breech positioning, weight, and family history were collected. The median (and interquartile range [IQR]) or mean (and standard deviation [SD]) were reported for all continuous variables. Independent 2-sample t tests and Mann-Whitney U tests were conducted to identify associations between the variables collected at the initiation of Pavlik harness treatment and the occurrence of nerve palsy., Results: Three hundred and fifty-one patients (547 hips) were included. Twenty-two cases of femoral nerve palsy (4% of all treated hips), 1 case of inferior gluteal nerve palsy (0.18%), and 2 cases of brachial plexus palsy (0.37%) were diagnosed. Patients with nerve palsy had more severe DDH as measured by the Graf classification (p < 0.001) and more severe DDH as measured on physical examination via the Barlow and Ortolani maneuvers (p = 0.003)., Conclusions: Nerve palsies were associated with more severe DDH at the initiation of Pavlik harness use. Upper and lower-extremity neurological status should be scrutinized at initiation and throughout treatment to assess for nerve palsies. The potential for femoral, gluteal, and brachial plexus palsies should be included in the discussion of risks at the beginning of treatment. Families may be reassured that nerve palsies associated with Pavlik harness can be expected to resolve with a short break from treatment., Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: No external funding was received for this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/H864)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Meralgia paresthetica (MP) is a disorder of lateral femoral cutaneous nerve mononeuropathy caused by entrapment or compression of the nerve. It is characterized by numbing, tingling, and burning pain in the lateral aspect of the thigh. The current treatments for MP include conventional medical management, peripheral nerve blocks, and surgical interventions. Some patients who suffer from MP can experience intractable pain and medical management of MP is often inadequate to provide satisfactory pain control. Although regional anesthesia provides excellent pain relief, the analgesic effects of peripheral nerve block are short-lived. Emerging evidence suggests that cryoneurolysis has a low-risk safety profile and can provide prolonged pain relief of superficial nerves when administered appropriately. We present a successful case of a patient with intractable neuropathic pain resulting from MP treated with cryoneurolysis therapy. The patient demonstrated immediate pain relief by 100% after the procedure followed by 80% and 60% pain reduction at 1-month and 3-months follow-up, respectively. Cryoneurolysis may be an alternative modality for patients who fail at conventional medical treatments of neuropathic pain., Competing Interests: Name: Lisa Pearson, DNAP, CRNA, NSPMc Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Victoria Schmelzer, MS, CRNA, NSPMc Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: John Maye, PhD, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Sarah Jingying Zhang, PhD, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. This author is the corresponding author for this article. Disclosures: None., (Copyright © by the American Association of Nurse Anesthetists.)

The femoral and obturator nerves both arise from the L2, L3, and L4 spinal nerve roots and descend into the pelvis before emerging in the lower limbs. The femoral nerve's primary function is knee extension and hip flexion, along with some sensory innervation to the leg. The obturator nerve's primary function is thigh adduction and sensory innervation to a small area of the medial thigh. Each may be injured by a variety of potential causes, many of them iatrogenic. Here, we review the anatomy of the femoral and obturator nerves and the clinical features and potential etiologies of femoral and obturator neuropathies. Their necessary investigations, including electrodiagnostic studies and imaging, their prognosis, and potential treatments, are discussed in this chapter., (Copyright © 2024 Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

The case exposes a lower left limb paresis within the cesarean section postoperative time, which was performed under subarachnoidal anesthesia. The reason for the cesarean section was the breech presentation. The pregnant patient, who suffered from gestational diabetes and overweight, presented a torpid postoperative due to a motor walking/standing deficiency, accompanied by left inguinal pain without apparent etiology. An MRI was performed to prevent possible complications, which discarded an epidural hematoma as well as an anesthetic complication over the lumbar roots. It only showed a wide soft tissue edema of considerable size, which was discarded as the cause of the neuropathy by the Radiology Service. Five days after discharge a 38,5°C fever and wound suppuration were added to the already existing clinic. She was diagnosed with celulitis, which required surgical drainage of the abscess. The intervetion provided pain relieved aluthough 3 weeks after she still presented a certain degree of difficulty when walking. Given the location of the femoral nerve near the cesarean incision zone (lower transversal abdominal section), it can be affected by surgical instruments and further complications (hematomas, abcesses). After the celulitis diagnose it was hypothesized that the femoral neuropathy had been an nervous irritation at the infrainguinal level. Other etiologies for an unilateral paresis in a puerpera could be: the pregnancy itself, the lithotomy position, the vasa nervorum ischemia or the retroperitoneal hematoma. (DOLOR. 2019;34:123-6) [ABSTRACT FROM AUTHOR]

Background: Peripheral neuropathy is a common complication of Lyme disease. Cranial mononeuropathy, particularly that affecting the facial nerve, can be a presenting symptom, and at times, it can be associated with polyradiculopathies or plexopathies. However, isolated femoral neuropathy has not yet been reported in Lyme disease; therefore, we felt the need to present this case. Case presentation: Laboratory investigations were performed on a 67-year-old man living in a region at high risk for Lyme disease after he developed erythema migrans on his chest, accompanied by the swelling of his left knee joint. A Western blot immunoglobulin assay was performed, including a screening for connective tissue disorders. Positive serological test results led to the administration of oral doxycycline therapy at a dosage of 100 mg twice daily. Shortly afterwards, he developed gait difficulties and frequent falls. The clinical examination and electrodiagnostic studies were consistent with femoral neuropathy. To look for etiologies other than Lyme disease, radiographic studies of his lumbar spine, pelvic cavity, retroperitoneal compartment, and hips were conducted. In addition, he was screened for diabetes. However, no other etiologies were found to explain the femoral neuropathy. Eventually, he recovered, and he was able to return to work. Conclusion: We firmly believe that the femoral neuropathy and Lyme disease seen in this patient were causally related. [ABSTRACT FROM AUTHOR]

Background and Purpose: Although femoral neuropathy is recognized as an adverse consequence following transfemoral neuroendovascular procedures, no reliable estimates are available. We analyzed data from a prospective registry to ascertain the frequency and characteristics of femoral neuropathy following transfemoral neuroendovascular procedures.Methods: Consecutive patients who underwent neuroendovascular procedures through the transfemoral route were included. Detailed assessment was performed if any patient reported occurrence of sensory or motor symptoms in the femoral or lower extremity region including neurological examination (sensory/motor deficits) and femoral region ultrasound.Results: Femoral neuropathy was diagnosed following 4 of 270 neurovascular procedures with an occurrence rate of 1.5% (95% confidence intervals = .4-3.7%). The symptoms were exclusively sensory without any motor involvement. The femoral neuropathy appeared to involve anterior femoral cutaneous nerves in all and medial cutaneous branches in 2 patients, and more than one nerve distribution in 1 patient in whom lateral cutaneous nerve appeared to be involved. All patients reported resolution of symptoms within a period ranging from 1 week to 2 months. No local hematoma or arterial pseudoaneurysm was identified at femoral region ultrasound.Conclusions: Femoral neuropathy is a rare occurrence following transfemoral neuroendovascular procedures and it usually occurs with pure sensory manifestations with complete resolution. [ABSTRACT FROM AUTHOR]

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Meralgia paresthetica is characterized by pain, paresthesia or burning sensation, and reduction of tactile and pain sensitivity in the anterolateral surface of the thigh. This disability is caused by a neuropathy of the lateral femoral cutaneous nerve (LFCN). Conservative treatment is often successful at relieving the symptoms in the majority of patients. We describe the case of a 44-year-old patient who presented with these symptoms caused by postoperative use of a surgical girdle after aesthetic surgery.

Objective: Adverse events of drug therapy Background: Femoral neuropathy as a result of retroperitoneal hemorrhage most commonly occurs following pelvic and lower extremity trauma, but has been described to develop as a less frequent complication of anticoagulation. Case Report: We present the case of a 64-year-old white woman who was being treated for pulmonary embolism and deep venous thrombosis with enoxaparin. In the course of her treatment, she was noted to be hypotensive, with a sudden drop in hematocrit. She had been previously ambulatory, but noted an inability to move her bilateral lower extremities. A diagnosis of bilateral femoral neuropathy as a result of psoas hematomas caused by enoxaparin was made. Anticoagulation was discontinued and she was treated conservatively, with an excellent outcome. At the time of discharge to a rehabilitation center, she had regained most of the motor strength in her lower extremities. Conclusions: We believe this is the first reported case of bilateral femoral nerve neuropathy following use of enoxaparin. A full neurological examination should always be performed when there is sudden loss of function. The constellation of bilateral groin pain, loss of lower extremity mobility, and decreased hematocrit raised the suspicion of massive blood loss into the cavity/compartment. Thus, a high index of suspicion should be maintained by clinicians when presented with such symptoms and signs, as there can be significant morbidity and mortality when prompt diagnosis is not made. [ABSTRACT FROM AUTHOR]

Warfarin is a widely used drug in patients with a high risk of thromboembolism in cardiovascular diseases. Serious complications can be encountered as a result of high side effect profile and narrow therapeutic window. Iliopsoas hematoma and secondary femoral neuropathy are among the complications that may be encountered. The patient was admitted to the hematology clinic because of warfarin intoxication. Paresis was observed in the right lower extremity during follow-up. Iliopsoas hematoma was detected in the imaging study and electrophysiological study revealed femoral nerve neuropathy. After the diagnosis, conservative treatment and rehabilitation program was initiated immediately. In this article, a case of femoral nerve neuropathy following iliopsoas hematoma due to warfarin intoxication was presented. [ABSTRACT FROM AUTHOR]

Femoral neuropathy associated with lower limb is treated by surgical intervention through activation/regeneration/ grafting of nerve fibers by a nerve cuff electrode implant or neuro-prosthesis. These procedures require detailed and precise knowledge of neuro-anatomical variants of the femoral nerve and its fascicular anatomy so that the nerve injury can be investigated and treated more efficiently. The aim of the study is to uncover the variations both in the femoral nerve and its branches, to classify them and to bring out corresponding fascicular anatomy using a hypothesis based on the principle of consistency, continuity and traceability of fascicles. The study was carried out in the Department of Anatomy AIIMS Rishikesh using 13 matched lower limbs (26 femoral nerves) from 13 cadavers. The femoral nerve was exposed in the femoral triangle and traced to the posterior abdominal wall. Variations in the shape, size and course of the femoral nerve and its branches were analyzed. The fascicular arrangement was also conceptualized based on the hypothesis. Seven classes, high division, trunk anomaly, semi-scattered, scattered branching pattern, pectocutaneous, lateral cutaneous nerve of thigh and nerve to sartorius anomalies were detected. The corresponding fascicular organizations were modeled. The seven classes along with corresponding fascicular pattern will be very useful for neurosurgeons, radiologists, anesthetists and anatomists in diagnosis and treatment of femoral neuropathy. [ABSTRACT FROM AUTHOR]

Os autores descrevem caso de paciente do sexo feminino, com 23 anos de idade, submetida à cirurgia do joelho para realinhamento patelar com uso de garrote pneumático e que desenvolveu neurapraxia femoral. Faz-se breve revisão da literatura sobre as vantagens e desvantagens do uso do garrote em cirurgias do joelho e discute-se a necessidade da sua indicação, considerando-se as complicações acarretadas por seu uso incorreto.The authors describe the case of a 27 year-old female patient submitted to knee surgery for patellar realignment with the use of a pneumatic tourniquet, who developed femoral neurapraxia. They make a brief literature review about the advantages and disadvantages of using a tourniquet in knee surgeries, and discuss the need for tourniquet indication considering the complications entailed by the incorrect use of the tourniquet.

The incidence of coronary heart disease is most prevalent among persons greater than 65 years of age (Fang et al., 2011). A cardiac catheterization is often required to confirm or evaluate the extent of the disease. Over 1 million inpatient cardiac catheterizations are performed annually in the United States, with approximately half of those patients needing a percutaneous cardiac intervention as a result of the catheterization findings. The use of larger catheters during this procedure may cause complications after removal of the catheter, and vascular access complications are a leading cause of morbidity, cost, and legal ramifications. One method to achieve hemostasis after a catheter is removed from the femoral artery is to mechanically close the puncture site with a femoral artery closure device (FACD) (Hamel, 2009). This case study describes how the complications of an FACD deployed after a coronary intervention created an impediment to progression of a geriatric patient's rehabilitation course. Opportunities to share lessons learned from this unexpected physiologic barrier are discussed, and consequences related to inadequate information at hand-off between institutions are described. [ABSTRACT FROM AUTHOR]

Femoral neuropathy has been reported with different conditions including hip replacement, obstetric and gynecological procedures, and abdominal and urological explorative laparatomies. Isolated lesions of the femoral nerve is rare; most cases of femoral neuropathy result from positioning or compression during abdominal or pelvic surgery. Femoral neuropathy can be seen as a consequence of hematoma formation from misguided femoral catheterizations. We report a 65 year old case with severe femoral neuropathy following diagnostic angiography caused by the sandbag placed on the groin for homeostasis. This condition should be kept on mind when a patient presents with difficulty in walking with a recent history of diagnostic catheterization. [ABSTRACT FROM AUTHOR]

Treatment of femoral neuropathy caused by iliacus hematoma can be divided according to operative treatment and non-operative treatment. Recently, percutaneous drainage has been more popular because it is relatively simple, convenient, and less invasive. After warfarin overuse, a 71-year-old male patient visited the emergency room with femoral neuropathy caused by a left iliacus muscle hematoma measuring approximately 110x64 mm, 75x60 mm in size on coronal and sagittal computed tomography angiograhy. Without trauma, weakness of the left hip flexor and left knee extensor was noted with strength of 2/5 (poor) each. Immediate medical treatment using vitamin K and fresh frozen plasma was started and percutaneous drainage was performed. Two days after visiting the emergency room, neurological symptoms were improved and non-operative treatment was continued. Twenty four days after being hospitalized, the size of the hematoma was reduced to approximately 75 x45 mm, 62x40 mm in size. Approximately three months after hospitalization, most of the hematoma was absorbed. After one year, mild atrphy of quadriceps and mild diffuse pain were noted, however, no other symptoms were observed. [ABSTRACT FROM AUTHOR]

Objective. Meralgia paresthetica (MP) is a mononeuropathy of the exclusively sensory lateral femoral cutaneous nerve (LFCN) that is difficult to treat with conservative treatments. Afferents from the LFCN enter the spinal cord through the dorsal root entry zones (DREZs) innervating L2 and L3 spinal segments. We previously showed that epidural electrical stimulation of the spinal cord can be configured to steer electrical currents laterally in order to target afferents within individual DREZs. Therefore, we hypothesized that this neuromodulation strategy is suitable to target the L2 and L3 DREZs that convey afferents from the painful territory, and thus alleviates MP related pain. Approach. A patient in her mid-30s presented with a four year history of dysesthesia and burning pain in the anterolateral aspect of the left thigh due to MP that was refractory to medical treatments. We combined neuroimaging and intraoperative neuromonitoring to guide the surgical placement of a paddle lead over the left DREZs innervating L2 and L3 spinal segments. Main results. Optimized electrode configurations targeting the left L2 and L3 DREZs mediated immediate and sustained alleviation of pain. The patient ceased all other medical management, reported improved quality of life, and resumed recreational physical activities. Significance. We introduced a new treatment option to alleviate pain due to MP, and demonstrated how neuromodulation strategies targeting specific DREZs is effective to reduce pain confined to specific regions of the body while avoiding disconfort., (© 2022 IOP Publishing Ltd.)

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A 67-year-old woman with rheumatoid arthritis (RA; Steinblocker stage IV, class 4) who had RA onset at 34 years of age had anterior thigh pain, femoral neuropathy and lower abdominal pain. Physical examination showed multidirectional limit of motion, and radiographic examination showed destruction of the hip joint. MRI and arthrography indicated a cystic lesion that communicated with the hip joint. The rheumatoid synovial cyst was removed during total hip arthroplasty. The symptoms were relieved, and the mass was reduced in size. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Physical Medicine & Rehabilitation Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Iatrogenic femoral nerve injury is a recognized complication of abdominal and pelvic surgery. It causes distress and disability and may lead to permanent motor and/or sensory sequelae. The aim of this systematic review was to explore the contemporary spectrum of this injury reported in the literature. Methods: A systematic review of iatrogenic femoral nerve injuries reported between 2000 and October 2010 was undertaken using the electronic databases Medline, PubMed, Cochrane Library, and Google Scholar. The context, frequency, mechanism of injury, and outcome were recorded. Relevant clinical and anatomical literature was reviewed to provide an overview of the surgical anatomy. Results: Iatrogenic femoral nerve injury is not rare, occurring as a complication of common abdominal, pelvic, and orthopedic operations and after femoral nerve blocks and femoral artery puncture. Mechanisms of injury are diverse and include direct trauma and ischemia from retraction or stretching of the nerve. Variant anatomy is very rarely the source of the problem. Although the prognosis in most cases is good some affected patients require nerve repair or grafting and some are left with permanent residual neurologic deficits. Conclusions: A wider awareness of this complication, particularly the context in which it may occur, together with an appropriate understanding of the anatomy of the femoral nerve may help to reduce the frequency of this distressing and disabling iatrogenic complication. [ABSTRACT FROM AUTHOR]

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Purpose: Genitofemoral nerve injury is an underappreciated complication after laparoscopic varicocele ligation in teenage boys. We describe the incidence according to ligation instrument and the pattern of spontaneous symptom resolution. Materials and Methods: Patients who underwent laparoscopic varicocele ligation between 2004 and 2007 were retrospectively grouped by ligation modality (clipping or cautery by ultrasonic shears). The incidence of iatrogenic genitofemoral nerve injury was assessed and compared. To illustrate the pattern of resolution, 1 affected patient documented the decreasing area of paresthesia through time on a topographic map. Results: During the study period laparoscopic varicocele ligation was performed using ultrasonic shears in 12 boys and endoscopic clips/cold dissection in 15. Genitofemoral nerve injury occurred in 2 patients using ultrasonic shears (17%) and no patient in the clip/cold dissection group (p = 0.10). In both patients the paresthesias resolved completely by 8 months. Conclusions: Genitofemoral nerve injury may be more frequent when the dissection is performed using “hot” methods such as cautery by ultrasonic shears. Preoperatively, patients should be made aware of the relatively high incidence and the usually self-limiting nature of this complication. [Copyright &y& Elsevier]

Concerns now exist about the long-term biological effects of exposure to orthopaedic metal alloys, particularly serum cobalt and chromium ions derived from metal-on--metal wear debris in these patients. A pseudotumour mass complicating metal-on-metal resurfacing arthroplasty has been recognized by orthopaedic oncologists and specialist hip units. Pseudotumours may also present with a major nerve palsy. Two cases of femoral neuropathy due to pseudotumour masses caused by metal-on-metal resurfacing arthroplasty are presented. Preoperative neurophysiological studies showed severe and irreversible pathological changes to nerve function with neurohistopathological evidence of complete nerve destruction with a previously unreported pathological appearance. This may represent a previously unrecognized pathological process, possibly 'toxic' in nature, resulting from metal-on-metal wear debris. Prolonged follow-up and detailed clinical assessment of patients after hip resurfacing arthroplasty is advocated with planned and expeditious revision of any patient in whom evidence of femoral neuropathy develops. [ABSTRACT FROM AUTHOR]

We present the case of a 63-year-old woman with a six-year history of rheumatoid arthritis (RA) and a left iliopsoas bursitis. Radiography had detected destructive changes in her hip joint associated with her bursitis, and she had reported some paresthesia along the left anterior distal thigh. Her pain and numbness remained tolerable, and her disease activity was well controlled until she accidentally fell on the floor, which resulted in an unstable intertrochanteric fracture of left femur with displacement of the proximal portion. The fracture was successfully treated with open reduction and internal fixation, but after the surgery, her femoral nerve palsy worsened. She subsequently underwent bursa excision after the failure of conservative treatment. Accordingly, after bursa excision, the postoperative course was uneventful, and her neurological symptoms gradually disappeared. We would recommend that bursa excision be considered even in cases of iliopsoas bursitis associated with mild femoral neuropathy when destructive changes in the hip joint are also present. [ABSTRACT FROM AUTHOR]

Abstract: Langerhans'' cell histiocytosis (LCH) is a rare condition of children and young adults in which Langerhans'' cells proliferate. The clinical spectrum ranges from solitary or few focal lesions to multisystem involvement mimicking vasculitis or hematological malignancy. Focal bone lesions, known as eosinophilic granulomas, are the most common manifestations. Eosinophilic granuloma usually presents with a variable combination of pain, swelling, fracture, and fever. Facial bone involvement may manifest as an ear discharge, hearing loss, or exophthalmos. Nerve root pain is rarely reported, even in patients with lesions in the axial skeleton. We report four cases of nerve root pain caused by LCH. Two male patients aged 25 and 34years, respectively, presented with truncated femoral neuralgia related to acetabular granulomas. A 25-year-old woman with involvement of the L5 vertebral body and a 41-year-old man with a sacral lesion presented with sciatica. [Copyright &y& Elsevier]

Abstract: Six cases of iliopsoas hematoma were diagnosed in 5 patients with hemophilia over the last 5years at our hemophilia center. We reviewed these cases to determine the incidence and precipitating factors of iliopsoas hematoma in hemophilia. Of the 5 patients, 4 had severe hemophilia A and 1 had moderate hemophilia A with a history of inhibitors to factor VIII concentrates. The age range was 13 to 33years. The hematoma was posttraumatic in 2 cases and spontaneous in 4 cases. Femoral nerve compression developed in 2 cases. There were four recurrences. At the time of the hematoma, 2 patients were receiving long-term prophylactic factor VIII concentrate therapy but one of them had stopped the injections of his own accord. The treatment consisted of recombinant factor VIII concentrates, a brief course of glucocorticoid therapy in the 2 cases with femoral nerve involvement, lower limb traction in 3 patients, and rehabilitation therapy. The annual incidence rate of iliopsoas hematoma was 2.9/1000 patients with severe or moderate hemophilia A. The use of prophylactic factor VIII therapy and compliance with recommendations about avoiding activities that put strain on the hip flexor muscles probably explain the low rate of iliopsoas muscle hematoma in patients with hemophilia in France. An early diagnosis allows early Factor VIII therapy, which decreases the risk of femoral nerve involvement and recurrence. [Copyright &y& Elsevier]

Résumé: L''histiocytose de Langerhans est une pathologie rare de l''enfant et de l''adulte jeune qui provoque aussi bien des lésions focales que des atteintes de plusieurs organes mimant une vascularite ou une hémopathie maligne, par prolifération et accumulation tissulaire d''histiocytes. L''atteinte osseuse ou granulome éosinophile est la plus fréquente. Les circonstances de découverte de telles lésions sont le plus souvent la douleur, une tuméfaction, une fracture, fièvre et parfois otorrhée, hypoacousie ou exophtalmie en cas d''atteinte des os de la face. Les radiculalgies sont rarement décrites même en cas d''atteinte du squelette axial. Nous reportons quatre cas de radiculagies liées à une histiocytose langerhansienne: deux cruralgies tronquées associées à une atteinte cotyloïdienne chez deux hommes de 25 et 34 ans, ainsi que deux lombosciatiques chez une jeune femme présentant une atteinte corporéale de L5 et chez un homme de 41 ans chez qui existe une localisation sacrée. [Copyright &y& Elsevier]

Résumé: Nous rapportons six hématomes du psoas diagnostiqués durant les cinq dernières années, afin de déterminer l''incidence de cette pathologie et les circonstances de survenue. Cinq hémophiles A, quatre sévères et un modéré avec antécédent d''inhibiteur, âgés de 13 à 33 ans, ont présenté six hématomes du psoas post-traumatique (2) ou spontané (4) compliqués de deux atteintes tronculaires du nerf crural et de quatre rechutes. Deux patients bénéficiaient d''un traitement prophylactique au long cours par concentrés de facteur VIII, interrompu à l''initiative du patient dans un cas. Le traitement a consisté en des concentrés de facteur VIII recombinant, une corticothérapie courte pour les patients dont le nerf crural était atteint, un alitement avec traction du membre inférieur pour trois patients associé à une prise en charge de rééducation. La fréquence des hématomes du psoas a été de 2,9 pour mille patients atteints d''hémophilie A sévère ou modérée par an. La réalisation de la prophylaxie par facteur VIII et le respect des recommandations par rapport aux activités contraignantes pour les muscles fléchisseurs de hanche sont sans doute à l''origine de la faible fréquence des hématomes du psoas en France. Le faible nombre de récidives et d''atteintes crurales dépend de la précocité du diagnostic qui conditionne la mise en œuvre du traitement adapté par facteur VIII. [Copyright &y& Elsevier]

The article evaluates the use of magnetic lumbosacral root stimulation for the assessment of lumbosacral plexus function in a 76-year-old man with femoral distribution weakness caused by a coumadin-associated retroperitoneal hematoma. Electrical femoral nerve conduction studies were conducted to the patient. The diagnosis indicates a left femoral neuropathy with axonal and myelin dysfunction. The study revealed that magnetic lumbosacral root stimulation adds diagnostic value in the evaluation of femoral distribution weakness resulting from retroperitoneal hematoma.

Iliopsoas haematoma is a well-recognized complication of haemophilia, and is considered as potentially life threatening and significantly associated with morbidity. There are only rare reports on the incidence or outcomes of iliopsoas bleeding since the widespread usage of modern therapies for haemophilia. In this study, we present the experience of Ege University Haemophilia Centre with iliopsoas bleeding and its early and late complications. We reviewed 146 haemophiliacs (106 haemophilia A, 40 haemophilia B). Fourteen iliopsoas bleeding episodes were identified in eight haemophiliacs. Three patients (37%) had one episode, four (50%) had two episodes and one (13%) had three episodes. Two patients had a high titre inhibitor against factor VIII and accounted for three bleeding episodes (21%). We did not observe any episodes in six patients receiving prophylaxis. Iliopsoas haematomas were confirmed by ultrasonography in all patients. In physical examination, the most common symptoms were thigh, hip and groin pain, hip flexion contracture, abdominal tenderness and paraesthesia in the distribution of the femoral nerve. The mean duration of therapy with clotting factor concentrate was 7.8 ± 1.6 days. The mean duration of hospitalization was 4.8 ± 2.0 days. All patients started to receive a physical therapy program 6.0 ± 2.4 days after the initiation of haemostatic therapy which lasted 20.0 ± 6.0 days. Ultrasonographic findings related to iliopsoas haematoma disappeared in all patients within 3 months from the initial episodes. Only in one patient with mild haemophilia A, heterotopic bone formation (myositis ossificans) developed as a long-term complication. In conclusion, pain around the hip joint, femoral neuropathy and hip flexion contracture in a patient with haemophilia should alert the physician to the possibility of an iliopsoas haematoma. Early and effective factor replacement therapy is essential in the prevention of the complications. [ABSTRACT FROM AUTHOR]

We present a patient with a spontaneous iliacus muscle hematoma, appearing immediately after a minor physical maneuver, presenting with pain and femoral neuropathy initially evidenced by massive quadriceps muscle fasciculations. A magnetic resonance imaging (MRI) study of the pelvic area confirmed the diagnosis, showing a hematoma secondary to a partial muscle tear. The patient was managed conservatively, and the continuous muscle activity ceased in 3 days, with progressive improvement of the pain and weakness. The recovery was complete. Femoral neuropathy is uncommon and usually due to compression from psoas muscle mass lesions of diverse nature, including hematomas. Usually subacute, femoral neuropathy may present acutely in cases of large or strategically placed compressive femoral nerve lesions, and may require surgical evacuation.The case presented herein is remarkable since the muscle hematoma appeared after a nonviolent maneuver, fasciculations were present at onset, and conservative management was sufficient for a full recovery. [Copyright &y& Elsevier]

The article presents a case study of a 71-year-old female patient with a right-sided congenital hip dysplasia who developed femoral nerve injury after the nephrectomy surgery. The patient experiences numbness, tingling and burning pain in the right thigh and muscle weakness. It is suggested that early physical therapy improves the quadriceps muscle weakness within six months.