OVERVIEW
OVERVIEW
Femoral neuralgia is a condition that produces pain when the femoral nerve is irritated. The femoral nerve consists of the L2 to L4 nerves and is the largest branch of the lumbar plexus. The innervation area of this nerve runs along the groin toward the front of the thigh, the medial aspect of the knee and the inner ankle of the calf. Femoral neuralgia is commonly associated with L3 and L4 nerve root lesions from various causes.
Whether medical insurance
Yes
Department
Neurology, Orthopedics
Synonyms: Wassrrmann’s sign
Wassrrmann’s sign
Clinical symptoms
Pain in the inguinal or anterior femoral region, inability to extend the calf, atrophy of the quadriceps muscle, loss of knee reflexes, skin sensory disturbances, difficulty in walking, and inability to flex the thigh toward the abdomen.
Hazards
It affects the patient’s activities, and the pain can interfere with sleep.
Examination
Prone position straight leg hip extension test, knee flexion test, neck flexion test, X-ray film, CT, etc.
Diagnosis
Diagnosis can be made on the basis of pain in the groin area or pre-femoral area, impaired mobility, skin sensation disorder, combined with physical examination, lumbar spine and pelvis x-ray film or CT.
Treatment principle
Remove the cause of the disease, neurotrophic treatment, pain relief, repair nerve damage.
Curability
Symptoms can be improved and pain relieved with active treatment.
Dietary advice
Choose a light, easily digestible, low-fat, high-protein, vitamin-rich diet.
Etiology
Etiology
Gunshot wounds, puncture wounds, surgical injuries, fractures, poisoning, diabetic radiculitis, infectious diseases, tumors in the pelvis, inflammation, varicose veins and other factors can injure the femoral nerve and its branches, which can lead to femoral neuralgia.
Symptoms and diagnosis
Typical symptoms
1. When the femoral nerve is injured below the inguinal ligament, the calf cannot be extended, the quadriceps muscle atrophies, the knee reflex disappears, and the skin of the anterior and medial side of the calf has sensory disorders, which may be accompanied by trophic changes such as edema, bruising and contracture.
2. The femoral nerve is injured above the inguinal ligament with impaired sensation in the front of the thigh.
3. When the femoral nerve is injured in the highest part, the thigh cannot be flexed to the abdomen, and the patient cannot sit up without supporting himself in the supine position. The patient has difficulty in walking, the gait becomes small, and cannot run or jump. When the femoral nerve is stimulated, severe neuralgia and hyperalgesia in the front of the thigh can be produced.
Diagnostic basis
1. Clinical pain in the inguinal or anterior femoral region, radiating to the medial side of the calf.
2. Hypersensitivity or hyperalgesia in the femoral nerve distribution area, difficulty in jumping and squatting, mild atrophy of the muscles in this area, and weakening of the knee reflex on the affected side.
3. Positive straight leg hip extension test and knee flexion test in prone position; radicular pain starts from the upper lumbar region; positive neck flexion test.
4. Pressure points can be found in the middle third of the inguinal ligament, lateral femoral artery, medial side of the knee, back of the inner ankle and inner edge of the foot. In radicular damage, the pressure and pain next to the spinous process of the upper lumbar vertebrae is obvious, radiating to the groin, and accompanied by tension of the lumbar back muscles.
Treatment
Treatment guideline
Remove the cause of the disease, neurotrophic treatment, application of analgesic drugs, femoral nerve closure, acupuncture and physiotherapy, acupoint closure, local drug iontophoresis and other treatment methods are adopted to relieve pain and restore nerve damage.
Drug treatment
1. Adrenocorticotropic hormone can be used for nerve trauma to eliminate or reduce local edema and adhesions.
2. Application of painkillers, such as painkillers, aspirin and ibuprofen.
3. Neurotrophic treatment, such as vitamin B1, vitamin B6, vitamin B12, adenosine triphosphate, diprazole and nerve growth factor.
Surgical treatment
Remove the cause of the disease: nerve dissections need to be sutured, nerve compression by scarring should be neurolysis; such as pelvic tumors or femoral aneurysms caused by compression, surgical resection should be carried out to relieve the compression of the nerve.
Other treatments
Femoral nerve closure, acupuncture, physiotherapy, acupoint closure, local drug iontophoresis, etc.
Prognosis
The treatment can improve the prognosis and relieve the pain symptoms.
Nursing care
Daily care
If the patient is unsteady in walking, he/she should be taken care of by a person, and should not pour boiled water or use sharp objects by himself/herself to avoid accidents such as scalding and bruising.
For people with reduced sensation, beware of scalding. When taking a bath, have someone test the water temperature first and use it only when it is suitable. In winter, avoid scalded by heater and use hot water bag with caution.
Patients should exercise limb function and daily life activities to restore self-care and working ability, and return to the society as soon as possible.
Diet
Choose a light, easy-to-digest, low-fat, high-protein, vitamin-rich diet.