Femoral Nerve Decompression to Restore Quadriceps Function
Jana Dengler, MD1,2, Elspeth J R Hill, MD PhD MRes1 and Amy M Moore, MD3, (1)Washington University School of Medicine, St Louis, MO, (2)Sunnybrook Health Sciences Centre, Toronto, ON, Canada, (3)Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO
Introduction: The femoral nerve can become entrapped as it travels from its origin at the L2-L4 nerve roots beneath the iliacus fascia to emerge in the anterior thigh under the inguinal ligament. While femoral nerve entrapment remains a rare condition, it can result in significant weakness in hip flexion and knee extension, gait disturbance, dysesthesias and pain in the antero-medial thigh and medial leg. The benefits of surgical decompression of the femoral nerve for management of femoral nerve entrapment are under-recognized. Here we present a series of 3 patients with femoral nerve entrapment who underwent decompression with immediate improvement in motor strength.
Methods: A series of 3 patients who underwent femoral nerve decompression by a single surgeon is presented. Patient demographics, etiology, symptom onset, physical exam findings and electrodiagnostic variables were collected from patient charts. All patients underwent femoral nerve decompression through a single proximal anterior thigh incision, with neurolysis of the femoral nerve proximally as it emerged under the inguinal ligament, and individual neurolysis of the subsequent motor branches distally. Primary outcome was improvement in Medical Research Council (MRC) motor scores. Pain and quality of life scores, Disabilities of the Arm, Shoulder and Hand (DASH) scores and sensory Ten testing were also recorded.
Results: Three patients with femoral nerve weakness underwent femoral nerve decompression with immediate improvement (within 3 days of surgery) in function post-operatively. Case 1: A 65-year old female with femoral nerve palsy following hip arthroplasty underwent femoral nerve decompression and end-to-side obturator to femoral nerve transfers 6.5 months after injury, and had immediate improvement in quadriceps function from MRC 2-/5 to 4/5. Case 2: A 26-year old male with femoral nerve palsy following a gun shot injury underwent femoral nerve decompression and end-to-side sartorius to femoral nerve transfers 15 months after injury, and had immediate improvement in quadriceps function from MRC 3-/5 to 4/5. Case 3: A 16-year old male with femoral nerve palsy following acute flaccid myelitis underwent femoral nerve decompression and end-to-side sartorius to femoral nerve transfers 8 months after injury, and had immediate improvement in quadriceps function from MRC 1/5 to 4/5.
Conclusions: Femoral nerve decompression can restore quadriceps function in patients with femoral nerve entrapment neuropathy. The immediate improvement of motor function days after surgery suggests a role for decompression in ischemic conduction block. Early referral to a nerve surgeon for nerve palsies is warranted.
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