Femoral nerve neuropathy is an uncommon peripheral neuropathy, which most commonly occurs when the femoral nerve is compressed as it passes under the inguinal ligament, anterior to the iliopsoas muscle.
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Clinical presentation
- groin pain
- loss of power of hip flexion and knee extension
- loss/reduced knee jerk
- decreased sensation
- anteromedial thigh
- medial aspect of the lower leg
- loss of muscle bulk of quadriceps
Pathology
Etiology
Most commonly the cause is iatrogenic 1
- pelvic and hip surgeries, e.g. hysterectomy
- vascular procedures, including femoral artery catheterization, arterial bypass
- femoral nerve block
- prolonged lithotomy position
- retroperitoneal hematoma due to anticoagulant medications
Non-iatrogenic causes are rarer, including 2
- pelvic mass
- trauma
- infection
- diabetes mellitus
- alcoholism
- radiation injury
Radiographic appearances
Mass effect from the iliacus/iliopsoas muscles may be visualized and may result from muscle tears, psoas hematomas or pseudoaneurysms of iliac vessels.
Treatment and prognosis
In general, it takes days to months to fully recover nerve function, a duration partially predicated on the chronicity of the compression. Most patients experience full resolution by 6 months 2.
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