DOCSLIB.ORG

Nerve Lesions and Entrapment Neuropathies of the Lower Limb

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Nerve Lesions and Entrapment Neuropathies of the Lower Limb Nerve lesions and entrapment neuropathies of the lower limb CHAPTER CONTENTS The effects of pressure on the peripheral nerves of leg and Introduction . e313 foot are discussed in this chapter. Sciatic .nerve . e313 Sciatic nerve Lateral .cutaneous .nerve . e313 Femoral .nerve . e315 Neurocompression syndromes of the sciatic nerve are not Saphenous .nerve . e315 common. Some believe that the nerve can become compressed Common .peroneal .nerve . e315 between the fibres of the piriformis muscle (the piriformis syndrome2). Deep .peroneal .nerve . e316 If the nerve becomes damaged or is chronically irritated, Superficial .peroneal .nerve . e317 serious deafferentation pain can result and occurs in circum- stances in which the sciatic nerve is locally bruised or has Tibial .nerve . e317 undergone damage after local injection of irritating substances. Plantar .nerves . e318 Continuous and burning pain, independent of posture, is then felt in the sensory distribution of the nerve. Local pressure on the nerve can increase the pain considerably.3–4 Introduction Lateral cutaneous nerve The main symptom of pressure on nerves is paraesthesia. Depending on the level of the compression, paraesthesia is Entrapment of the lateral cutaneous femoral nerve is not accompanied by pain and numbness. The combination of these uncommon and results in meralgia paraesthetica. three symptoms and their interrelation are of importance in The lateral cutaneous nerve is sensory only. It originates at localizing the site of compression.1 L2 and runs retroperitoneally to emerge at the outer edge of Pressure on the distal spinal cord induces painless pins and the psoas and then crosses the iliacus muscle at the lateral needles in both feet, soon followed by numbness, incoordina- border of the pelvis, which it follows to the anterior superior tion and abnormal reflexes. This mechanism has been discussed spine of the ilium. It then passes under the lateral aspect of in the chapters on the cervical and thoracic spine. the inguinal ligament to follow the fibres of the sartorius Pressure on a nerve root causes segmental pain, paraesthesia muscle. Its course and the location as it exits the pelvis are at the distal aspect of the respective dermatome and, if the very variable. Aszmann et al5 investigated its relation to soft- pressure increases, motor and sensory deficit. For detailed tissue and bony landmarks in the inguinal region through dis- descriptions of these pathologies, see the chapters on the section of 52 human anatomic specimens and identified five lumbar spine. different types: type A, posterior to the anterior superior iliac Pressure on the lumbosacral plexus causes little pain but spine, across the iliac crest (4%); type B, anterior to the ante- increasing numbness and weakness. For instance, compression rior superior iliac spine and superficial to the origin of the of the plexus by a neoplasm does not cause pain in the limbs sartorius muscle but within the substance of the inguinal liga- but only sacral or coccygeal pain. However, it does give rise to ment (27%); type C, medial to the anterior superior iliac spine, gross weakness of the muscles of one or both legs and feet. ensheathed in the tendinous origin of the sartorius muscle © Copyright 2013 Elsevier, Ltd. All rights reserved. Nerve Lesions and Entrapment Neuropathies of the Lower Limb Fig 2 • Area innervated by the lateral cutaneous nerve. Box 1 Fig 1 • Course of the lateral cutaneous nerve. Differentiation of meralgia paraesthetica from a second lumbar root lesion (23%); type D, medial to the origin of the sartorius muscle The zone of paraesthesia is very well delineated located in an interval between the tendon of the sartorius There are no symptoms towards the medial side of the thigh and muscle and thick fascia of the iliopsoas muscle deep to the the groin inguinal ligament (26%); and type E, most medial and embed- Hypersensitivity of the paraesthetic zone ded in loose connective tissue, deep to the inguinal ligament, The numbness is well outlined and almost total in the centre overlying the thin fascia of the iliopsoas muscle and contribut- Tapping the nerve provokes paraesthesia (Tinel’s sign) ing the femoral branch of the genitofemoral nerve (20%). MRI of the lumbar spine is negative Other studies located the nerve most commonly at 10–15 mm medial to the anterior superior iliac spine but in some cases it was located as far medially as 46 mm.6,7 A few centimetres during pelvic traction can compress the nerve just medial to below the anterior superior iliac spine it emerges through the the anterior superior iliac spine. deep fascia and continues its course subcutaneously (Fig. 1). The symptoms are typical of any lesion of a small peripheral The nerve supplies the anterolateral aspect of the thigh from sensory nerve: pain, paraesthesia and numbness, confined to its the upper border of the trochanter to the level of the superior distribution. The patient typically describes a burning or tin- margin of the patella (Fig. 2). gling sensation over the anterolateral aspect of the thigh. The The nerve can become trapped at any point along its course, edge is well defined and the centre is often completely anaes- although most cases result from nipping at the inguinal liga- thetic. A common complaint is hypersensitivity: the patient ment or beyond the fascial tunnel, usually at the point where even dislikes the touch of a cloth in the affected area.15 Clinical the nerve becomes superficial. Occasionally the symptoms examination reveals the extent of anaesthesia, which has a clear stem from an abnormality in the pelvis, the typical example of edge. Tenderness to pressure can sometimes be evoked distal which is meralgia during pregnancy (Cyriax:1 pp. 297–298), to the anterior superior iliac spine. In some cases, the paraes- encountered between the fourth and seventh months. In this thesia can be aggravated by tapping the nerve.16,17 condition, the symptoms are always unilateral and disappear Differentiation of meralgia paraesthetica from a second spontaneously during the pregnancy. They have been ascribed lumbar root lesion remains the greatest problem in diagnosis18 to the pressure of a small fibromyoma against the nerve, close and relies on the careful delineation of the paraesthetic area, to where it emerges at the lateral border of the psoas. Meralgia the degree of numbness and a negative MR scan of the lumbar paraesthetica has also been reported after pelvic osteotomies spine.19,20 Although the L2 area and the area supplied by the for Perthes’ disease,8,9 shelf operations for acetabular insuffi- lateral cutaneous nerve correspond well laterally, the second ciency10 and after the removal of bone from the iliac crest for root also contributes to the innervation of the groin and the a graft.11 However, most cases of meralgia paraesthetica are inner aspect of the thigh. Furthermore, in L2 root lesions the idiopathic, although some external causes such as tight trou- analgesia is very slight because of the overlap between L2 and sers,12 obesity,13 the use of belts, corsets and trusses, or an L3, whereas in lesions of the lateral cutaneous nerve, there is overtight bandage round the pelvis14 after an operation or almost full anaesthesia, with a clear-cut border (Box 1). © Copyright 2013 Elsevier, Ltd. All rights reserved. e314 Nerve lesions and entrapment neuropathies of the lower limb Treatment depends on the underlying cause. In external Saphenous nerve pressure at the fascial tunnel, it is sometimes sufficient to remove the cause. Should this simple action fail, infiltration The saphenous nerve is the largest cutaneous branch of the with anaesthetic at the point of contact is indicated. femoral nerve. It leaves the subartorial canal about 8–10 cm Technique: infiltration above the medial condyle of the knee. Some of the branches A 10 ml syringe is filled with procaine 0.5% and fitted to a thin there provide innervation of the medial aspect of the knee. needle 5 cm long. A point is chosen 5 cm below and medial to Another branch follows the sartorius muscle and becomes the anterior superior iliac spine. The needle is inserted and superficial just below the medial condyle of the tibia.29 It then moved upwards along the anterior and medial side of the sar- runs down on the leg to follow the great sapheneous vein over 21 torius muscle. A fan-wise infiltration is made here. Two to the anterior aspect of the medial malleolus (see Fig. 6). Its four weekly infiltrations may be necessary. territory of distribution is the medial side of the leg, the medial 22 In intractable cases surgery can be considered. It should malleolus and the medial border of the foot30 (Fig. 4). be remembered, however, that in about two-thirds of cases the Traction on the saphenous nerve as it leaves the subsartorial 23,24 symptoms subside spontaneously over 2 years. canal may cause oedema, inflammation and thus compression31–33 (Fig. 5). Direct compression of the nerve may also occur in Femoral nerve front of the inner tibial condyle.34,35 However, the usual site of compression is at the ankle, at the anterior aspect of the medial malleolus. Although the femoral nerve can be compressed by different Saphenous neuralgia is also a well-known and common com- processes in the psoas region, the pelvis and the groin, neither plication after harvesting of great saphenous vein for coronary pain nor paraesthesia ever result.25 The symptoms are a vague artery bypass grafting. The main symptom is anaesthesia which numbness in the anterior crural area and increasing weakness may persist for a considerable time postoperatively.36–38 of the psoas and quadriceps femoris muscles. A new cause of Paraesthesia over the inner aspect of the ankle and along the femoral compression neuropathy has been reported during medial border of the foot, together with aching and numbness recent decades – retroperitoneal bleeding resulting from anti- along the subcutaneous border of the tibia, results from either coagulant therapy.26–28 a direct contusion or sustained compression.
Load more

Recommended publications
  • Ultrasound-Guided Treatment of Peripheral Entrapment Mononeuropathies John W
    AANEM MONOGRAPH ULTRASOUND-GUIDED TREATMENT OF PERIPHERAL ENTRAPMENT MONONEUROPATHIES JOHN W. NORBURY, MD,1 and LEVON N. NAZARIAN, MD2 1 Department of Physical Medicine and Rehabilitation, The Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Greenville North Carolina 27834, USA 2 Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA Accepted 13 May 2019 ABSTRACT: The advent of high-resolution neuromuscular ultrasound high-resolution linear-array transducers has allowed neu- (US) has provided a useful tool for conservative treatment of periph- romuscular US to emerge as a powerful tool for the diag- eral entrapment mononeuropathies. US-guided interventions require 2–6 careful coordination of transducer and needle movement along with a nosis of peripheral entrapment mononeuropathies. detailed understanding of sonoanatomy. Preprocedural planning and US-guided treatment of entrapment mononeuropathies positioning can be helpful in performing these interventions. Cortico- has also greatly expanded in recent years. Technical steroid injections, aspiration of ganglia, hydrodissection, and minimally invasive procedures can be useful nonsurgical treatments for aspects of performing therapeutic US-guided proce- mononeuropathies refractory to conservative care. Technical aspects dures and the current state of the science regarding US- as well as the current understanding of the indications and efficacy of guided treatment for common peripheral entrapment these procedures for common entrapment mononeuropathies are reviewed in this study. mononeuropathies are reviewed and discussed in this Muscle Nerve 60: 222–231, 2019 monograph. The expansion of high-resolution linear-array trans- TYPES OF ULTRASOUND-GUIDED INTERVENTIONS ducers has allowed neuromuscular ultrasound (US) Corticosteroid Injections. Corticosteroids suppress 7–9 to emerge as a powerful tool for the diagnosis and treat- proinflammatory cytokines.
    [Show full text]
  • Meralgia Paraesthetica
    Meralgia Paraesthetica Meralgia paraesthetica is numbness or pain in the outer thigh not caused by injury to the thigh, but by injury to a nerve that extends from the thigh to the spinal column. This chronic neurological disorder involves a single nerve—the lateral cutaneous nerve of the thigh. The lateral femoral cutaneous nerve most often becomes injured by entrapment or compression where it passes between the upper front hip bone (ilium) and the inguinal ligament near the attachment at the ASIS. Signs and symptoms Pain on the outer side of the thigh, occasionally extending to the outer side of the knee, usually constant. A burning sensation, tingling, or numbness in the same area Multiple bee-sting like pains in the affected area Occasionally, aching in the groin area or pain spreading across the buttocks Usually more sensitive to light touch than to firm pressure Hyper sensitivity to heat (warm water from shower feels like it is burning the area) Treatments Wearing looser clothing and suspenders rather than belts Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammatory pain Pain killers if pain level limits motion and prevents sleep Reducing physical activity in relation to pain level. Acute pain may require absolute bed rest MP can occur in any age group but is most frequently reported in middle-age persons and is generally regarded as uncommon. The incidence rate of MP reported in Holland in 2004 was 4.3 per 10,000 persons. There is no consensus about sex predominance, but in 1 study evaluating 150 MP cases, a higher incidence was reported in men.
    [Show full text]
  • Free PDF Download
    Eur opean Rev iew for Med ical and Pharmacol ogical Sci ences 2014; 18: 2766-2771 Peripheral neuropathy in obstetrics: efficacy and safety of α-lipoic acid supplementation M. COSTANTINO, C. GUARALDI 1, D. COSTANTINO 2, S. DE GRAZIA 3, V. UNFER 3 Chemistry and Pharmaceutical Technologies, University of Ferrara, Ferrara, Italy 1Obstetrics and Gynaecology Unit, Ospedale di Valdagno (VI), Italy 2Female Health Centre, Azienda USL, Ferrara, Italy 3A.G.UN.CO. Ostetric and Gynecological Center, Rome, Italy Abstract. – OBJECTIVE : Neuropathic pain more prone to the development of neuropathic during pregnancy is a common condition due to syndromes. First and foremost, the physical the physical changes and compression around changes caused by the enlargement of the uterus pregnancy and childbirth that make pregnant women more prone to develop several medical and the development of the foetus cause postural conditions such as carpal tunnel syndrome, sci - changes and nutation of the pelvic girdle that fa - atica, meralgia paraesthetica and other nerve en - cilitate the development of low back pain and en - trapment syndromes. Most of the treatments trapment neuropathies. The mutation of the usually performed to counteract neuropathic pelvic girdle is favoured during pregnancy also pain are contraindicated in pregnancy so that, by the presence of high concentrations of relaxin, the management of these highly invalidating conditions remains an issue in the clinical prac - which is produced from the tenth week of gesta - tice. We aimed to review the efficacy and safety tion and causes a laxity in the joints not only in of alpha lipoic acid supplementation in the treat - the pelvis, but also on a vertebral level, which ment of neuropathic pain.
    [Show full text]
  • Diagnosis of the of the Extremities
    Postgrad Med J: first published as 10.1136/pgmj.22.251.255 on 1 September 1946. Downloaded from DIAGNOSIS OF THE COMMON FORMS OF NERVE INJURY OF THE EXTREMITIES By COLIN EDWARDS, M.B., B.S., M.R.C.P., D.P.M. History-taking is the first step in diagnosis and panying diminution or loss of reflexes. In the it is useful to know how varied the causes of peri- absence of an external wound or contusion near the pheral nerve injuries can be. Otherwise the true nerve concerned these muscle changes may be the nature of a traumatic lesion sometimes may not only guide. be suspected. Look first at the most peripheral muscles and The commoner ones are the result of:- particularly those which move the hands and feet. (I) Cutting and laceration. If these are normal (indicating an intact nerve (2) Stretching, which may be sudden (e.g. supply) it is uncommon, although not impossible, stretching of the sciatic by jumping upon the for muscles to be involved whose supply leaves extended foot) causing fibre rupture and those same nerves at a more proximal level. And haemorrhage, or prolonged (e.g. lying with the proximal involvement with normal peripheral arm extended for hours above the head) muscles only occurs close to the actual spot where ischaemia. causing the nerve is injured. The state of innervation of Contusion. the muscles moving the hands and feet gives no (3) to that of the limb (4) Concussion (including that produced by a guide, however, girdle muscles,Protected by copyright. "near miss" when a missile passes through as they are supplied by comparatively short nerves neighbouring tissues without touching the nerve).
    [Show full text]
  • Peripheral Neuropathy in Older People Peripheral Neuropathies Are Common in Older People
    Pain 47 Peripheral neuropathy in older people Peripheral neuropathies are common in older people. Although the ageing process itself may play a part, there are multiple other causes. Peripheral neuropathy interferes with normal daily activities and leads to increased risk of falls, injury and poor quality of life. Management of peripheral neuropathy ofen needs a multidisciplinary team approach. Siyum Strait, Specialist Registrar Acute Medicine, Great Western Hospital, Swindon Pippa Medcalf, Consultant Physician, Gloucester Royal Hospital, Great Western Road, Gloucestershire Email [email protected] Peripheral neuropathy is one involvement, time course, type of (eg. diabetic distal symmetrical pattern of damage to the peripheral defcit or nature of the underlying polyneuropathy), purely nervous system.1 Physical signs of pathology.8 (Box 1) motor (eg. acute motor axonal peripheral neuropathy are common The patterns of nerve neuropathy), mixed motor and in older people.2 Recognition involvement that occur include sensory (eg. Charcot-Marie-Tooth of these deficits is particularly mononeuropathy, multiple disease) and autonomic. important because peripheral mononeuropathy (mononeuritis Te responsible pathology may neuropathy may contribute to the multiplex), symmetrical be axonal, demyelinating or mixed vulnerability to falls that is common polyneuropathy, radiculopathy and axonal and demyelinating. in this age group.3,4 More than 30% polyradiculoneuropathy. Peripheral neuropathies of all of patients aged over 65 years will Mononeuropathy refers to groups may involve large nerve fall at least once per year.5 involvement of major nerve trunks, fbres, small nerve fbre or both. Peripheral neuropathy singly or multiply. Radiculopathy Large nerve fibres are long, commonly causes impairment refers to involvement of nerve myelinated and enable fast of proprioception and balance, roots, again singly or multiply.
    [Show full text]
  • Bypassing the Challenges of Lower-Limb ELECTROMYOGRAPHY by Using Ultrasonography: Anatomus-II
    J Rehabil Med 2013; 45: 604–605 LETTER TO THE EDITOR BYPASSING THE CHALLENGES OF LOWER-LIMB ELECTROMYOGRAPHY BY USING ULTRASONOGRAPHY: ANATOMUS-II Electrodiagnostic studies are the gold-standard evaluation real-time imaging tool, whereby it is practical for the physician tools for peripheral nerve entrapment syndromes. However, to scan several peripheral nerves immediately after medical/ although they can indirectly localize the site of injury (through physical examination of the patient. In addition, in the afore- physiological data), they cannot provide morphological confir- mentioned challenging cases, it becomes a powerful diagnostic mation as do other imaging methods (1). Furthermore, during tool rather than merely an adjunct to electrodiagnostics. With lower limb diagnostics in particular, electrophysiologists may ultrasound, one can morphologically confirm entrapment, un- encounter various challenges concerning certain entrapment cover the underlying cause of injury, precisely guide onward syndromes, e.g. meralgia paraesthetica, tarsal tunnel syn- intervention (injection/surgery), and follow up the injury (1). drome, Morton’s neuroma. In addition, technical difficulties Thus, having organized study of the upper limb in 2012 (6), during sensory evaluations with surface electrodes (even with in a similar workshop in 2013 we studied the lower limb nerves near-nerve needle techniques) may overwhelm the diagnostics in parallel sessions using cadavers and ultrasound (Fig. 1). (2–5). In this case, ultrasound appears to be a very convenient, This time we included in-depth electrophysiological discussion Fig. 1. Anatomical dissections and their corresponding ultrasound images for (A, B) lateral femoral cutaneous, (C, E) superficial and (D, F) deep peroneal nerves. (A) Lateral femoral cutaneous nerve is shown distal to its bifurcation in the inguinal region lateral to the femoral nerve and vessels.
    [Show full text]
  • Meralgia Paresthetica Caused by Entrapment of the Lateral Femoral Subcutaneous Nerve at the Fascia Lata of the Thigh : a Case Report and Literature Review
    248 CASE REPORT Meralgia paresthetica caused by entrapment of the lateral femoral subcutaneous nerve at the fascia lata of the thigh : a case report and literature review Yasuyuki Omichi1, Ichiro Tonogai2, Shinsuke Kaji1, Teruaki Sangawa1, and Koichi Sairyo2 1Department of Orthopedics, Shikokuchuo Hospital, Ehime, Japan, 2Department of Orthopedics, Tokushima University, Tokushima, Japan Abstract : Meralgia paresthetica (MP) causes tingling, stinging or a burning sensation in the anterolateral part of the thigh, usually as a result of entrapment of the lateral femoral cutaneous nerve (LFCN) at the inguinal liga- ment (IL) due to mechanical or iatrogenic injury. However, there are few reports on MP caused by entrapment of the LFCN at a more distal site from the IL. We report here a rare case of MP caused by entrapment of the LFCN at the fascia lata of the thigh level. A 23-year-old man felt numbness and sharp pain at the anterolateral aspects of both thighs soon after direct repair surgery for L5 isthmic spondylolisthesis. Although his symptoms were re- lieved a few days later, numbness and sharp pain in the right thigh recurred 6 months after the surgery. A diag- nosis of MP was made, and decompression of the LFCN was performed because conservative treatment for MP was inadequate. Intraoperatively, it was noted that the LFCN was entrapped underneath the fascia lata of the thigh, not at the IL level. His symptoms disappeared after LFCN was released. This case demonstrates that it is necessary to consider the possibility of entrapment of the LFCN at the fascia lata at the thigh level in MP.
    [Show full text]
  • Aetiology of Neuropathic Pain (NP) Along with Role of Gabapentinoids
    ISSN: 2474 - 9206 Review Article Journal of Anesthesia & Pain Medicine Aetiology of Neuropathic Pain (NP) Along with Role of Gabapentinoids Like Pregabalin and Gabapentin in Treating the Excruciating Pain Besides Other Newer Alternatives-a Systematic Review Kulvinder Kochar Kaur1*, Gautam Allahbadia2 and Mandeep Singh3 1Scientific Director Centre for Human Reproduction 721, G.T.B. Nagar Jalandhar-144001 Punjab, India * 2 Corresponding author Scientific Director Ex-Rotunda-A Centre for Human reproduction Kulvinder Kochar Kaur, Scientific Director Centre for Human Reproduction 672, Kalpak Garden, Perry Cross Road, Near Otter’s Club, Bandra 721, G.T.B. Nagar Jalandhar-144001 Punjab, India (W)-400040 Mumbai, India 3Neurology Consultant Neurologist Swami Satyanand Hospital Submitted: 29 Jan 2020; Accepted: 13 Feb 2020; Published: 20 Feb 2020 near Nawi Kachehri, Baradri, Ladowali road, Jalandhar, Punjab, India Abstract Neuropathic pain (NP) by definition is a problem that involves the somatosensory system either as a manifestation as disease or as a lesion. Lot of differing causes either of central/peripheral origin can stimulate NP and that might affect life’s quality badly. Worldwide prevalence of NP varies from 6.9-10% with spinal cord injury (SCI) explaining 40% of them. The 2nd commonest cause is diabetic peripheral neuropathy (DPN) that accounts for 22-28% of type 2 diabetes mellitus (T2DM). After having reviewed thoroughly how to manage diabetic neuropathic pain here we decided to conduct a systematic review on varying causes of NP and
    [Show full text]
  • Entrapment Neuropathies of the Lower Extremities
    ACU Sağlık Bil Derg 2017(4):185-191 DERLEME / REVIEW Fiziksel Tıp ve Rehabilitasyon / Physical Medicine and Rehabilitation Entrapment Neuropathies of The Lower Extremities Meral Bayramoğlu1 1Acıbadem Mehmet Ali Aydınlar ABSTRACT University Faculty of Medicine, Department of Physical Medicine and Peripheral nerves of the lower extremities might be compressed on their course where the anatomic configuration Rehabilitation, Istanbul, Turkey puts them in a vulnerable position. Neuropathic states can also be the result of any kind of trauma which directly injures the nerves or leads to a state of inflammation around the nerves. A wide variety of etiologies, as well as clinical presentations, may lead to diagnostic challenges for the clinician. The main symptom of a peripheral neuropathy is paresthesia. This could be accompanied by pain and numbness depending on the severity of the compression. The lumbosacral plexus, which arises from the ventral rami of the L1-S3 roots, serves the lower extremities. There are par- Meral Bayramoğlu, Prof. Dr. ticular anatomic sites where the nerves are more vulnerable. A clear identification of the anatomic course, and motor and sensory distribution of each nerve arising from the lumbosacral plexus, is critical in localizing the injury and plan- ning the optimal treatment. Electrodiagnostic studies help localize the site of the lesion, give a clue about the severity and potential recovery, and help differentiate any plexopathy and/or radiculopathy. Imaging studies, mostly magnetic imaging, can be ordered to help confirm the entrapment or exclude other pathologies. Most, but not all, of the cases can be treated by conservative measures. Common entrapments of the lower extremities, namely, meralgia paresthe- tica, femoral, obturator, sciatic, peroneal and tibial neuropathies will be discussed in this review.
    [Show full text]
  • Simvastatin-Induced Meralgia Paresthetica
    J Am Board Fam Med: first published as 10.3122/jabfm.2011.04.100229 on 7 July 2011. Downloaded from BRIEF REPORT Simvastatin-Induced Meralgia Paresthetica Menahem Sasson, MD, and Shvartzman Pesach, MD 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) cause mainly muscular adverse effects. During the last 20 years there has been solid evidence of peripheral neuropathy caused by st- atins, with a risk of one in 10,000 patients treated for 1 year. Meralgia paresthetica is an entrapment neuropathy occasionally encountered by primary care physicians. To date there has been no report of entrapment neuropathy that could have been caused or aggravated by statins. This case report presents meralgia paresthetica aggravated by simvastatin use that disappeared after simvastatin cessation. (J Am Board Fam Med 2011;24:469–473.) Keywords: Case Report, Entrapment Neuropathy, Meralgia Paresthetica, Peripheral Neuropathy, Simvastatin Meralgia paresthetica (MP) is an entrapment neu- present an entrapment neuropathy syndrome that ropathy of the lateral femoral cutaneous nerve. It is seems to be induced or aggravated by simvastatin. characterized by a localized paresthesia and numb- ness on the anterolateral aspect of the thigh.1 Its reported incidence is 0.43 per 10,000 person-pri- Case mary care years per a computerized registration A 58-year-old white man who was born in Kurdish copyright. network of a Dutch population study between 1990 Iran and currently working as a bus driver pre- to 1998.2 Before this, an incidence of 3 cases in sented with a burning pain along the lateral aspect 10,000 general clinic patients was reported.3 of his right thigh for the past 2 months that wors- 3-hydroxy-3-methylglutaryl coenzyme A reduc- ened when he stood erect.
    [Show full text]
  • Effectiveness of Ultrasound-Guided
    EFFECTIVENESS OF ULTRASOUND-GUIDED CORTICOSTEROID INJECTION AND ALCOHOL NEUROLYSIS IN THE TREATMENT OF MERALGIA PARESTHETICA DURING A 28-MONTH FOLLOW-UP PERIOD: A RETROSPECTIVE COHORT STUDY Ozge¨ Yapıcı1 and Meri¸cU˘gurlar2 1Marmara University School of Medicine 2Silivri Anadolu Private Hospital June 2, 2021 Abstract Abstract Objectives Meralgia paresthetica is a very rare sensory mononeuropathy of the lateral femoral cutaneous nerve (LFCN). The purpose of this study was to evaluate the outcomes and compare the results of ultrasound-guided corticosteroid injection and ultrasound-guided alcohol neurolysis in the treatment of meralgia paresthetica. Methods We performed a retrospective clinical study of 26 patients with a diagnosis of marelgia paresthetica with a duration of [?]10 months. The patients were divided into 2 groups, with the Group 1 receiving ultrasound-guided local corticosteroid injection and Group 2 receiving ultrasound- guided alcohol neurolysis to the entrapment site of the LFCN. Results The mean age of the patients in Group 1 was 42.2 years and in Group 2 was 40.8 years. The mean follow-up period of Group 1 was 28.7 months and Group 2 was 28.4 months. At the end of the follow-up period 9 patients in Group 1 and 10 patients in Group 2 declared full pain relief and improvement in cutaneous sensitivity. Conclusion Once meralgia paresthetica has persisted corticosteroid injection and alcohol neurolysis are both effective methods. Although the recurrence rates are higher in corticosteroid injection, both treatment methods decreased the pain and improved the patients’ satisfaction and long-term curative effect. EFFECTIVENESS OF ULTRASOUND-GUIDED CORTICOSTEROID INJECTION AND ALCOHOL NEUROLYSIS IN THE TREATMENT OF MERALGIA PARESTHETICA DUR- ING A 28-MONTH FOLLOW-UP PERIOD: A RETROSPECTIVE COHORT STUDY Abstract Objectives Meralgia paresthetica is a very rare sensory mononeuropathy of the lateral femoral cutaneous nerve (LFCN).
    [Show full text]
  • Dr Vanessa Sammons
    NEUROSURGEON Dr Vanessa Sammons Dr Vanessa Sammons MBBS (Hons) MPhil FRACS Surgeons, the international Association of Women Surgeons, and is a Neurosurgeon at Gosford Private Hospital, treating all the American Society of Peripheral Nerve Surgery. Dr Sammons neurosurgical conditions, but with a particular interest in Peripheral is also a mother of two. Nerve Surgery. Dr Sammons prides herself on providing Conditions Dr Sammons manages include: personalised patient care and utilising her skills to achieve the best • Nerve entrapments (including, but not limited to carpal tunnel outcome possible. syndrome, ulnar neuropathy, common peroneal neuropathy, Dr Sammons attended the University of Sydney, graduating tarsal tunnel syndrome, meralgia paraesthetica) with honours, also being awarded the Hinder Memorial Prize for • Nerve and brachial plexus injuries Surgery. Prior to Neurosurgery training, Dr Sammons completed • Thoracic outlet syndrome a Master of Philosophy in Advanced Medicine, researching brain • Nerve tumours (including schwannomas and neurofibromas) arteriovenous malformations. • Spinal cord and spinal nerve root compression Dr Sammons completed her training at several Sydney hospitals • Spinal cord and brain tumours including, Royal Prince Alfred Hospital, St George Hospital, Prince • Spinal degenerative conditions of Wales Hospital, Liverpool Hospital, Royal North Shore Hospital • Chiari malformations and Sydney Children’s Hospital. After the award of Fellowship to • Hydrocephalus the Royal Australasian College of Surgeons as a Neurosurgeon, Dr Sammons travelled to Foothills Medical Centre in Calgary, • Trigeminal neuralgia Canada where she undertook subspecialty training in Peripheral • Hemifacial spasm Nerve Surgery under the mentorship of Dr Rajiv Midha, a world Referrals: renowned Peripheral Nerve Surgeon. For referrals to Dr Sammons, please contact Central Coast During training Dr Sammons was the elected trainee representative Neurosciences at Suite 202, Level 1, 200 Central Coast to the Training Board of the Neurosurgical Society of Australasia.
    [Show full text]