Neuralgia of the thigh: causes, symptoms, diagnosis and treatment

Peculiarities

The lateral cutaneous nerve of the thigh contains only a sensory fiber; it does not innervate muscles, so no movement will be impaired if affected. The main complaint made by patients is pain and impaired sensitivity of the thigh surface in the upper part. The discomfort may be constant or occur periodically. The pain can be severe and is sometimes accompanied by an intense burning sensation, which causes significant discomfort.

Clinical manifestations of root compression in osteochondrosis

*The table shows the most commonly affected roots that can cause pelvic pain (the L5, S1 roots are most often affected).

In conclusion, one cannot help but mention such a pathological condition as COMPRESSION NEUROPATHY - damage to the peripheral nerves, in this case the pelvic nerves, when they are compressed, as the cause of pelvic pain.

Such compression may occur as a result of narrowing of the musculofascial and/or musculoskeletal canals in which the nerves pass. This occurs due to local proliferation of connective tissue, with prolonged monotonous overstrain of the musculo-ligamentous apparatus in athletes and/or as a result of professional activity, with soft tissue injuries and/or dislocations.

Compression syndromes are also called tunnel syndromes, when due to compression of the nerve trunk and the vessels feeding it, certain changes occur in it.

In our article we will look at damage (neuropathy) of the pudendal nerve, obturator nerve, “causalgia syndrome of the inguinal-genital zone”, lateral cutaneous nerve of the thigh and damage to the lumbosacral plexus.

Symptoms of sciatic nerve compression are discussed in piriformis syndrome (see above).

Increased pain when walking

The pain usually intensifies when standing upright or while walking, which is caused by skin tension on the front of the thighs, where the nerve actually branches. Some patients experience virtually no discomfort in the area of ​​innervation, but there are complaints of numbness, goosebumps, and skin tightness in this area. Sometimes pain appears or intensifies as the pathology progresses, but it can also be almost absent. With a prolonged course of neuropathy of the external cutaneous nerve of the thigh, a decrease in sensitivity often develops in a certain area of ​​the body.

The essence of the problem

The term neuralgia of the femoral nerve usually means severe pain caused by damage to the nerve fibers that form this nerve structure. This phenomenon can have a very different etiology, and is usually identified with diseases such as neuropathy and neuritis, while, in the first case, the lesion is caused by a degenerative mechanism and pinched fibers, and in the second by an inflammatory process. In any case, these pathologies lead to dysfunction of the nerve, which can have serious consequences.

In order to understand the degree of danger of the disease, you need to understand the functional and anatomical factors. The femoral nerve is a fairly large peripheral nerve and forms the largest branch of the lumbar nerve plexus. In addition to its main task - innervation of the thigh muscles, it provides skin sensitivity in areas such as the thigh, lower leg, and foot. The significant length of its main trunk explains the frequent damage to the fibers.

The nerve in question is formed by spinal roots (L1, L2 and L3), which, leaving the spinal trunk, gather together and descend below, passing between the psoas and iliacus muscles. It is these muscles that are primarily innervated by the motor branches of the femoral nerve and ensure adduction of the thigh to the abdomen, rotation of the thigh in the outer direction, and tilt of the body forward from a vertical position.

Next, the nerve bypasses the psoas muscle in the anterior zone and rushes into the femoral triangle through a small gap under the inguinal ligament. Here the femoral nerve branches, and each branch enters the deepened canals between the femoral muscles, which are closed by fascia. Nerve branches in this area provide innervation to the muscles responsible for hip flexion and knee extension. Sensory branches provide skin sensitivity over an extended area from the groin to the knee.

The longest sensory branch rushes in the lower direction to the lower leg and foot, forming the so-called saphenous nerve. This branch is responsible for skin sensitivity on the anterior surface from the knee to the foot. In the area of ​​the popliteal cap, the infrapatellar branch departs from the femoral nerve, which is involved in the movement of the knee joint.

The lesion of the femoral nerve can be located at any part of its course. Any damage to nerve fibers, first of all, reflexively causes intense pain, as well as various specific manifestations depending on the location of the affected area. Particularly noticeable is neuralgia of the external cutaneous nerve of the thigh, which has a significant length and is responsible for the motor and sensory functions of the lower limb.

Neuropathy - description of the disease

This pathology according to ICD 10 is assigned class VI - diseases of the nervous system (codes G50-G99).

This neuropathy usually occurs near the superior anterior iliac spine, where the nerve pierces the bundles of inguinal ligaments. In addition, the disease can appear due to pinching at the point where the impulse fiber passes through the fascia lata of the thigh. Most often, this pathology develops in men of retirement age due to fibrosis of the inguinal ligament. The deviation is manifested by numbness, paresthesia on the outer surface, usually with burning pain when walking.

Extension of the hip can increase pain, while flexion, on the contrary, reduces it. Over time, there is likely to be a decrease in tactile, temperature, and then pain sensitivity in this area. Losing weight sometimes reduces the manifestation of the disease. This disease is rarely observed in women. And if it does occur, it happens during pregnancy, which is accompanied by late toxicosis. The disease can also have an infectious toxic origin, in particular in diabetes, against the background of typhoid fever, vitamin deficiency, and so on.

Causes of pathology

Among the triggers that can cause pathologies of the lateral cutaneous nerve of the thigh, the most common are factors that cause compression of the fibers in the groin area. These include wearing a corset, tight belts or too tight underwear, along with obesity, pregnancy, curvature of the spine (we are talking about scoliosis, lordosis), hip injuries and bone fractures.

In addition, the causes of the disease are the following factors: muscle tonic and reflex changes that occur during disease and injury of the spine (lumbar radiculitis, osteochondrosis, discogenic myelopathy, lumbar sector fractures, and so on). All of the above reasons lead to a change in the relative position of the anatomical structure of the inguinal ligament area, which causes friction of the nerve against the ligament or iliac spine when bending forward and against the background of hip movements. Next, we will find out how the disease is currently treated.

Treatment

Effective therapy for pathologies of the lateral cutaneous nerve of the thigh is a combination of medications and reflex therapeutic methods. This treatment is usually carried out by a neurologist. A special role is played by the elimination of triggers that cause the development of neuropathy. For example, weight loss along with tumor removal, treatment of hip joint pathologies, and correction of vertebral disorders.

Pain relief is carried out by prescribing anti-inflammatory drugs and analgesics, such as Nemisulide along with Ketorolac and Ibuprofen. In more complex cases, it is advisable to locally administer local anesthetics, such as Lidocaine, Novocaine, or use glucocorticoids (Hydrocortisone, Diprospan). Improvement of the trophism of the affected structure is achieved through the use of vasoactive medications (nicotinic acid, Pentoxifylline) and metabolic pharmaceuticals such as Cyanocobalamin, Thiamine, Pyridoxine and their combinations.

Disease prevention

A set of measures to prevent the occurrence of femoral neuralgia includes:

• regular moderate physical activity and physical activity to strengthen muscles and ligaments;
• adherence to the principles of healthy and rational nutrition, control of body weight;
• avoidance of sports, household, professional injuries and hypothermia;
• correction and prevention of postural disorders;
• timely detection and treatment of any infections;
• regular preventive examinations with a doctor.

With timely diagnosis and adequate treatment, neuralgia of the femoral nerves can be successfully treated with complete restoration of limb function.

Physiotherapy

Physiotherapeutic treatment is prescribed after consultation with a doctor. It may include, for example, darsonvalization along with mud therapy, hydrogen sulfide or radon baths, massage, and so on. Acupuncture or electroacupuncture may be performed. True, the effectiveness of reflexology depends largely on the professionalism of the treating specialist.

In some cases, against the background of the lack of proper effect from conservative therapy and in the presence of intense pain syndrome, the question of performing surgical intervention in the area of ​​the inguinal ligaments is raised. In this situation, the goal is to decompress the nerve.

Now let's look at cutaneous lateral femoral nerve syndrome.

Treatment methods

In the vast majority of cases, after all symptoms have been clarified, treatment of femoral neuralgia is carried out conservatively. Surgery is necessary in cases of serious injury and compression of nerve fibers resulting from the accumulation of blood in the retroperitoneal space.

Conservative therapy

Conservative treatment of neuralgia of the femoral nerves is carried out according to the following scheme:

• relief of pain using analgesics or injection blockade;
• the use of glucocorticosteroid drugs to reduce inflammation;
• muscle relaxants are used to reduce muscle spasms;
• To restore the functions of nerve fibers, vasoactive therapy is carried out using vitamin complexes and drugs based on pentoxifylline and nicotinic acid.

Physiotherapy

During the recovery stage, patients are shown physical therapy to stimulate tissue regeneration, improve blood supply, strengthen the muscular-ligamentous system and accelerate rehabilitation. A few simple exercises from the complex:

• From a standing position, lift your straightened leg and turn its toe towards and away from you. Repeat several times, then change legs.
• While standing, lift your legs one at a time, bending them at the knees.
• Lying on your side with emphasis on your elbow, raise and lower your straight leg. As you lower your leg, try to relax your muscles.
• From a supine position, lift your body slightly, extend your arms several times, performing swimming movements, and return to the starting position.

Traditional medicine

Any traditional medicine should be used as an addition to the main course of treatment and only after consultation with your doctor.

Traditional methods are mostly aimed at increasing blood flow to the affected area in order to relieve muscle spasm and reduce pain:

• Massage with heated oil. Add 10 drops of pine essential oil to 2 tablespoons of olive oil, heated in a water bath. The affected limb is massaged with the mixture.
• Compress with alcohol tincture of radish. The pulp of black radish and horseradish root, crushed to a pulp, is mixed in equal parts with alcohol and left for 1-2 weeks in a cool, dark place. Compresses are applied to the affected limb overnight.
• Homemade ointment. Mix a tablespoon of apple cider vinegar and turpentine with one egg yolk. The mixture is applied under a warm bandage for several hours.

Neuropathy of the external cutaneous nerve of the thigh: causes and symptoms

Neuropathy of this femoral nerve was described in the last century by the Russian neurologist Roth. It is observed mainly in men who are over the age of fifty. It is worth noting that men between fifty and sixty years old make up seventy-five percent of cases. This pathology occurs in pregnant women, mainly in the last trimester, which is directly related to the ongoing change in the position of the pelvis.

In most medical cases, external cutaneous nerve syndrome of the thigh is unilateral. Bilateral lesions account for about twenty percent. There are known family examples of such neuropathy, which are probably caused by genetically determined features in the structure of this element and the anatomical structure surrounding it.

Carrying out an ultrasound

Ultrasound examination of the lumbar plexus nerve was first used to diagnose pathologies in the late nineties. With the beginning of the use of this technique, its undeniable advantage over other diagnostic methods became clear. Electrophysiological techniques such as electromyography and neuromyography are traditionally recognized as a kind of gold standard for identifying diseases of the peripheral nervous system.

However, it must be emphasized that the information that was obtained during the listed examinations does not give an idea of ​​​​the state of the surrounding tissue, and also does not indicate the nature and causes of damage to the nerve trunks, and does not always accurately reflect the localization of the change. At the same time, it is this information that helps the doctor determine the tactics of surgical or conservative treatment.

Diagnostics

The success of treatment primarily depends on how accurately the diagnosis was made. Primary characteristic symptoms may indicate pathology, however, instrumental research methods may be needed to accurately determine the location of disorders:

• X-rays can reveal changes in the acetabulum and femur;
• ultrasound examination of the nerve allows you to get a more accurate picture;
• electroneurography helps to clarify the degree of damage to nerve fibers and the quality of conduction of nerve impulses;
• CT and MRI to clarify the diagnosis if other methods do not provide a complete picture of the pathology.

Femoral nerve neuropathy - what is this pathology?

Neuropathy of the lateral cutaneous nerve and femoral nerve at the iliac psoas level is often caused by compression as a result of muscle spasms or hemorrhage into the psoas muscle, which occurs during overuse or injury. Less commonly, neuropathy of the femoral nerves is caused by a retroperitoneal hematoma or tumor, for example, sarcoma, lymphoma. A hematoma can form in the presence of hemophilia and thrombocytopenia.

In addition, one of the factors in the development of this kind of neuropathy of the posterior cutaneous nerve of the thigh is the complication of anticoagulant treatment used for thromboembolism and thrombosis, especially among patients with abdominal aortic aneurysms. Cases of femoral neuropathy that were caused by nerve damage as a result of appendectomy, surgery on the kidneys or ureters, as well as bursitis and abscess of the iliac psoas muscle have also been described in medicine.

The cause of compression of the femoral nerves in the area of ​​the inguinal ligaments may be lymphogranulomatosis along with a hernia. Damage to structures is possible, among other things, during surgery on the hip joints, in the case of surgical treatment of inguinal hernias, etc.