Definition
Femoral neuropathy is a neurological disorder due to lesions or dysfunction of this nerve and is accompanied by pain and neurological deficits in region of the femoral nerve.
Aetiology
There are many causes for femoral neuropathy, but it is most frequently seen (2%) after hip surgery. In addition, diabetes, iliac haematoma, radiation, prostrate surgery, gynaecological exploratory surgery and tumours are also related to femoral neuropathy.
Signs and symptoms
The symptoms in femoral neuralgia usually consist of an unpleasant painful feeling in the front of the upper leg.
Patients complain of a characteristic burning, stabbing pain in the ventral side of the upper leg, together with a tingling sensation. Allodynia can be present. In addition, patients sometimes complain of a loss of strength that mainly occurs when using the stairs.
Diagnostics
Physical Examination
Neurological examination, particularly in the region of the femoral nerve, can confirm the diagnosis.
Additional Somatic Diagnostics
- Diabetes must be excluded.
- EMG of the femoral nerve.
- Referral, when there is suspicion of other aetiology.
Additional Psycho-cognitive Diagnostics
- RAND-36 (quality of life)
- VAS Pain (maximal, minimal, actual, average/week)
- PCS (catastrophising)
- HADS (fear and depression)
Multidisciplinary Treatment
Whether or not somatic treatment is indicated is based on the pain diagnosis. Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment comprising various non-somatic treatments may be necessary.
Non-somatic Treatment
- Psychological Treatment
- Depression Treatment
- Cognitive-Behavioural Treatment
- Rehabilitation Treatment
Somatic Treatment
Pharmacological treatment:
- Tricyclic antidepressants
- Anticonvulsives: carbamazepine, oxcarbazepine, gabapentine and pregabaline.
Interventional Pain Treatment