1/5. Acute femoral neuropathy secondary to an iliacus muscle hematoma.We present a patient with a spontaneous iliacus muscle hematoma, appearing immediately after a minor physical maneuver, presenting with pain and femoral neuropathy initially evidenced by massive quadriceps muscle fasciculations. A magnetic resonance imaging (MRI) study of the pelvic area confirmed the diagnosis, showing a hematoma secondary to a partial muscle tear. The patient was managed conservatively, and the continuous muscle activity ceased in 3 days, with progressive improvement of the pain and weakness. The recovery was complete. femoral neuropathy is uncommon and usually due to compression from psoas muscle mass lesions of diverse nature, including hematomas. Usually subacute, femoral neuropathy may present acutely in cases of large or strategically placed compressive femoral nerve lesions, and may require surgical evacuation.The case presented herein is remarkable since the muscle hematoma appeared after a nonviolent maneuver, fasciculations were present at onset, and conservative management was sufficient for a full recovery.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/5. femoral nerve injury complicating continuous psoas compartment block.OBJECTIVES: The objective of this case report is to describe a femoral nerve injury after a psoas compartment block (PCB) and to discuss the probable mechanisms of injury and neuron regeneration. To date, this is the first report of severe femoral nerve injury after PCB. CASE REPORT: A 60-year-old, American Society of Anesthesiologists II woman underwent right total knee replacement under general anesthesia and continuous PCB for postoperative analgesia. Postoperatively, she showed signs of severe femoral nerve injury. A physical therapy program and muscle electrical stimulation were instituted and continued for 6 months. The patient recovered completely with no residual motor or sensory deficit and had no other complication. CONCLUSIONS: Severe nerve injuries after regional anesthesia techniques remain infrequent and probably unreported. Our case report suggests that severe femoral nerve injury should be added to the list of reported complications during PCB. This case report is also encouraging because it shows the possibility of a good recovery after such injury.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/5. femoral nerve palsy secondary to traumatic pseudoaneurysm and iliacus hematoma.The authors report a case of traumatic femoral nerve palsy caused by a pseudoaneurysm of the iliolumbar artery and a iliacus muscle hematoma. This case report details not only the classic history and physical findings seen in patients such as this one, but also illustrates an unusual source of the hematoma and a discussion of its treatment. A 20-year-old man was assaulted and presented to the authors's institution with a 1-week history of severe pain in the left anterior thigh and groin, weakness in the left quadriceps muscle, and numbness in the anterior thigh and medial distal leg. Imaging studies demonstrated a large, 9.4 x 6.4 x 5.2-cm iliacus hematoma as well as a pseudoaneurysm originating from the left iliolumbar artery. The patient underwent angiographic embolization of the pseudoaneurysm followed by surgical evacuation of the hematoma. The embolization was performed before surgery to prevent any possible rebleeding from the pseudoaneurysm during evacuation of the hematoma. femoral nerve palsy caused by traumatic iliacus hematoma is an infrequent diagnosis often missed because of its insidious presentation. In this case, embolization of the iliolumbar artery pseudoaneurysm followed by surgical evacuation of the hematoma resulted in a nearly full recovery of the femoral nerve as of the last follow-up examination.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/5. femoral neuropathy after pelvic surgery.Postoperative femoral neuropathy is an uncommon complication occurring after pelvic surgery. Inappropriate stretching and prolonged compression of the nerve are 2 major mechanisms of the neuropathy. Here we report 2 cases of femoral neuropathy immediately following pelvic surgery. Both cases had neither previous vascular nor peripheral nerve disease. They suffered from weakness of left hip flexion and knee extension and sensory impairment over the left lower limb after surgery. electromyography and nerve conduction studies confirmed left femoral neuropathy. Both of the patients received physical therapy and had nearly total neurological recovery within 3 months. We report this unusual complication that followed major pelvic surgery and also review the literature and discuss the possible etiology for prevention of this injury.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/5. Treatment concepts for idiopathic and iatrogenic femoral nerve mononeuropathy.Femoral mononeuropathy has many etiologies and is often quite disabling, causing lower extremity paresthesia, anesthesia, pain, or paresis. Despite its morbidity, few therapies have been described to treat the femoral nerve palsy that does not resolve with conservative management or that is refractory to physical therapy. In this report, we present 3 cases of femoral nerve palsy; one as a complication of local nerve block, one as a complication of laparotomy, and one of idiopathic origin. In each case, symptomatic and objective improvement was achieved with femoral neurolysis. We suggest guidelines for the management of those patients who fail to respond to conservative therapy and indications for surgical intervention.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |