Podcast
Questions and Answers
Which nerve roots contribute to the formation of the femoral nerve?
Which nerve roots contribute to the formation of the femoral nerve?
- L1-L3
- L2-L4 (correct)
- L4-S1
- L3-L5
A patient presents with weakness in knee extension and loss of patellar reflex. These findings are most likely indicative of a lesion affecting which nerve?
A patient presents with weakness in knee extension and loss of patellar reflex. These findings are most likely indicative of a lesion affecting which nerve?
- Superior gluteal nerve
- Sciatic nerve
- Femoral nerve (correct)
- Obturator nerve
Which of the following muscles does the femoral nerve innervate?
Which of the following muscles does the femoral nerve innervate?
- Biceps femoris
- Gluteus maximus
- Rectus femoris (correct)
- Adductor magnus
A patient reports sensory loss on the anteromedial aspect of the thigh and leg. Which nerve is most likely involved?
A patient reports sensory loss on the anteromedial aspect of the thigh and leg. Which nerve is most likely involved?
Which of the following conditions is characterized by compression of the lateral femoral cutaneous nerve?
Which of the following conditions is characterized by compression of the lateral femoral cutaneous nerve?
Which activity would most likely aggravate the symptoms of meralgia paresthetica?
Which activity would most likely aggravate the symptoms of meralgia paresthetica?
What is a common location for compression of the lateral femoral cutaneous nerve in meralgia paresthetica?
What is a common location for compression of the lateral femoral cutaneous nerve in meralgia paresthetica?
A patient with meralgia paresthetica reports relief when sitting. What is the most likely reason for this?
A patient with meralgia paresthetica reports relief when sitting. What is the most likely reason for this?
In assessing a patient for meralgia paresthetica, where should a Tinel's test be performed to assess the lateral femoral cutaneous nerve?
In assessing a patient for meralgia paresthetica, where should a Tinel's test be performed to assess the lateral femoral cutaneous nerve?
Which of the following is a common symptom associated with restless leg syndrome (RLS)?
Which of the following is a common symptom associated with restless leg syndrome (RLS)?
Which time of day do the symptoms of restless leg syndrome typically worsen?
Which time of day do the symptoms of restless leg syndrome typically worsen?
Which of the following is a potential aggravating factor for restless leg syndrome?
Which of the following is a potential aggravating factor for restless leg syndrome?
Which of the following is a recommended treatment for restless leg syndrome?
Which of the following is a recommended treatment for restless leg syndrome?
A patient is diagnosed with axonotmesis of the Femoral nerve. As a massage therapist, what precaution is MOST important considering the nerve damage?
A patient is diagnosed with axonotmesis of the Femoral nerve. As a massage therapist, what precaution is MOST important considering the nerve damage?
In assessing a person presenting with possible Meralgia paresthetica, palpation over which anatomical structure is MOST likely to reproduce their symptoms?
In assessing a person presenting with possible Meralgia paresthetica, palpation over which anatomical structure is MOST likely to reproduce their symptoms?
What action could be performed to slacken the tissue around the inguinal ligament, potentially providing relief in cases of meralgia paresthetica?
What action could be performed to slacken the tissue around the inguinal ligament, potentially providing relief in cases of meralgia paresthetica?
Which of the following best describes the sensory distribution of the lateral femoral cutaneous nerve?
Which of the following best describes the sensory distribution of the lateral femoral cutaneous nerve?
A patient presents with pain and sensory changes in the anterolateral thigh, but no motor deficits. What is the MOST likely condition?
A patient presents with pain and sensory changes in the anterolateral thigh, but no motor deficits. What is the MOST likely condition?
Which of the following is a characteristic sign or symptom of a femoral nerve lesion?
Which of the following is a characteristic sign or symptom of a femoral nerve lesion?
A patient has undergone an inguinal hernia repair and now presents with symptoms of meralgia paresthetica. What is the MOST likely cause of the nerve compression?
A patient has undergone an inguinal hernia repair and now presents with symptoms of meralgia paresthetica. What is the MOST likely cause of the nerve compression?
Which of the following statements is MOST accurate regarding the position of the lateral femoral cutaneous nerve in relation to the ASIS?
Which of the following statements is MOST accurate regarding the position of the lateral femoral cutaneous nerve in relation to the ASIS?
The femoral nerve is typically in the middle of which two bony landmarks?
The femoral nerve is typically in the middle of which two bony landmarks?
What is the primary function of the Lateral Femoral Cutaneous Nerve?
What is the primary function of the Lateral Femoral Cutaneous Nerve?
Which category of nerve injury is typically associated with internal compression from soft tissue or external compression from clothing/belts/equipment?
Which category of nerve injury is typically associated with internal compression from soft tissue or external compression from clothing/belts/equipment?
Which activity should be avoided in the acute stage of meralgia paresthetica treatment?
Which activity should be avoided in the acute stage of meralgia paresthetica treatment?
A client reports symptoms of Restless Leg Syndrome (RLS). Which lifestyle modification is MOST appropriate to suggest?
A client reports symptoms of Restless Leg Syndrome (RLS). Which lifestyle modification is MOST appropriate to suggest?
Which of these is an accurate description of the pathway of the femoral nerve?
Which of these is an accurate description of the pathway of the femoral nerve?
Which test biases the Saphenous nerve?
Which test biases the Saphenous nerve?
Which of the following signs and symptoms are associated with Femoral nerve lesions?
Which of the following signs and symptoms are associated with Femoral nerve lesions?
Which test biases the Femoral nerve?
Which test biases the Femoral nerve?
Which of the following muscles are MMTS tested with a Femoral nerve assessment?
Which of the following muscles are MMTS tested with a Femoral nerve assessment?
During a Femoral Nerve Assessment, what signs or symptoms would you look for to indicate a sensory issue?
During a Femoral Nerve Assessment, what signs or symptoms would you look for to indicate a sensory issue?
During an assessment, your client describes their pain as aggravated by walking, standing, and relieved by sitting. Where is their potential pain located?
During an assessment, your client describes their pain as aggravated by walking, standing, and relieved by sitting. Where is their potential pain located?
When treating a Meralgia Paresthetica condition, what is your focus?
When treating a Meralgia Paresthetica condition, what is your focus?
Which of the following would be an appropriate treatment for Meralgia Paresthetica?
Which of the following would be an appropriate treatment for Meralgia Paresthetica?
In Meralgia paresthetica, radiculopathy is related to which dermatome?
In Meralgia paresthetica, radiculopathy is related to which dermatome?
What Homecare would you provide, for someone who is experiencing symptoms of Lateral Femoral Cutaneous Nerve?
What Homecare would you provide, for someone who is experiencing symptoms of Lateral Femoral Cutaneous Nerve?
Which of the following conditions may lead to a compression of the femoral nerve?
Which of the following conditions may lead to a compression of the femoral nerve?
Which sign confirms if it is very badly irritated, working in the area may exacerbate symptoms?
Which sign confirms if it is very badly irritated, working in the area may exacerbate symptoms?
When performing the Prone Knee Extension Test, which nerve are you biasing for?
When performing the Prone Knee Extension Test, which nerve are you biasing for?
Flashcards
Femoral Nerve Pathway
Femoral Nerve Pathway
L2-L4, travels through psoas major, behind the inguinal ligament, through the femoral triangle.
Femoral Nerve Branches
Femoral Nerve Branches
Motor branch to anterior thigh; Sensory branch to thigh and leg; Articular branch to hip and knee.
Muscles supplied by Femoral Nerve
Muscles supplied by Femoral Nerve
Iliacus, Pectineus, Sartorius, Rectus femoris, Vastus medialis/lateralis/intermedius
Femoral Nerve Sensory Function
Femoral Nerve Sensory Function
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Types of Femoral Nerve Lesions
Types of Femoral Nerve Lesions
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Motor signs of Femoral Nerve Lesions
Motor signs of Femoral Nerve Lesions
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Sensory signs of Femoral Nerve Lesions
Sensory signs of Femoral Nerve Lesions
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MMT assessment of Femoral Nerve
MMT assessment of Femoral Nerve
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Meralgia Paresthetica
Meralgia Paresthetica
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Meralgia Paresthetica symptoms
Meralgia Paresthetica symptoms
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Trigger points in Meralgia Paresthetica
Trigger points in Meralgia Paresthetica
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Meralgia Paresthetica Precautions
Meralgia Paresthetica Precautions
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Meralgia Paresthetica Treatment
Meralgia Paresthetica Treatment
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Meralgia Paresthetica Assessment
Meralgia Paresthetica Assessment
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Restless Leg Syndrome
Restless Leg Syndrome
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Restless Leg Syndrome Sensations
Restless Leg Syndrome Sensations
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Restless Leg Syndrome Treatment
Restless Leg Syndrome Treatment
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Meralgia Paresthetica Etiology
Meralgia Paresthetica Etiology
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Lateral Femoral Cutaneous Nerve Anatomy
Lateral Femoral Cutaneous Nerve Anatomy
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Lateral Femoral Cutaneous Nerve Sensory Function
Lateral Femoral Cutaneous Nerve Sensory Function
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Meralgia Paresthetica Etiology
Meralgia Paresthetica Etiology
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Meralgia Paresthetica Treatment
Meralgia Paresthetica Treatment
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Meralgia Paresthetica Home care
Meralgia Paresthetica Home care
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Study Notes
Femoral Nerve - Anatomy
- Lumbar plexus origin at L2-L4
- Travels through psoas major and behind the inguinal ligament
- Passes through the femoral triangle
- Branches include articular branches to hip and knee, motor branches to anterior thigh, and sensory branches to thigh and leg
Femoral Nerve Motor Function
- Innervates the iliacus, pectineus, sartorius, rectus femoris, vastus medialis, vastus lateralis, and vastus intermedialis muscles
Femoral Nerve Sensory Function
- Lateral cutaneous nerve supplies the anterolateral thigh
- Saphenous nerve supplies the anteromedial thigh and leg
Causes of Femoral Nerve Lesions
- Neuropraxia, axonotmesis, or neurotemesis
- Fractures of the femur or pelvic bones
- Surgeries
- Compression from the iliopsoas muscle or inguinal ligament
- Space-occupying lesions
Femoral Nerve Lesions Signs & Symptoms
- Motor signs include quadriceps weakness, loss of patella Deep Tendon Reflex (DTR) at L4, loss of coordination, loss of knee extension and some hip flexion, and muscle wasting
- Sensory signs include altered sensation in the anteromedial thigh, medial lower leg, and foot
- Pain may be present at the inguinal ligament
Femoral Nerve Assessment
- Patellar DTR assessment
- Manual Muscle Tests (MMTs) of the quadriceps, pectineus, sartorius, and iliacus
- Sensory assessment in affected areas
- Prone knee bending test which biases the femoral nerve
- Prone knee extension test which biases the saphenous nerve
- Femoral nerve traction test (side-lying, passive knee flexion and hip extension)
Meralgia Paresthetica
- Compression of the lateral femoral cutaneous nerve (from posterior division of ventral rami L2-L3)
- Usually compressed at the inguinal ligament
- Can result from trauma (e.g., seat belt in MVA), pregnancy, birth, tight clothing, heavy equipment belts, or inguinal hernia repair
Meralgia Paresthetica Signs & Symptoms
- No motor deficits
- Sensory symptoms in the upper, lateral thigh: numbness, paresthesia, and burning pain
- Usually unilateral
- Aggravated by walking or standing
- Relieved by sitting or slackening tissue around the inguinal ligament
Meralgia Paresthetica Differential Diagnosis
- Trigger points in vastus lateralis, vastus intermedialis, TFL, or glute med
- L2 radiculopathy
- Lumbar cutaneous nerve injury
Meralgia Paresthetica Precautions
- Avoid further irritation to the nerve
- Avoid increasing symptoms
- Avoid mobilizing in axonotmesis or neurotmesis cases with persistent, severe symptoms
Meralgia Paresthetica Assessment
- Sensory assessment in nerve distribution area
- Tinel's test: tap at the inguinal ligament, medial to ASIS, to elicit tingling in the nerve
- Pelvic compression test: deep palpation over inguinal ligament reproduces symptoms
- Hip extension may exacerbate symptoms
Meralgia Paresthetica Treatment
- Focus on decompression and relaxation
- Inguinal ligament release and myofascial release (MFR) for quads, sartorius, and iliacus
- May pillow legs into hip flexion
- Sensory stimulation
- ADL modifications
- Posterior pelvic tilt may slacken the inguinal ligament
Restless Leg Syndrome
- Neurological disorder with noxious sensations in the leg without external stimuli
- May be CNS related
- Sensations include burning, creeping, tugging, and insects crawling
- Irresistible impulse to move or shift for relief
- Often worse in the evening or at night, or during long periods of rest
- May have a genetic component; women are more affected than men, usually older adults
- Possible associations include iron, vitamin B12, or folic acid deficiency, kidney failure, diabetes, Parkinson's, peripheral neuropathy, or pregnancy
- May be aggravated by stimulants (coffee, alcohol, tobacco)
Restless Leg Syndrome Treatment
- Relaxation-focused massage
- Decreasing stimulants
- See MD to assess nutritional deficiencies
- Maintaining good sleep hygiene
- Regular exercise (not too close to bedtime)
- Hydro-warm or cool (no extreme temperatures)
Lateral Femoral Cutaneous Nerve - Anatomy
- Comes from the lumbar plexus, nerve roots L2-L3, a sensory nerve without motor fibers
- Located between anterior superior iliac spine (ASIS) and femoral nerve, more lateral and close to the ASIS
- Femoral nerve typically in the middle of the ASIS and the pubis, just lateral to the femoral artery
Lateral Femoral Cutaneous Nerve Function
- Only sensory function for the skin over the lateral thigh
Grade of Injury Lateral Femoral Cutaneous Nerve
- Can be any grade of nerve injury
- Neuropraxia normally results from internal or external compression like clothes or belts
- Axonotmesis or Neurotmesis normally results from iatrogenic causes such as post-surgery, post-injections, or due to conditions like diabetes or other metabolic pathologies
Etiology of Lateral Femoral Cutaneous Nerve
- Meralgia Paresthetica is a compressive mononeuropathy with burning pain in the anterolateral thigh
- Goal is to alleviate compression occurring below the inguinal ligament or due to tight clothes/belts/equipment
- Treatment includes surgical decompression, injections (steroid, or nerve block), or conservative management such as weight loss, physio, massage therapy
Lateral Femoral Cutaneous Nerve Signs and Symptoms
- Most common entrapment at the inguinal ligament
- Trauma (seat belt in MVA)
- Pregnancy; delivery - hips in flexion
- Tight clothing
- Surgery - hernia
- Incidence is much higher in people with diabetes
- Symptoms occur in the upper lateral thigh and can include numbness, paresthesia, burning pain
- Walking & standing aggravate symptoms
- Usually unilateral
- Trigger points - vastus lateralis, vastus intermedius, glute min, TFL
Lateral Femoral Cutaneous Nerve Differential Diagnosis
- Radiculopathy - L2 dermatome
- Lumbar cutaneous nerves (iliohypogastric, subcostal) will have associated low back pain wrapping around obliques and be more proximal than the LFC distribution
Lateral Femoral Cutaneous Nerve Precautions
- Do not irritate an irritated nerve
- Applying pressure in the area of the nerve should not increase symptoms
- Stop decompressing or mobilizing the nerve directly if persisting symptoms occur from the pressure applied
- Ask how quickly symptoms dissipate after you remove your pressure
Lateral Femoral Cutaneous Nerve Treatment
- Skin rolling the entire lateral thigh
- Cross-hands around ilium / inguinal ligament and abdomen
- Treat active TrP which refer into area
- Bow inguinal ligament
- Thigh 3D wringing either supine or supine with flexion
- Side-lying lift skin and mobilize nerve (hip flex-ext)
- Supine lift skin and mobilise nerve (knee flex-ext)
- Modify techniques to suit the healing stage and severity of the condition
- The more acute or severe, the less direct the attempt to decompress or mobilize tissue
Lateral Femoral Cutaneous Nerve Homecare
- Modify ADLs around external compression sources (clothes, belts, equipment)
- Encourage posterior tilt of pelvis to slacken inguinal ligament
- Lift skin and flex hip standing
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