PNS: Femoral Nerve

• The presentation concerns the femoral nerve, its pathways, compression sites, and treatment plans

Class Outline

• Topics for discussion are questions, nerve mobilization demo for upper extremity, femoral nerve lecture, demo, and treatment exchange

Femoral Nerve

• The femoral nerve originates from the lumbar plexus, specifically L2-L4
• It travels through the psoas major
• Travels behind the inguinal ligament and through the femoral triangle
• Has the following branches: articular branch to hip and knee, motor branch to anterior thigh, sensory branch to thigh and leg

Femoral Nerve Motor Function

• The following muscles are innervated: iliacus, pectineus, sartorius, rectus femoris, vastus medialis, vastus lateralis, vastus intermedialis

Femoral Nerve Sensory Function

• Lateral cutaneous nerve provides sensation to the anterolateral thigh
• Sapphenous nerve provides sensation to the anteromedial thigh and leg

Causes of Femoral Nerve Lesions

• Neuropraxia, axonotmesis, and neurotemesis can cause femoral nerve lesions
• Fractures of the femur or pelvic bones can cause femoral nerve lesions
• Surgeries can cause femoral nerve lesions
• Compression from the iliopsoas or inguinal ligament
• Compression from a space-occupying lesion

Femoral Nerve Lesions Signs and Symptoms

• Motor signs include quad weakness, loss of patellar DTR (L4), loss of coordination in walking/running, loss of knee extension and some hip flexion, and muscle wasting
• Sensory signs include anteromedial thigh and medial lower leg and foot, inguinal ligament pain

Femoral Nerve Assessment

• Tests include patellar DTR, MMTs (quariceps, pectinus, sartorius, iliacus), sensory assessment in affected areas, prone knee bending test (biases femoral nn), prone knee extension test (biases saphenous nerve), femoral nerve traction test (sidelying, passive knee flexion and hip extension)

Meralgia Paresthetica

• This condition involves compression of the lateral femoral cutaneous nerve, which is the posterior division of ventral rami L2-L3
• Usually compressed at the inguinal ligament
• Can be caused by trauma like seat belts, pregnancy/birth, tight clothing, heavy equipment belts, and inguinal hernia repair

Meralgia Paresthetica Signs and Symptoms

• Has no motor deficits
• Causes sensory issues like numbness, paresthesia, and burning pain in the upper, lateral thigh
• Is usually unilateral
• Aggravated by walking or standing
• Relieved by sitting or slackening tissue around the inguinal ligament

Meralgia Paresthetica Diagnosis

• Consider trigger points in vastus lateralis, vastus intermedialis, TFL, and gluteus medius.
• Differential diagnosis should include L2 radiculopathy and lumbar cutaneous nerve injury
• Precautions include avoiding further irritation to the nn, avoiding increasing symptoms, and not mobilizing a axonotmesis or neurotmesis because they are presistent, severe symptoms.

Meralgia Paresthetica Assessment

• Sensory assessment of nerve distribution is important
• Tinel's Test: Tap at the inguinal ligament, just medial of ASIS to elicit tingling in nn
• Pelvic Compression Test: Deep palpation over inguinal ligament reproduces symptoms
• Hip extension may exacerbate symptoms

Meralgia Paresthetica Treatment

• Decompression is key
• Incorporate relaxation techniques
• Focus on inguinal ligament release
• Perform MFR (myofascial release)
• Various techniques can be applied to the quads, sartorius, and iliacus muscles
• May pillow legs into hip flexion for comfort
• Use sensory stimulation
• Recommend ADL modifications
• Posterior pelvic tilt may slacken inguinal ligament

Restless Leg Syndrome

• Restless Leg Syndrome is a neurological disorder characterized by noxious sensations in the leg, absent of external stimuli
• Sensations include burning, creeping, tugging, insects crawling
• It can be uncomfortable, irritating, or painful
• There is an irresistible impulse to move or shift for relief
• symptoms are often worse in the evening or at night, or long periods of rest
• It is idiopathic, but may be a genetic component since 50% of cases have a familial connection
• Women are more likely to be affected than men
• Common in older adults
• Possible associations include iron, vitamin B12, or folic acid deficiency; kidney failure; diabetes; Parkinson's; peripheral neuropathy; and pregnancy
• May be aggravated by stimulants like coffee, alcohol, and tobacco
• Treatment options include relaxation-focused massage, decreased consumption of stimulants, consulting a physician to assess nutritional deficiencies, maintaining good sleep hygiene, regular exercise but not too close to bedtime, and hydrotherapy