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Femoral neuropathy
Introduction
- Uncommon as isolated peripheral lesion since nerve is well protected by muscle.
- Cause: pressure on medial thigh.
- Bilateral femoral nerve injury has been seen after extreme hip flexion.
- External trauma.
- Peripheral nerve neoplasia.
- Signs: unable to extend stifle, non-weight bearing, absence patellar of reflex, decreased skin sensation on medial thigh.
- Diagnosis: signs, electrophysiology.
Presenting signs
- Recent perineal surgery.
- Non-weight bearing on limb.
- Inability to extend stifle and decreased hip flexion.
- Loss of sensation to medial surface of the thigh, stifle and lower limb.
- Atrophy of quadriceps muscles.
Cost considerations
- Surgical exploration of femoral nerve (especially if associated with femoral fractures).
- Acupuncture.
- Limb amputation if peripheral nerve tumor.
- General supportive care and physiotherapy.
Pathogenesis
Etiology
- Same as nerve trauma neuritis Nerve trauma neuropathy.
- Pressure on medial thigh during perineal surgery, eg due to positioning hindlimbs over edge of operating table.
- Neoplasia affecting nerve as it passes through iliopsoas muscle, or within the nerve anywhere along its length.
- Trauma to femur (fractures).
Pathophysiology
- Constant pressure on femoral nerve → development of neuropraxia (localized conduction block without degenerative changes), local demyelination or axonotmesis (axon interruption), the latter leading to Wallerian-type degeneration distally → loss of function to extensor muscles of stifle → loss of sensation to medial thigh → neurogenic atrophy of quadriceps muscles.
Timecourse
- Immediately after injury: loss of function.
- Quadriceps muscle atrophy will be delayed by 7-10 days.
- Slow, progressive signs if peripheral nerve tumor.
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Bailey C S (1987) Cutaneous sensory testing in the dog. J Vet Int Med 1 (3), 128-135 PubMed.
Other sources of information
- Summers B A et al (1995) diseases of the peripheral nervous system. Veterinary Neuropathology. Mosby. pp 402-279.
- Braund K G (1994) Clinical syndromes in veterinary neurology. Mosby. pp 277-279.