Differential diagnosis L2L4 radiculopathy

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Therapy Depends on etiology and type of nerve injury

Prognosis Depends on etiology and type of nerve injury

References Roger LR, Borkowski GP, Albers JW, et al (1993) Obturator mononeuropathy caused by pelvic cancer: six cases. Neurology 43: 1489-1492

Sorenson EJ, Chen JJ, Daube JR (2002) Obturator neuropathy: causes and outcome. Muscle Nerve 25: 605-607

Staal A, van Gijn J, Spaans F (1999) The obturator nerve. In: Staal A, van Gijn J, Spaans F (eds) Mononeuropathies; examination, diagnosis and treatment. Saunders, London, pp 109-111

Femoral nerve

Genetic testing

Fig. 40. Femoral nerve lesion after vascular surgery

Anatomy The femoral nerve is derived from the lumbar plexus (originating from the ventral roots of L2-L4). Proximal (intrapelvic) branches go to the psoas major and iliacus muscles, passing through the inguinal ligament. Motor branches go to the pectineus, sartorius and quadriceps muscles. Sensory branches to the medial aspect of the thigh, anterior medial knee, and lower leg (saphenous nerve) (see Fig. 39).

Symptoms Sensory loss on the ventral thigh, perhaps with saphenal involvement (over the tibial bone).

Buckling of the knee (on uneven surfaces) and falls (leg "collapses"). Sensory symptoms may be mild or absent.

Pain is variable, depending on the cause of the neuropathy. Often felt in the inguinal region or iliac fossa. Nerve trunk pain with or without sensory symptoms (e.g., in diabetes).

Clinical syndrome Atrophy and weakness of quadriceps muscles. Weakness of the psoas and quadriceps muscles only occurs with proximal lesions. Decreased or absent knee jerk. Sensory loss over anterior aspect of thigh and medial side of lower leg.

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