Polyneuropathy Differential diagnosis

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Radicular lesion (S2-S4) Sacral plexus

Structural abnormalities of the pelvic floor or viscera

EMG of external anal sphincter Diagnosis

Bulbocavernosus reflex Pudendal SEP

Anorectal manometry, urodynamic examinations Imaging

Amarenco G, Ismael SS, Bayle B, et al (2001) Electrophysiological analysis of pudendal References neuropathy following traction. Muscle Nerve 24: 11 6-11 9

Podnar S, Vodusek DB (2001) Standardization of anal sphincter electromyography: utilty of motor unit potential parameters. Muscle Nerve 24: 946-951

Mononeuropathies: lower extremities

Obturator nerve

Fig. 38. Obturator nerve anatomy. 1 Obturator nerve. 2 Cutaneous femoris posterior nerve. 3 Sapheneous nerve. 4 Calcaneal nerve. 5Sural nerve. 6 Lateral plantar nerve. 7 Medial plantar nerve

The obturator nerve fibers stem from L2-4, and course within the belly of the Anatomy psoas muscle, emerging on the medial side of the psoas, then passing over the sacroiliac joint, and continuing along the wall of pelvis to the obturator canal.

Sensory loss, paresthesias, or radiating pain in the medial thigh. Disability in Symptoms walking due to impaired stabilization of the hip joint. The leg is held in an abducted position, leading to a wide-based gait. The adductor tendon reflex may be absent.

Neuralgic pain may be confused with osteitis. Signs Adductor weakness, with or without sensory deficits.

Causes Compression: Obturator hernia, scar in thigh, labor, endometriosis, retroperito neal Schwannoma

Iatrogenic: Hip surgery, fixation of acetabular fracture, intrapelvic surgery Laparoscopic dissection of pelvic nodes, gracilis flap, prostatectomy Hypogastric artery aneursym Metastatic cancer

Trauma: pelvic fracture, gunshot, retroperitoneal hematoma

Obturator nerve injury occurs commonly with a femoral nerve lesion. Causes include retroperitoneal hematoma, cancer, hip arthroplasty, lymphoma.

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