Femoral Neuropathy

The femoral nerve arises in the lumbar plexus from branches of the posterior division of the L2-4 roots. The nerve passes between and innervates the iliac and psoas muscles. It then descends beneath the inguinal ligament, just lateral to the femoral artery, to enter the femoral triangle in the thigh, where it divides into the anterior and posterior divisions. The nerve may be damaged by penetrating lacerations or missile wounds, complications of femoral angiography, retroperitoneal tumors or abscesses, irradiation, fractures of the pelvis or femur, surgical table malpositioning, hip arthroplasty, and renal transplantation.

Femoral nerve injury produces weakness of knee extension due to quadriceps paresis. Proximal lesions can also impair hip flexion, due to iliopsoas weakness.

Sensory loss over the anterior and medial aspect of the thigh extends at times to the medial malleolus and the great toe. Electromyography demonstrates neurogenic changes, and electrophysiological studies show reduced motor potential amplitude. The differential diagnosis includes the following.

High lumbar herniated - In purely femoral nerve palsy, the function of the disk adductors and their reflexes remains intact, whereas in an L2-3 root lesion, the adductors are weak

- In an L4 root lesion, the tibialis anterior is also involved.

- The distribution of sensory loss is characteristic of each type of lesion

Lumbar plexus palsies

Muscular dystrophy of the quadriceps

Lipodystrophy after insulin injection in diabetics

Arthritic muscle atrophy

Sarcoma of the proximal femur

Ischemic infarction of the knee extensors

Diabetes 2

Diabetes 2

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