What are the symptoms and treatment options for femoral nerve entrapment (femoral neuropathy)?

From the Guidelines

Femoral nerve entrapment should be initially managed with conservative measures, including rest, activity modification, and pharmacological treatment with medications such as gabapentin or pregabalin, as these have shown efficacy in treating neuropathic pain 1. The treatment of femoral nerve entrapment aims to alleviate symptoms, improve function, and prevent further nerve damage.

• Conservative management is the first line of treatment and includes:
  • Rest and activity modification to reduce pressure on the nerve
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation
  • Physical therapy to improve flexibility and strength
• For patients with moderate to severe pain, medications such as gabapentin or pregabalin may be considered, as they have been shown to be effective in treating neuropathic pain 1.
• If symptoms persist, nerve blocks with lidocaine and corticosteroids may be considered, and surgical decompression may be reserved for cases that fail conservative management or show progressive neurological deficits. The choice of treatment should be individualized based on the patient's symptoms, medical history, and response to treatment, and should prioritize minimizing morbidity, mortality, and improving quality of life 1.
• It is essential to monitor patients for potential side effects of medications and adjust treatment accordingly.
• Patients should be educated on how to avoid activities that exacerbate symptoms, maintain proper posture, and use ergonomic modifications in daily activities to prevent further nerve damage.
• The treatment approach should be stepwise, with careful attention to relative symptom improvement, medication adherence, and medication side effects, to achieve pain reduction and improve quality of life 1.

From the Research

Causes of Femoral Nerve Entrapment

• Femoral nerve entrapment can be caused by various factors, including idiopathic compression, neurovascular conflict, and iatrogenic compression 2
• Iatrogenic compression can occur due to medical procedures such as cardiac catheterization, intra-abdominal vascular surgery, and laparoscopic hernia treatment 2
• Muscular slips from iliacus and psoas can also compress the femoral nerve, with a prevalence of 7.9% in a study of 242 specimens 3

Symptoms and Diagnosis

• Femoral neuropathies can cause severe and prolonged debility, with symptoms including weakness, sensory loss, and pain 4
• The most common presenting symptoms of femoral neuropathy are weakness (96%), sensory loss (73%), and pain (53%) 4
• Electrodiagnostic testing, including femoral motor nerve conduction studies, can be used to diagnose femoral neuropathy 4

Treatment and Management

• Microsurgical nerve decompression and elimination of neurovascular conflict can give satisfactory results in treating femoral nerve entrapment 2
• Femoral nerve blocks can be used to manage acute pre-hospital pain, with studies showing that they can reduce pain more effectively than other forms of analgesia 5, 6
• Catheter-mediated femoral nerve block analgesia can provide effective pain management in patients with proximal femoral fractures, with significant pain relief achieved in the first 30 minutes after administration 6

Prognosis and Outcomes

• The prognosis for femoral neuropathy is variable, with 83% of patients experiencing subjective clinical improvement at follow-up, but only 48% achieving nearly complete or complete recovery 4
• The time to initial improvement is typically around 3.3 months, with a mean time to recovery at final follow-up of 14.8 months 4