Excerpt from Femoral Mononeuropathy

Synonyms, Key Words, and Related Terms: femoral nerve, nerve entrapment, nerve compression, femoral nerve anatomy, knee buckling

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Background

Femoral neuropathies can occur secondary to direct trauma, compression, stretch injury, or ischemia. Femoral neuropathy causes weakness predominantly of the quadriceps, which results in difficulty with ambulation.

Pathophysiology

Knowledge of femoral nerve anatomy is essential to understanding the mechanism of its injury and to localizing the lesion.

The femoral nerve is part of the lumbar plexus. It is formed by L2-4 roots and reaches the front of the leg by penetrating the psoas muscle before it exits the pelvis by passing beneath the medial inguinal ligament to enter the femoral triangle just lateral to the femoral artery and vein. Approximately 4 cm proximal to passing beneath the inguinal ligament, the femoral nerve is covered by a tight fascia at the iliopsoas groove. The nerve can be compressed anywhere along its course, but it is particularly susceptible within the body of the psoas muscle, at the iliopsoas groove, and at the inguinal ligament.

The main motor component innervates the iliopsoas (a hip flexor) and the quadriceps (a knee extensor). The motor branch to the iliopsoas originates in the pelvis proximal to the inguinal ligament. The sensory branch of the femoral nerve, the saphenous nerve, innervates skin of the medial thigh and the anterior and medial aspects of the calf.

Frequency

United States

Femoral mononeuropathies account for approximately 1% of all mononeuropathies seen in the author's active electrodiagnostic laboratory.

Race

No racial predilection has been noted.

Sex

No gender preponderance is known.

Age

Femoral mononeuropathy is reported in all age groups.

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