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Nerve Conduction Quick Set-Ups : Thigh / Leg / Foot Problems

WHAT IS INVOLVED

Lateral Cutaneaous Nerve of Thigh.

LOCATION

Lateral Cutaneaous Nerve of Thigh in the upper and outer thigh

COMMON SYMPTOMS

- Pain, burning in the thigh
- Poor tolerance to touch, clothes, cover or anything that rubs against thigh
- In mothers (or fathers) pain/burning with children sitting on lap
- No thigh or leg weakness or atrophy
- Usually unilateral
- Symptoms always present, no night/day preference

ONSET

- Usually Gradual over days, weeks
- May be Sudden

RISK FACTORS

- No gender preference
- Diabetes or family history of Diabetes, Alcoholism or other occupational or nutritional causes of Neuropathies, HIV infection
- Overweight
- Tight undergarments or clothing in the inguinal area

EXAM

- Decreased sensation over upper and lateral area of thigh
- Sometimes decreased sensation all the way to the patella
- Difficult to examine because of pain/burning induced by touching or rubbing
- Normal strength, no atrophy in thigh muscles
- Preserved Knee Jerk (if absent or unilaterally decreased suspect L3 root lesion)

LOCALIZATION

Pure sensory branch involvement at the upper and lateral end of the inguinal ligament

EMG

- Study Lateral Cutaneous Nerve of Thigh, usually small amplitude (<10 μV)
- Study both sides to compare amplitudes
- Response may be absent or significantly (<50%) smaller than healthy side
- Nerve Conductions may be difficult to perform in overweight subjects
- Rule out L3 root lesion by studying other Femoral and non-Femoral innervated muscles to include:

   - Vastus Lateralis (derived from Femoral Nerve below Inguinal ligament)
   - Ilio-Psoas (from Femoral Nerve above Inguinal ligament)
   - Thigh Adductors (from Obturator Nerve)

- In Meralgia Paresthetica, the needle exam of the Thigh muscles will be normal
- In L3 root lesions, Vastus Lateralis, Ilio-Psoas, Thigh Adductors and/or paraspinals could be involved
- In Femoral Nerve lesions, Vastus Lateralis and Ilio-Psoas, but not Thigh Adductors, are involved
- In Obturator Neuropathy, only Thigh Adductors are involved

RECOMMENDATIONS

- Can be very annoying
- Symptomatic treatment
- Stop/decrease cause, tight undergarments, clothing
- Lose weight
- Anti epileptics, tricyclics have been tried with various degrees of success
- Nerve blocks/Injections

WHAT ELSE COULD IT BE?

- Could be an L3 root lesion if associated muscle weakness (Vastus Lateralis, Ilio-Psoas and/or Thigh adductors) or absent or unilaterally decreased Knee jerk
- Few other conditions can cause the same symptoms