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Table of Contents    
LETTER TO EDITOR
Year : 2016  |  Volume : 64  |  Issue : 6  |  Page : 1303-1304

Sports induced femoral neuropathy: Review of literature


Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Web Publication11-Nov-2016

Correspondence Address:
Jayantee Kalita
Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.193823

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How to cite this article:
Kalita J, Misra UK, Singh RK, Bhoi SK. Sports induced femoral neuropathy: Review of literature. Neurol India 2016;64:1303-4

How to cite this URL:
Kalita J, Misra UK, Singh RK, Bhoi SK. Sports induced femoral neuropathy: Review of literature. Neurol India [serial online] 2016 [cited 2019 Aug 20];64:1303-4. Available from: http://www.neurologyindia.com/text.asp?2016/64/6/1303/193823


Sir,

Femoral neuropathy as a result of sports injury is rare; only 11 case reports in the English literature were noted when a PubMed search was made using the key word “femoral neuropathy” and “sports” or “iliacus hematoma.”[1],[2],[3],[4],[5],[6],[7],[8],[9],[10] We report a patient with femoral neuropathy following a Kabaddi game and review the literature.

A 22-year-old engineering student fell down while playing Kabaddi, with his right lower limb in the extreme extension at hip, with the left one abducted, and the trunk falling forward. He had pain in his right hip and his right knee buckled frequently while walking. His symptoms worsened after exercise. Neurological examination at 3 weeks revealed a mild wasting and weakness of the right quadriceps [Figure 1]a and absent right knee reflex. He had 20% sensory impairment in the right anteromedial aspect of thigh. His coagulation profile was normal. Magnetic resonance imaging (MRI) revealed a hematoma of 6 × 2.4 cm in size involving the right iliacus soft tissue planes [Figure 1]b. Femoral nerve conduction study revealed a mild prolongation of latency on the right side (right 4.9 ms, left 3.5 ms) with reduced compound muscle action potential (right 0.8 mv/left 7.6 mv). Right saphenous nerve conduction was unrecordable [Figure 1]c. Electromyography revealed fibrillations and neurogenic motor unit potentials on right vastus lateralis. He was treated with analgesics and bed rest. At a 3-month follow-up, the neurological deficit improved completely, except for a mild wasting of the right quadriceps. Ultrasound revealed resolution of the hematoma.
Figure 1: Photograph of the patient shows wasting of the right thigh (a). His magnetic resonance imaging revealed an iliacus hematoma. (b). Femoral nerve conduction study of this patient revealed prolonged distal latency (R/L 4.9/3.5ms) and reduced compound muscle action potential (R/L 0.1/7.6mv) on the right side. The gain in the right is 200ìv/division, and the left, 2mv/division. (arrow, c)

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Our patient suffered from a right femoral nerve palsy following a Kabaddi game. The site of the lesion was likely at the inguinal ligament because his iliacus power was normal. The femoral nerve injury may be due to the stretch because he fell down in extreme extension at the hip joint, and the iliacus hematoma was away from the femoral nerve; furthermore, there was absence of hip flexor weakness which usually occurs due to the presence of retropelvic lesions. In the reported literature, femoral neuropathy occurred during gymnastics in 6 patients, athletetic events in 2 patients and basketball, karate, and ice skating in 1 patient each.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10] Iliacus hematoma was noted in 10 patients; 6 of them were operated. Five patients improved with conservative treatment [Table 1].[1],[2],[3],[4],[5],[6],[7],[8],[9],[10] Our patient also improved following conservative treatment. Nonsteroidal anti-inflammatory drugs should be avoided as analgesics because of the high frequency of occurrence of an iliacus hematoma, which may enlarge. Recordable femoral nerve conduction may suggest a good recovery in spite of the presence of fibrillation on an electromyogram.
Table 1: Sports induced femoral neuropathy

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Murray IR, Perks FJ, Beggs I, Moran M. Femoral nerve palsy secondary to traumatic iliacus haematoma--A young athlete's injury. BMJ Case Rep 2010;22;2010.  Back to cited text no. 1
    
2.
Weiss JM, Tolo V. Femoral nerve palsy following iliacus hematoma. Orthopedics 2008;31:178.  Back to cited text no. 2
    
3.
Giuliani G, Poppi M, Acciarri N, Forti A. CT scan and surgical treatment of traumatic iliacus hematoma with femoral neuropathy: Case report. J Trauma 1990;30:229-31.  Back to cited text no. 3
    
4.
Sanders SM, Schachter AK, Schweitzer M, Klein GR. Iliacus muscle rupture with associated femoral nerve palsy after abdominal extension exercises: A case report. Am J Sports Med 2006;34:837-9.  Back to cited text no. 4
    
5.
Patel A, Calfee R, Thakur N, Eberson C. Non-operative management of femoral neuropathy secondary to a traumatic iliacus haematoma in an adolescent. J Bone Joint Surg Br 2008;90:1380-1.  Back to cited text no. 5
    
6.
Kumar S, Anantham J, Wan Z. Posttraumatic hematoma of iliacus muscle with paralysis of the femoral nerve. J Orthop Trauma 1992;6:110-2.  Back to cited text no. 6
    
7.
Gertzbein SD, Evans DC. Femoral nerve neuropathy complicating iliopsoas haemorrhage in patients without haemophilia. J Bone Joint Surg Br 1972;54:149-51.  Back to cited text no. 7
    
8.
Pirouzmand F, Midha R. Subacute femoral compressive neuropathy from iliacus compartment hematoma. Can J Neurol Sci 2001;28:155-8.  Back to cited text no. 8
    
9.
Ramirez G, Rofes S, Bordas JL, Gomez J, Fernandez JM. Posttraumatic haematoma of the iliacus muscle with paralysis of the femoral nerve. A case report. Acta Orthop Belg1983;49:372-8.  Back to cited text no. 9
    
10.
Green JP. Proximal avulsion of the iliacus with paralysis of the femoral nerve. Report of a case. J Bone Joint Surg Br 1972;54:154-6.  Back to cited text no. 10
    


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