Tuesday, July 18, 2006

Obturator and combined obturator/femoral neuropathy

Obturator neuropathy-- sensory symptoms, including paresthesias and pain, possibly radiating in medial thigh. Motor involvement leads to trouble walking, due to inability to adduct the thigh, so thigh will be abducted and the gait is wide based. Examination-- weakness of thigh adductors is seen. There are no deep tendon reflex changes but the adductor tendon reflex may be absent.Etiology-- extension or lateral movements of leg that stretch it through the pelvis. Most cases are due to severe trauma: gunshot wounds, pelvic fracture or major trauma, and very rarely, childbirth.

Combined obturator/femoral neuropathy-- much more common, occurs in upper plexus lesions near psoas muscle. Causes include retroperitoneal hematoma, metastatic cancer and lymphoma. Clinically the quadriceps and the adductors are both paralyzed leading to a functional deficit of the leg.

Within pelvis the obturator nerve is medial to femoral or sciatic lesions and rare cases occur due to cement extrusion after hip surgery and after pelvic fracture.

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