The 68th
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| 19S-050 |
Sciatica and lower extremity weakness secondary to femoral nerve neuroma
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Introduction
A neuroma is a tumor of nerve tissue which can arise from any peripheral nervous system. Although it is usually clinically insignificant, it can sometimes cause neurologic disability, numbness, or paresthesia. We reported a case of femoral nerve neuroma because it was associated with unilateral sciatica and lower extremity weakness.
Case report
An 82-year-old female patient came to our pain clinic. She presented with radiating pain on the right lateral leg from the thigh to the foot during the past 2 weeks. She had already received lumbar magnetic resonance imaging (MRI), which had not revealed any pathologic lesions that could be associated with her symptoms. She graded her pain intensity as an 8 on an 11-point numeric rating scale (NRS). The pain had been present continuously, and it was exacerbated by sitting, standing, or walking. It was alleviated when lying down. Right leg weakness and significant gait disturbance also presented.
On physical examination, there was tenderness at her right buttock area, especially in her piriformis muscles. Straight leg raising test was negative. The Patrick test was positive on the right side. Motor weakness (motor grade 4+/5) was observed at the right lower extremity. Sensation was 80-90% and decreased along with the right L5 dermatome. Sensation was also 50% and decreased at the right anterior thigh. After a detailed history taking and further physical examination, we found that there was a palpable mass at her right inguinal area for more than two years. The ultrasound exam showed about 4x3 cm sized heterogeneous mass (Figure 1). The MRI demonstrated a 3.1x2.7x5.2 cm sized well-defined soft tissue mass in the right inguinal area. The mass was closely located near the right femoral nerve. These finding suggested that the inguinal mass may be a neurogenic tumor. (Figure 2) Electromyography revealed right femoral neuropathy with L4-S1 radiculopathy. We prescribed pregabalin 75 mg, duloxetine 30 mg, and acetaminophen/tramadol for pain control. She is scheduled for surgery to remove the neuroma.
Conclusion
We presented a rare case of a femoral nerve neuroma, which caused buttock pain with sciatica and lower extremity weakness. Although rare, neuromas of the femoral nerve should be considered if sciatica with motor weakness is observed in a patient with no signs of lumbosacral radicular compression at imaging.
A neuroma is a tumor of nerve tissue which can arise from any peripheral nervous system. Although it is usually clinically insignificant, it can sometimes cause neurologic disability, numbness, or paresthesia. We reported a case of femoral nerve neuroma because it was associated with unilateral sciatica and lower extremity weakness.
Case report
An 82-year-old female patient came to our pain clinic. She presented with radiating pain on the right lateral leg from the thigh to the foot during the past 2 weeks. She had already received lumbar magnetic resonance imaging (MRI), which had not revealed any pathologic lesions that could be associated with her symptoms. She graded her pain intensity as an 8 on an 11-point numeric rating scale (NRS). The pain had been present continuously, and it was exacerbated by sitting, standing, or walking. It was alleviated when lying down. Right leg weakness and significant gait disturbance also presented.
On physical examination, there was tenderness at her right buttock area, especially in her piriformis muscles. Straight leg raising test was negative. The Patrick test was positive on the right side. Motor weakness (motor grade 4+/5) was observed at the right lower extremity. Sensation was 80-90% and decreased along with the right L5 dermatome. Sensation was also 50% and decreased at the right anterior thigh. After a detailed history taking and further physical examination, we found that there was a palpable mass at her right inguinal area for more than two years. The ultrasound exam showed about 4x3 cm sized heterogeneous mass (Figure 1). The MRI demonstrated a 3.1x2.7x5.2 cm sized well-defined soft tissue mass in the right inguinal area. The mass was closely located near the right femoral nerve. These finding suggested that the inguinal mass may be a neurogenic tumor. (Figure 2) Electromyography revealed right femoral neuropathy with L4-S1 radiculopathy. We prescribed pregabalin 75 mg, duloxetine 30 mg, and acetaminophen/tramadol for pain control. She is scheduled for surgery to remove the neuroma.
Conclusion
We presented a rare case of a femoral nerve neuroma, which caused buttock pain with sciatica and lower extremity weakness. Although rare, neuromas of the femoral nerve should be considered if sciatica with motor weakness is observed in a patient with no signs of lumbosacral radicular compression at imaging.
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