Entrapment Neuropathies of The Lower Extremities

Abstract

ABSTRACT Peripheral nerves of the lower extremities might be compressed on their course where the anatomic configuration puts them in a vulnerable position. Neuropathic states can also be the result of any kind of trauma which directly injures the nerves or leads to a state of inflammation around the nerves. A wide variety of etiologies, as well as clinical presentations, may lead to diagnostic challenges for the clinician. The main symptom of a peripheral neuropathy is paresthesia. This could be accompanied by pain and numbness depending on the severity of the compression. The lumbosacral plexus, which arises from the ventral rami of the L1-S3 roots, serves the lower extremities. There are particular anatomic sites where the nerves are more vulnerable. A clear identification of the anatomic course, and motor and sensory distribution of each nerve arising from the lumbosacral plexus, is critical in localizing the injury and planning the optimal treatment. Electrodiagnostic studies help localize the site of the lesion, give a clue about the severity and potential recovery, and help differentiate any plexopathy and/or radiculopathy. Imaging studies, mostly magnetic imaging, can be ordered to help confirm the entrapment or exclude other pathologies. Most, but not all, of the cases can be treated by conservative measures. Common entrapments of the lower extremities, namely, meralgia paresthetica, femoral, obturator, sciatic, peroneal and tibial neuropathies will be discussed in this review.