Department of Neurosurgery, University of Wisconsin, Madison, WI, USA
13.1 Case Presentation
A 57-year-old female complains of pain and numbness in the left anterolateral thigh for 9 months. This followed surgery for hip replacement via an anterior approach. The pain is worse with touch, walking, going upstairs, downstairs, and prolonged standing. It is relieved by standing still and relaxing. The pain fluctuates between 2 and 6 on the VAS depending on her activity. Pregabalin helped some. PMH: migraine, DVT, kidney infections, diabetes, kidney stones, arthritis, and pancreatitis. PSH: two tubal pregnancies, tubal ligation, left total hip replacement, cervical fusion, and hemithyroidectomy. FH: positive for lymphoma in her father, stomach cancer in her paternal grandfather, breast cancer in her paternal grandmother, leukemia in her maternal grandmother, and diabetes in her mother. On examination, the area of diminished sensation is depicted in Fig. 13.1. The arrows point to the hip incision, which is tender to palpation. Otherwise motor examination and reflexes are normal.
What is the diagnosis? What is the cause?
What tests are needed?
What is the plan for treatment?
Meralgia paresthetica , probably from LFCN damage during surgery or entrapment in scar tissue.
EMG : absent SNAP from the LFCN on the left side, while they were present on the right side. US : The LFCN was not visualized at the distal margin of the scar . There was no neuroma observed.
US -guided injection of the left LFCN for both diagnostic and therapeutic purposes. This gave her relief for only a few hours.
Premium Wordpress Themes by UFO Themes
WordPress theme by UFO themes