Question Title: nerve compression injury

I have been diagnosed with entrapment of the lateral cutaneous branch
of the iliohypogastric nerve following extensive pelvic surgery. This
has left me with severe intractable pain in the lateral/hip, thigh
buttock area. This was initially diagnosed as trochanter bursitis
and treated for trochanter bursitis some 9 months post-operatively.
Then trochanter bursitis was ruled out, and the diagnosis of entrapment
of the lateral cutaneous branch of the iliohypogastric nerve was made.
The lateral cutaneous branch of this nerve has been diagnostically
blocked successfully several times. The block stops the pain. Surgery
has been done twice, once on Sept 11 and once on October 23 of this
year to cut the branch of this nerve. Neither surgery has worked.
Do you have any ideas as to why it has not worked? This surgery was
done by a general surgeon. I understand there is now available testing
by MR neurography. Do you have this testing available at Cleveland
Clinic? Would such a test more definitively show where this nerve
is damaged? Could the surgeon have missed the nerve branch? Thank
you..

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Dear Maggie,

Thank you for the question.
Iliohypogastric entrapment neuropathy is rare, both the anterior and the lateral branches may be affected. In your case from the symptoms you described above, I agree that it sounds like the lateral division. How did they make the diagnosis? Lateral femoral cutaneous neropathy is more common and can cause similar symptomps. The area of the skin supplied by the iliohypgastric, ilioinguinal, and genitofemoral nerves overlap with those innervated by the T12 spinal nerve, and the lateral femoral cutaneous nerves. This overlap, individual varaiations in distribution, and communications between these nerves often make it difficult to know which nerve is involved in a patient with complaints in this area.

The fact that nerve block worked helped in localizing the lesion. The surgery did not work for several possible reasons: it was the wrong nerve that was cut, you do not have iliohypogastric neuropathy but rather ilioinguinal or lateral femoral neuropathy, or the problem might have been caused by a compression of the nerve by scarr tissue and this was not addressed (the pathway needs to be widened and scarr tissue removed).

We here at the CLeveland Clinic has a world class pain management clinic and Plastic surgery Depts. If you would like to be evaluated please call us at 1-800-CCF CARE. The pain management dept also are working on innovative techniques such as nerve stimulator, dorsal colum stimulator, and nerve block.

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