Question Title: L4 radio.. acute denervation and genitofemoral damage

I recently had a emg/ncs done and the findings revealed "L4 radiculopathy
with acute denervation changes and clinically there is a entrapment or stretching
injury to the genitofemoral nerve". A sacral/lumbar mri after the emg/ncs
revealed a normal spine, therefore I was told the damage is beyond the spine.
Since an abdominal hysterectomy/ooph. in 12/96 I have had severe pain with
burning and stinging in lower left abdominal area from hip bone around to
mid pubic and left groin down thigh to knee. Since day one of the surgery
I have had NO genital area sensation other than a slight feeling of pressure
when applied. I have also felt as though a belt was being pulled across the
scar from hip bone to hip bone with pain worsened in bladder as it filled.
I have had an incontience problem since surgery that I did not have before.

I have pursued these problems with several doctors since 12/96 and in 10/96
a gyn performed a laproscopy and was able to cut some of the adhesions which
freed my bladder & were described as severe dense adhesions throughout lower
abdominal cavity into intestines. Dr. said only could remove with a laparotomy
incision. My question is, what does the emg/ncs findings mean exactly, and
in relation to getting rid of the pain and recovering feeling in the genital area?
If this nerve damage is causing the pain and lack of sensation, what could have
caused the damage and can it be reversed? Sorry this is so long but felt you
needed background info. Thank you for your time and input.

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Dear Angie:

The symptoms you describe in the left groin and genital area can well result from a left genitofemoral neuropathy. Such a neuropathy can at times occur as a complication of horizontal lower abdominal incisions such as may be used for hysterectomy or hernia repair.

The diagnosis of genitofemoral neuropathy (and other related neuropathies in that region, such as ilioinguinal and iliohypogastric neuropathy) is essentially clinical. EMG techniques to address these neuropathies are just not good enough.

I do not think the L4 radiculopathy diagnosed in your case has any meaningful connection with your groin-genital symptoms, or with the genitofemoral nerve, which is supplied by higher lumbar roots.

The treatment of genitofemoral neuropathy involves the use of drugs for pain control, local nerve blocks, and even possibly local re-exploration with neurolysis. I cannot comment on the prognosis or chances of recovering genital sensation, because these treatments are more directed at controlling pain.

I hope this is helpful. Good luck!

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