Lateral Femoral Neuropathy: Post-Traumatic

[LovetoLive]

My 41-year-old husband was injured in a work related accident back in 1992.  After slipping, he landed on an air tool that he was running, which hit him in the hip/pelvic area.  Throughout the years he has had episodes experiencing sharp stabbing pains in his hip region, as though an ice pick is penetrating the area-it is horrible to watch him go through it.  

After the last flare up in Sept/02, for which he was off work for 2 wks, we aggressively pursued appts with specialists that could finally give us an answer to the problem, no one was able to help before.  A second neurologist knew the problem immediately: post-traumatic (lateral) femoral neuropathy.  Neurontin was started (currently 400mg QID).  A NCS revealed that the right lateral femoral cutaneous nerve was unobtainable.  

Doctor said this is a permanent impairment, nothing could be done to reverse the damage, and medication would be required for the rest of his life.  Pain has subsided dramatically through Neurontin although he can still feel a dull pounding in the area and in his testicle; the med also makes him feel disconnected.  Certain every day movements such as bending over, squatting, sitting/walking for extended periods or bouncing in a vehicle aggravate the problem.  

The point of my post is to obtain more info regarding his prognosis in support of reopening his worker's comp claim as well as learning what to expect.  Been all over the internet and find conflicting information and lack there of since his problem is due to trauma.  Any additional references or opinions would be much appreciated.

[LovetoLive]

Thank you for the response.  Just to provide additional case history for the record, I will add the following:

A NCS was done on both the left and right, with readings on the left [Lat(ms): 4.0; Pk Lat(ms) 5.5; Amp(uV) 45.7] and no response on the right.  According to the Doctor his left result was normal.  My husband is also fit at 180lbs, 6ft tall.  I believe the Doctor explained that there is a close proximity to the femoral nerve and the 'spermatic' cord - after the incident he had enormous swelling in the testicle, with the stabbing pain in the inguinal area occurring 1-2 months later.  

[CCF-Neuro-M.D.-JT]

Sorry to hear about your husband's accident. It is quite possible that it may be permanent if the nerve injury was severe enough.  However, the NCS are unhelpful unless the left side was done and the femoral nerve was documented normal on that side. This nerve can be technically difficult to measure especially if your husband is overweight. So to have it missing on one side without another for comparison is not that helpful. There are some reports in the literature of patients having this condition after extensive pelvic surgery and trauma.  One patient who had it postop pelvic surgery reportedly returned to normal after 4 months while another who had nerve trauma due to bone grafting required special nerve release surgery for symptomatic relief.  

However, given that your husband's problem dates back to 1992 and he still has recurrent pain, it's unlikely that it will go away on its own.  

Another thing is that lateral femoral cutaneous neuropathies should not involve the testicle.  It may be a more extensive problem involving the posterior femoral nerve or perhaps other nerves. It's a complex case and one thing to consider is a more extensive EMG if the previous one did not include the other side.  Here are some websites that may be of help:
1.Femoral neuropathies in general:
www.emedicine.com/neuro/topic589.htm
2.Meralgia paresthetica:
www.emedicine.com/NEURO/topic590.htm
3.Peripheral neuropathy info and support group
www.neuropathy.org

Good luck.