Posted By CCF Neurology W6 MD on March 09, 1999 at 20:39:23:
In Reply to: Femoral nerve damage following surgery posted by Bill on March 09, 1999 at 13:03:30:
Following emergency surgery for a ruptured appendix and a very complicated post-op course which included the placement of abdominal drains and renal dialysis ,I am left with a complete paralysis of may left quadracept muscle. I cannot move my leg at all.
I would like to know the differential diagnosis,the frequency,and the proper procedures for evaluating this kind of injury.
If anyone would care to hazard a prognosis on the limited information available,I would like to know what the odds are that I will regain use of my leg. It has been two months since the operation. Thank you for your time
thank you for your question, it's an important one, and I will try to be systematic in my answer.
Injury to the femoral nerve is a recognized complication during abdominal, pelvic, inguinal and hip operations. The most common surgical cause associated with femoral nerve injury has been abdominal hysterectomy, (7.5-10% incidence quoted). I don't have the number for appendectomy but I'm sure the figure is lower.
The nerve usually is inadvertently damaged (either cut, snared by suture, stretch or pressure from retractors) during the procedure. Post op complication such as a large blood clot (iliacus hematoma) can also injure the nerve. Infection (abscess) my develop post op and cause injury.
Other causes of femoral nerve injury/problem include:lithotomy position,
trauma(bullet and stab wound, hip and pelvic fractures), tumors, diabetes.
In your case it is important to know when the weakness occur, right away, soon after surgery or delayed (such as hematoma or abscess formation)
The most useful test is an EMG of not only your quadriceps muscles but also other muscles in the area in search of involvement outside the femoral nerve territory. A nerve conduction study may be helpful too.
If you have not been evaluated by a neurologist and EMG/NCS, then you should talk to your doctor. The prognosis is dependent on the cause and the extent of the injury.
If a complete laceration of the nerve is suspected, exploration and suturing of the nerve are indicated. In lesser injuries, it is best to await spontaneous recovery for a few weeks.
The EMG should be done after at least 3 weeks after the surgery/onset of the weakness. What kind of improvement if any have you noticed since then?
I'm very much interested in learning about your case and the results of your EMG. Please don't hesitate to post updates.
If youlive near Cleveland and would like to be evaluated here at CCF, please call 1-800-CCF CARE.
key words: femoral neuropathy, EMG, leg weakness