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  • Updated 01.29.2024
  • Released 11.21.1997
  • Expires For CME 01.29.2027

Femoral neuropathy



Femoral neuropathy is a rare but serious mononeuropathy of the lower extremity causing knee extension (quadriceps) and weakness (and at times hip flexion weakness), typically with numbness of the medial leg. If careful neurologic examination is not performed, symptoms may initially be attributed to orthopedic injury, such as pathology of the hip joint, muscle strain, or quadriceps tendon tear. Common causes include trauma, surgical procedures, and retroperitoneal hematoma. Nerve conduction studies and electromyography can confirm the diagnosis and offer prognostic information. Management remains controversial as some patients with mild cases will achieve good outcomes with conservative management. However, urgent surgical intervention may be prudent in cases caused by retroperitoneal hematoma leading to severe, progressive weakness.

Key points

• The femoral nerve is a mixed sensorimotor nerve comprised of the ventral rami of spinal roots L2–L4.

• Femoral neuropathy presents with quadricep weakness, numbness, and variable pain. Hip flexion weakness is observed in more proximal lesions, often acutely.

• Examination typically reveals weakness of knee extension with absent or depressed patellar reflex and normal thigh adduction.

• Most femoral neuropathies are caused by compression of the nerve either in the pelvis or beneath the inguinal ligament.

• Nerve conduction studies and needle EMG are useful for diagnostic and prognostic purposes. Important alternative considerations in the differential diagnosis, such as lumbosacral radiculopathy and plexopathy, typically can be distinguished from femoral neuropathy using these studies.

Historical note and terminology

Early published literature led many to believe that diabetes mellitus is associated with femoral mononeuropathy. It is now clear that isolated femoral neuropathy in diabetics is rare, and most reported cases were mislabeled and were actually diabetic lumbosacral radiculoplexus neuropathy (also known as diabetic amyotrophy). Because this condition has become more widely recognized, no reliable reports of isolated diabetic femoral neuropathy have been published during the last 3 decades.

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