Question Right Femoral-Femoral bypass performed for severe claudication Sept. 2000, afterwards have had persistent pain in right groin radiating into the medial thigh. Neurologist says it is femoral neuropathy under tube where surgery performed. What caused injury, and how?
Is this complication that just sometimes happens, or did surgeon do something he should not have?
Is there any way to correct or lessen damage? Are pain killers only course? Thank You!
Answer the big problem in these type of surgery are the thrombi and emboli,bleeding, hematoma, infection, rare nerve injury depending the incision and where exactly the bypass has been done
sometime there is small nerve injury when dissection or scar tissue can give this type of problem
now the neurologist need to determine if really there is a nerve injury by an EMG.Pain in the leg in the distribution of the nerve (thigh, inner calf)
Sensation changes in the thigh, knee, or leg
Numbness, decreased sensation
Tingling, burning sensation
Pain
Abnormal sensations
A feeling of "the knee giving way"
Weakness of the knee or leg
Difficulty ascending stairs
Difficulty descending stairs (main problem)
Signs and Tests: A neuromuscular examination of the legs indicates femoral nerve dysfunction. There may be weakness on extension of the knee or flexion of the hips. Sensation changes are located in the lateral and anterior thigh and medial calf. The knee jerk reflex may be abnormal. There may be atrophy (loss of muscle mass) of the quadriceps muscles of the anterior (front) thigh.
Tests that reveal femoral nerve dysfunction may include:
An EMG (a recording of electrical activity in muscles)
Nerve conduction tests
Tests are guided by the suspected cause of the dysfunction as suggested by the patient's history, symptoms presented, and pattern of symptom development. They may include various blood tests, x-rays, scans, or other tests and procedures.
i womnder that may be a nerve was not raped up with the sutures or it is the scar tissue that is compressing the nerve hard for me to say without examination and the surgical report.
you will need to see back your surgeon for an examination he might know if he did any mistake to redirect you on what he has to do.or if there is a thrombi formation which give you this pain that irradiate to the groin
it can be also a failure of the bypass?
it can be neuropathy without relation to the surgery ?
now it is important to determine by investigation EMG if there is a nerve injury or a neiropathy due to other cause
if there is no neuroma formation if nerve surgery has been done
thrombi in the area .
pain killer is not the long term solution but the finding of the cause and to treat the cause.
there is also the type of anethesia if it was a femoral block or not that might also cause complication
Corticosteroids injected into the area may reduce swelling and pressure on the nerve in some cases. Over-the-counter or prescription analgesics may be needed to control pain (neuralgia). Various other medications may reduce the stabbing pains that some people experience, including phenytoin, carbamazepine, gabapentin or tricyclic antidepressants such as amitriptyline. Whenever possible, medication use should be avoided or minimized to reduce the risk of side effects.
Surgical removal of lesions that press on the nerve may benefit some cases.
Physical therapy exercises may be appropriate for some people to maintain muscle strength. Orthopedic assistance may maximize the ability to walk. This may include the use of braces, splints, or other appliances. Vocational counseling, occupational therapy, occupational changes, job retraining, or similar interventions may be recommended.
in conclusion if I consider that there is a femoral nerve injury
Treatment is aimed at maximizing mobility and independence. The cause should be identified and treated as appropriate. In some cases, no treatment is required and recovery is spontaneous.
If there is no history of trauma to the area, conservative treatment is indicated by sudden onset, minimal sensation changes and no difficulty in movement, and no evidence on testing of degeneration of the nerve axon.
Corticosteroids injected into the area may reduce swelling and pressure on the nerve in some cases. Over-the-counter or prescription analgesics may be needed to control pain (neuralgia). Various other medications may reduce the stabbing pains that some people experience, including phenytoin, carbamazepine, gabapentin or tricyclic antidepressants such as amitriptyline. Whenever possible, medication use should be avoided or minimized to reduce the risk of side effects.
Surgical removal of lesions that press on the nerve may benefit some cases.
Physical therapy exercises may be appropriate for some people to maintain muscle strength. Orthopedic assistance may maximize the ability to walk. This may include the use of braces, splints, or other appliances. Vocational counseling, occupational therapy, occupational changes, job retraining, or similar interventions may be recommended.
Prognosis: If the cause of the femoral nerve dysfunction can be identified and successfully treated, there is a possibility of full recovery. In some cases, there may be partial or complete loss of movement or sensation resulting in various extent of disability. Nerve pain may be quite uncomfortable and persist for a prolonged period of time.
hope this help if you have further information please let me know to be more specific
thanks
dan
