Objective of the Study: To investigate patterns of the development of femoral nerve entrapment caused by abnormal shortening of the psoas muscle in the region of the inguinal ligament in patients with osteoarthritis of the hip.
Study Design: This was a comparative study.
Materials and Methods: Thirty-four patients with terminal osteoarthritis of the hip were included in the study. All study participants were asked to fill out a visual analogue scale and complete the Oswestry Low Back Pain Disability Questionnaire and the Douleur Neuropathique 4 (DN4) questionnaire. Study assessments included anthropometry, electromyography with stimulation of the right and left femoral nerves accompanied by measurement of terminal latency and M-response amplitude, as well as needle electromyography of the right and left psoas muscles coupled with measurement of mean motor unit potential duration, spontaneous activity, and amplitude of muscle contraction.
Study Results: All patients had axonal neuropathy of the femoral nerve ipsilateral to the affected hip joint. The study revealed that in 32 patients (94%) the ipsilateral psoas muscle was abnormally shortened. Clinical manifestations included increased lumbar lordosis, relative shortening of the limb, reduced muscle tone in the quadriceps femoris, and severe nociceptive pain.
Conclusion: Statistical correlation analysis showed a direct impact of pathologically excessive muscle tone in a relatively well innervated psoas muscle on the development of ischemic-compression femoral neuropathy. A strong negative correlation between femoral nerve compression and severity of pain in the hip joint and the anterior thigh suggested that femoral nerve entrapment contributes to hip joint pain and degeneration.
Contributions: Pilieva, A.V. — was responsible for selection, examination, and treatment of patients; reviewed relevant publications; collected clinical data; processed, analyzed, and interpreted the study data; assisted with statistical analysis of the study data, and participated in writing the final manuscript; Arkov, V.V. — was responsible for study design; reviewed critically important content, and approved the final version submitted for publication; Grishina, N.A. — performed stimulation and needle electromyography and assessed and interpreted electroneuromyography data.
Conflict of interest: The authors declare that they do not have any conflict of interests.
A.V. Pilieva (Corresponding author) — Rostov State Medical University (a Federal Government-funded Educational Institution of Higher Education), Russian Federation Ministry of Health; 29 Nakhichevansky Pereulok, Rostov-on-Don, Russian Federation 344022. e-LIBRARY.RU SPIN: 5797-0117. E-mail: email@example.com
V.V. Arkov — Moscow Research and Practice Center for Medical Rehabilitation, Restorative and Sports Medicine (a State Autonomous Healthcare Institution), Moscow City Department of Health; 53 Zemlyanoy Val St., Moscow, Russian Federation 105120. e-LIBRARY.RU SPIN: 1533-9994. E-mail: firstname.lastname@example.org
N.A. Grishina — Rostov State Medical University (a Federal Government-funded Educational Institution of Higher Education), Russian Federation Ministry of Health; 29 Nakhichevansky Pereulok, Rostov-on-Don, Russian Federation 344022. E-mail: email@example.com