Advertisement

Sports Medicine

, Volume 27, Issue 4, pp 261–274 | Cite as

Nerve Entrapment Syndromes as a Cause of Pain in the Hip, Groin and Buttock

  • Paul McCroryEmail author
  • Simon Bell
Injury Clinic
First Online:

Abstract

In sports medicine, chronic hip, groin and buttock pain is a common diagnostic problem. Because of the complex anatomy of this region and the many potential neurological causes for pain, few sports clinicians have a detailed understanding of this problem. This paper discusses the clinical aspects of nerve entrapment syndromes related to sport and takes a regional approach in order to provide a diagnostic framework for the general sports physician. The various neurological syndromes are discussed and the surgical management elaborated in detail.

For some specific conditions, such as the so-called ‘piriformis syndrome’, the pathophysiological understanding has changed since the early descriptions and now this particular diagnosis is often ascribed to almost any cause of buttock and/or hamstring symptoms. We discuss the nature of the origin of local symptoms and note that the often described symptoms are more likely due to compression of structures other then the sciatic nerve. Furthermore, the role of piriformis hypertrophy or anatomical nerve variations in the genesis of this syndrome must be questioned. We suggest renaming this the ‘deep gluteal syndrome’ to account for all of the observed phenomena.

As sports medicine continues to develop a scientific basis, the role of nerve entrapments as the basis for chronic symptomatology is undergoing a new understanding and clinicians need to be aware of the diagnostic possibilities and be able to advise patients accordingly on the basis of scientific fact not anecdotal fiction.

Keywords

Pudendal Nerve Anterior Superior Iliac Spine Nerve Entrapment Obturator Nerve Piriformis Muscle 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Brukner P, Khan KM. Clinical Sports Medicine. Sydney: McGraw-Hill, 1993Google Scholar
  2. 2.
    Baquie P, Brukner P. Injuries presenting to an Australian sports medicine centre. Clin J Sports Med 1997; 7: 28–32CrossRefGoogle Scholar
  3. 3.
    Kannus P, Aho H, Jarvinen M, et al. Computerised recording of visits to an outpatient sports clinic. Am J Sports Med 1987; 15: 79–85PubMedCrossRefGoogle Scholar
  4. 4.
    Galasko C, Monor T, Lenon G, et al. University of Manchester sports injury clinic. Br J Sports Med 1982; 16: 23–6PubMedCrossRefGoogle Scholar
  5. 5.
    Witman P, Melvin M, Nicholas J. Common problems seen in a metropolitan sports injury clinic. Phys Sportsmed 1981; 9: 105–8Google Scholar
  6. 6.
    Fricker P, Taunton J, Ammann W. Osteitis pubis in athletes: infection, inflammation or injury? Sports Med 1991; 12 (4): 266–79PubMedCrossRefGoogle Scholar
  7. 7.
    Bradshaw C, McCrory P, Bell S, et al. Obturator nerve entrapment: a cause of groin pain in athletes. Am J Sports Med 1997; 25: 402–8PubMedCrossRefGoogle Scholar
  8. 8.
    Bradshaw C, McCrory P. Obturator nerve entrapment. Clin J Sports Med 1997; 7: 217–9CrossRefGoogle Scholar
  9. 9.
    Stewart J. Focal peripheral neuropathies. 2nd ed. New York: Raven Press, 1993Google Scholar
  10. 10.
    Missoul C. Nerve Injuries. In: Dee R, editor. Principles of orthopaedic practice. New York: McGraw-Hill, 1989Google Scholar
  11. 11.
    Kopell HP, Thompson W. Peripheral nerve entrapments of the lower extremity. N Engl J Med 1962; 266: 16–9PubMedCrossRefGoogle Scholar
  12. 12.
    Mumenthaler M, Schliack H. Peripheral nerve lesions: diagnosis and therapy. New York: Thieme, 1991Google Scholar
  13. 13.
    Sunderland S. Nerves and nerve injuries. 2nd ed. Edinburgh: Churchill Livingstone, 1978Google Scholar
  14. 14.
    Stulz P, Pfeiffer KM. Peripheral nerve injuries resulting from common surgical procedures in the lower portion of the abdomen. Arch Surg 1982; 117: 324–7PubMedCrossRefGoogle Scholar
  15. 15.
    Kopell H, Thompson W, Postel A. Entrapment neuropathy of the ilioinguinal nerve. N Engl J Med 1962; 266: 16–9PubMedCrossRefGoogle Scholar
  16. 16.
    Knockaert D, D’Heygere FG, Bobbaers H. Ilio-inguinal nerve entrapment: a little known cause of iliac fossa pain. Postgrad Med J 1989; 65: 632–5PubMedCrossRefGoogle Scholar
  17. 17.
    Hahn L. Clinical findings and results of operative treatment in ilio-inguinal nerve entrapment syndrome. Br J Obstet Gynaecol 1989; 96: 1080–3PubMedCrossRefGoogle Scholar
  18. 18.
    Bohm E, Fiorillo A, Pellettieri L. Ilio-inguinal neuralgia: a forgotten disease. Acta Neurol Scand 1979; 34: 33–8Google Scholar
  19. 19.
    Smith C, DeLee J, Ramamurthy S. Ilioinguinal neuralgia following iliac bone grafting: report of two cases and review of the literature. J Bone Joint Surg 1984; 66A: 1306–8PubMedGoogle Scholar
  20. 20.
    Dawson D, Hallett M, Millender L. Entrapment Neuropathies. Boston: Little Brown and Co., 1963Google Scholar
  21. 21.
    Nakano K. The entrapment neuropathies. Muscle Nerve 1978; 1: 264–79PubMedCrossRefGoogle Scholar
  22. 22.
    Starling J, Harms BA, Schroeder M, et al. Diagnosis and treatment of genitofemoral and ilioinguinal entrapment neuralgia. Surgery 1987; 102: 581–6PubMedGoogle Scholar
  23. 23.
    Winer JB, Harrison M. Iatrogenic nerve injuries. Postgrad Med J 1982; 58: 142–5PubMedCrossRefGoogle Scholar
  24. 24.
    Komar J. Das Ilioinguinalis Syndrom. Nervenarzt 1971; 42: 637–40PubMedGoogle Scholar
  25. 25.
    Lichtenstein I, Schulman A, Amid P, et al. Cause and prevention of postherniorraphy neuralgia: a proposed protocol for treatment. Am J Surg 1988; 155: 786–90PubMedCrossRefGoogle Scholar
  26. 26.
    Purves J, Miller J. Inguinal neuralgia: a review of 50 patients. Can J Surg 1986; 29: 43–5PubMedGoogle Scholar
  27. 27.
    Sippo W, Gomez A. Nerve entrapment syndromes from lower abdominal surgery. J Fam Pract 1987; 25: 585–7PubMedGoogle Scholar
  28. 28.
    Miyazaki F, Shook G. Ilioinguinal nerve entrapment during needle suspension for stress incontinence. Obstet Gynaecol 1992; 80: 246–8Google Scholar
  29. 29.
    Starling J, Harms B. Diagnosis and treatment of genitofemoral and ilioinguinal neuralgia. World J Surg 1989; 13: 586–91PubMedCrossRefGoogle Scholar
  30. 30.
    McGee R. Genitofemoral causalgia (a new syndrome). Can Med Assoc J 1942; 46: 326–9Google Scholar
  31. 31.
    Lyon E. Genitofemoral causalgia. Can Med Assoc J 1945; 53: 213–6PubMedGoogle Scholar
  32. 32.
    Laha R, Rao S, Pidgeon C. Genitofemoral neuralgia. Surg Neurol 1977; 8: 280–2PubMedGoogle Scholar
  33. 33.
    O’Brien M. Genito-femoral neuropathy. BMJ 1979; 1: 1052PubMedCrossRefGoogle Scholar
  34. 34.
    Romanes GJ. Cunningham’s manual of practical anatomy. Vol. 1. London: Oxford University Press, 1976Google Scholar
  35. 35.
    Clark JM. Obstetrical palsy. J Bone Joint Surg 1956; 47B: 806Google Scholar
  36. 36.
    Silski J, Scott R. Obturator nerve palsy resulting from intrapelvic extrusion of cement during total hip arthroplasty. J Bone Joint Surg 1985; 67A: 1225–30Google Scholar
  37. 37.
    Weber E, Daube J, Coventry M. Peripheral neuropathies associated with total hip arthroplasty. J Bone Joint Surg 1976; 58A: 66–73PubMedGoogle Scholar
  38. 38.
    Sowell A, Ljungdahl I, Spanger L. Thigh neuralgia as a symptom of obturator hernia. Acta Chir Scand 1976; 142: 457–9Google Scholar
  39. 39.
    Kozlowski JM, Beck JM. Obturator hernia: an elusive diagnosis. Arch Surg 1977; 112: 1001–2PubMedCrossRefGoogle Scholar
  40. 40.
    Williams P, Trzil K. Management of meralgia paraesthetica. J Neurosurg 1991; 74: 76–80PubMedCrossRefGoogle Scholar
  41. 41.
    Stookey B. Meralgia parasthetica: etiology and surgical treatment. JAMA 1928; 90: 1705–7CrossRefGoogle Scholar
  42. 42.
    Stevens H. Meralgia paraesthetica. Arch Neurol Psychiatr 1957; 77: 557–74Google Scholar
  43. 43.
    Jefferson D, Eames R. Subclinical entrapment of the lateral femoral cutaneous nerve: an autopsy study. Muscle Nerve 1979; 2: 145–54PubMedCrossRefGoogle Scholar
  44. 44.
    McGregor J, Moncur J. Meralgia paraesthetica: a sport lesion in girl gymnasts. Br J Sports Med 1977; 11: 16–7CrossRefGoogle Scholar
  45. 45.
    Ecker A, Woltman H. Meralgia paraesthetica: a report of 150 cases. JAMA 1938; 110: 1650–2CrossRefGoogle Scholar
  46. 46.
    Fulton J. Harvey Cushing: a biography. Springfield (IL): Charles C Thomas, 1946Google Scholar
  47. 47.
    van Eerten F, Polder T, Broere C. Operative treatment of meralgia paraesthetica: transection versus neurolysis. Neurosurg 1995; 37: 63–5CrossRefGoogle Scholar
  48. 48.
    Nahabedian M, Dellon A. Meralgia paraesthetica: aetiology, diagnosis and outcome of surgical decompression. Ann Plast Surg 1995; 25: 590–4CrossRefGoogle Scholar
  49. 49.
    Aldrich E, van den Heever C. Suprainguinal ligament approach for the surgical treatment of meralgia paraesthetica. J Neurosurg 1989; 70: 492–4PubMedCrossRefGoogle Scholar
  50. 50.
    Fraser D, Campbell I, Ewing D. Mononeuropathy in diabetes mellitus. Diabetes 1979; 28: 96–101PubMedCrossRefGoogle Scholar
  51. 51.
    Goodman J. Femoral neuropathy in relation to diabetes mellitus. Diabetes 1954; 3: 266–73PubMedGoogle Scholar
  52. 52.
    Coppack S, Watkins P. The natural history of diabetic femoral neuropathy. Q J Med 1991; 79: 307–13PubMedGoogle Scholar
  53. 53.
    Allen R, Hosker G, Smith A, et al. Pelvic floor damage and childbirth: a neurophysiological study. Br J Obstet Gynaecol 1990; 97: 770–9PubMedCrossRefGoogle Scholar
  54. 54.
    Hofmann A, Jones R, Schoenvogel R. Pudendal nerve neuropraxia as a result of traction on the fracture table. J Bone Joint Surg 1982; 64A: 136–8PubMedGoogle Scholar
  55. 55.
    Goodson J. Pudendal neuritis from biking [letter]. N Engl J Med 1981; 304: 365PubMedGoogle Scholar
  56. 56.
    Desai K, Gingell J. The hazards of long distance cycling. BMJ 1989; 298: 1072–3PubMedCrossRefGoogle Scholar
  57. 57.
    Hinman F. Atlas or uro-surgical anatomy. Philadelphia (PA): WB Saunders & Co., 1993Google Scholar
  58. 58.
    Arnoldussen W, Korten J. Pressure neuropathy of the posterior femoral cutaneous nerve. Clin Neurol Neurosurg 1982; 82: 57–60CrossRefGoogle Scholar
  59. 59.
    Muller-Vahl H. Isolated complete paralysis of the tensor fascia latae muscle. Eur Neurol 1985; 2: 289–91CrossRefGoogle Scholar
  60. 60.
    Rask M. Superior gluteal nerve entrapment syndrome. Muscle Nerve 1980; 3: 304–7PubMedCrossRefGoogle Scholar
  61. 61.
    Pecina M, Krmpotic-Nemanic J, Markiewitz A. Tunnel syndromes: peripheral nerve compression syndromes. 2nd ed. Boca Raton (FL): CRC Press, 1997Google Scholar
  62. 62.
    Pecina M. Contribution to the etiological explanation of the piriformis syndrome. Acta Anat 1979; 105: 181–7PubMedCrossRefGoogle Scholar
  63. 63.
    LaBan M, Meerschaert J, Taylor R. Electromyographic evidence of inferior gluteal nerve compromise; an early representation of recurrent colo-rectal carcinoma. Arch Phys Med Rehabil 1982; 63: 33–5PubMedGoogle Scholar
  64. 64.
    Stohr M. Traumatic and postoperative lesions of the lumbosacral plexus. Arch Neurol 1978; 35: 757–60CrossRefGoogle Scholar
  65. 65.
    Puranen J, Orava S. The hamstring syndrome. A new diagnosis of gluteal sciatic pain. Am J Sports Med 1988; 16: 517–21PubMedCrossRefGoogle Scholar
  66. 66.
    Yeoman W. The relationship of arthritis of the sacro-iliac joint to sciatica. Lancet 1928; II: 1119–22CrossRefGoogle Scholar
  67. 67.
    Freiburg A, Vinkle T. Sciatica and the sacro-iliac joint. J Bone Joint Surg 1934; 16: 126–36Google Scholar
  68. 68.
    Fishman L, Zybert P. Electrophysiologic evidence of piriformis syndrome. Arch Phys Med Rehabil 1992; 73: 359–64PubMedCrossRefGoogle Scholar
  69. 69.
    Synek V. Short latency somatosensory evoked potentials in patients with painful dysaesthesias in peripheral nerve lesions. Pain 1987; 29: 49–58PubMedCrossRefGoogle Scholar
  70. 70.
    Vandertop W, Bosma N. The piriformis syndrome. J Bone Joint Surg 1991; 73A: 1095–7PubMedGoogle Scholar
  71. 71.
    Durrani Z, Winnie A. The piriformis muscle syndrome: an under diagnosed cause of sciatica. J Pain Symptom Manage 1991; 6: 374–9PubMedCrossRefGoogle Scholar
  72. 72.
    Solheim L, Siewers P, Paus B. The piriformis muscle syndrome. Acta Orthop Scand 1981; 52: 73–5PubMedCrossRefGoogle Scholar
  73. 73.
    Binnie C, Cooper R, Fowler C, et al. Clinical neurophysiology. Oxford: Butterworth-Heinemann, 1995Google Scholar
  74. 74.
    Kimura J. Electrodiagnosis in diseases of nerve and muscles: principles and practice. 2nd ed. Philadelphia: FA Davis, 1989Google Scholar

Copyright information

© Adis International Limited 1999

Authors and Affiliations

  1. 1.Department of NeurologyOlympic Park Sports Medicine CentreMelbourneAustralia
  2. 2.Department of OrthopaedicsOlympic Park Sports Medicine CentreMelbourneAustralia

Personalised recommendations

Cite article

Buy options