Obturator Nerve Entrapment

  • Elan Jack Golan
  • Srino Bharam


Obturator neuropathy is a rare condition occurring secondary to compression of the anterior branch of the obturator nerve at several different sites of entrapment. The condition most commonly manifests with deficits in medial thigh sensation and adductor musculature strength. Symptoms are often vague due to dual innervation of structures involved in the condition’s pathoanatomy. Diagnosis is often complicated by the many adjacent structures that are prone to other forms of injury. Advanced imaging including MRI and EMG can facilitate accurate identification of obturator pathology. Potential treatments including injection and therapy have been described; however, surgical release is advocated as the consensus method of definitive intervention, especially in the setting of confirmed chronic nerve entrapment.


Obturator nerve Hip pain Nerve entrapment Physical therapy Nerve decompression 


  1. 1.
    Anagnostopoulou S, Kostopanagiotou G, Paraskeuopoulos T, Chantzi C, Lolis E, Saranteas T. Anatomic variations of the obturator nerve in the inguinal region: implications in conventional and ultrasound regional anesthesia techniques. Reg Anesth Pain Med. 2009;34(1):33–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Anloague PA, Huijbregts P. Anatomical variations of the lumbar plexus: a descriptive anatomy study with proposed clinical implications. J Man Manip Ther. 2009;17(4):e107–14.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Gerlach U, Lierse W. Functional construction of the superficial and deep fascia system of the lower limb in man. Cells Tissues Organs. 1990;139(1):11–25.CrossRefGoogle Scholar
  4. 4.
    Harvey G, Bell S. Obturator neuropathy. An anatomic perspective. Clin Orthop Relat Res. 1999;363:203–11.CrossRefGoogle Scholar
  5. 5.
    Kowalska B, Sudol-Szopinska I. Ultrasound assessment of selected peripheral nerves pathologies. Part II: entrapment neuropathies of the lower limb. J Ultrasonography. 2012;12(51):463–71.CrossRefGoogle Scholar
  6. 6.
    Quain J, Sharpey-Schäfer EA, Symington J, Godlee RJ, Thane GD. Quain’s elements of anatomy. London: Longmans, Green; 1894.Google Scholar
  7. 7.
    Sinnatamby CS. Last’s anatomy: regional and applied. Amsterdam: Elsevier Health Sciences; 2011.Google Scholar
  8. 8.
    Tipton JS. Obturator neuropathy. Curr Rev Musculoskelet Med. 2008;1(3–4):234–7.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Warwick R, Williams PL. Gray’s anatomy. Edinburgh: Longman; 1973.Google Scholar
  10. 10.
    Akkaya T, Comert A, Kendir S, Acar HI, Gumus H, Tekdemir I, et al. Detailed anatomy of accessory obturator nerve blockade. Minerva Anestesiol. 2008;74(4):119–22.PubMedGoogle Scholar
  11. 11.
    Katritsis E, Anagnostopoulou S, Papadopoulos N. Anatomical observations on the accessory obturator nerve (based on 1000 specimens). Anat Anz. 1980;148(5):440–5.PubMedGoogle Scholar
  12. 12.
    Jo SY, Chang JC, Bae HG, Oh JS, Heo J, Hwang JC. A morphometric study of the obturator nerve around the obturator foramen. J Korean Neurosurg Soc. 2016;59(3):282–6.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Bradshaw C, McCrory P, Bell S, Brukner P. Obturator nerve entrapment. A cause of groin pain in athletes. Am J Sports Med. 1997;25(3):402–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Soong J, Schafhalter-Zoppoth I, Gray AT. Sonographic imaging of the obturator nerve for regional block. Reg Anesth Pain Med. 2007;32(2):146–51.CrossRefPubMedGoogle Scholar
  15. 15.
    Sorenson EJ, Chen JJ, Daube JR. Obturator neuropathy: causes and outcome. Muscle Nerve. 2002;25(4):605–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Sureka J, Panwar S, Mullapudi I. Intraneural ganglion cysts of obturator nerve causing obturator neuropathy. Acta Neurol Belg. 2012;112(2):229–30.CrossRefPubMedGoogle Scholar
  17. 17.
    Van Ba OL, Wagner L, de Tayrac R. Obturator neuropathy: an adverse outcome of a trans-obturator vaginal mesh to repair pelvic organ prolapse. Int Urogynecol J. 2014;25(1):145–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Ghijselings S, Bruyninckx F, Delport H, Corten K. Inflammatory neuropathy of the lumbosacral plexus following periacetabular osteotomy. Case Rep Orthop. 2016;2016:3632654.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Stuplich M, Hottinger AF, Stoupis C, Sturzenegger M. Combined femoral and obturator neuropathy caused by synovial cyst of the hip. Muscle Nerve. 2005;32(4):552–4.CrossRefPubMedGoogle Scholar
  20. 20.
    Lehmann W, Hoffmann M, Fensky F, Nuchtern J, Grossterlinden L, Aghayev E, et al. What is the frequency of nerve injuries associated with acetabular fractures? Clin Orthop Relat Res. 2014;472(11):3395–403.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Ashby EC. Chronic obscure groin pain is commonly caused by enthesopathy: ‘tennis elbow’ of the groin. Br J Surg. 1994;81(11):1632–4.CrossRefPubMedGoogle Scholar
  22. 22.
    Brukner P, Bradshaw C, McCrory P. Obturator neuropathy: a cause of exercise-related groin pain. Phys Sportsmed. 1999;27(5):62–73.CrossRefPubMedGoogle Scholar
  23. 23.
    Harmon KG. Evaluation of groin pain in athletes. Curr Sports Med Rep. 2007;6(6):354–61.PubMedGoogle Scholar
  24. 24.
    LeBlanc KE, LeBlanc KA. Groin pain in athletes. Hernia. 2003;7(2):68–71.CrossRefPubMedGoogle Scholar
  25. 25.
    Schilders E, Talbot JC, Robinson P, Dimitrakopoulou A, Gibbon WW, Bismil Q. Adductor-related groin pain in recreational athletes: role of the adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections. J Bone Joint Surg Am. 2009;91(10):2455–60.CrossRefPubMedGoogle Scholar
  26. 26.
    Suarez JC, Ely EE, Mutnal AB, Figueroa NM, Klika AK, Patel PD, et al. Comprehensive approach to the evaluation of groin pain. J Am Acad Orthop Surg. 2013;21(9):558–70.PubMedGoogle Scholar
  27. 27.
    Dimitrakopoulou A, Schilders E. Current concepts of inguinal-related and adductor-related groin pain. Hip Int. 2016;26(Suppl 1):2–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Schilders E, Dimitrakopoulou A, Cooke M, Bismil Q, Cooke C. Effectiveness of a selective partial adductor release for chronic adductor-related groin pain in professional athletes. Am J Sports Med. 2013;41(3):603–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Robinson P, Barron DA, Parsons W, Grainger AJ, Schilders EM, O’Connor PJ. Adductor-related groin pain in athletes: correlation of MR imaging with clinical findings. Skelet Radiol. 2004;33(8):451–7.CrossRefGoogle Scholar
  30. 30.
    Dawson D, Hallett M, Wilbourn A. Miscellaneous uncommon syndromes of the lower extremity. In: Entrapment neuropathies. 3rd ed. Philadelphia: Lippincott-Raven; 1988. p. 369–79.Google Scholar
  31. 31.
    Stewart JD. Peripheral nerve fascicles: anatomy and clinical relevance. Muscle Nerve. 2003;28(5):525–41.CrossRefPubMedGoogle Scholar
  32. 32.
    Bradshaw C, McCrory P. Obturator nerve entrapment. Clin J Sport Med. 1997;7(3):217–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Gottschalk F. Transfemoral amputation: biomechanics and surgery. Clin Orthop Relat Res. 1999;361:15–22.CrossRefGoogle Scholar
  34. 34.
    Vasilev SA. Obturator nerve injury: a review of management options. Gynecol Oncol. 1994;53(2):152–5.CrossRefPubMedGoogle Scholar
  35. 35.
    Mumenthaler M, Schliack H. Lesions of individual nerves of the lower limb plexus and the lower extremity. In: Peripheral nerve lesions diagnosis and therapy. New York: Thieme Medical; 1991. p. 297–343.Google Scholar
  36. 36.
    Pecina MM, Markiewitz AD, Krmpotic-Nemanic J. Tunnel syndromes. Boca Raton: CRC; 2001.CrossRefGoogle Scholar
  37. 37.
    Saurenmann P, Brand S. Obturator neuralgia (Howship-Romberg phenomenon). Schweiz Med Wochenschr. 1984;114(42):1462–4.PubMedGoogle Scholar
  38. 38.
    Akkaya T, Ozturk E, Comert A, Ates Y, Gumus H, Ozturk H, et al. Ultrasound-guided obturator nerve block: a sonoanatomic study of a new methodologic approach. Anesth Analg. 2009;108(3):1037–41.CrossRefPubMedGoogle Scholar
  39. 39.
    Pavlov H, Nelson TL, Warren RF, Torg JS, Burstein AH. Stress fractures of the pubic ramus. A report of twelve cases. J Bone Joint Surg Am. 1982;64(7):1020–5.CrossRefPubMedGoogle Scholar
  40. 40.
    Freire M, Winalski CS, Miniaci A, Sundaram M. Radiologic case study. Avulsion of the right adductor longus from the symphysis pubis. Orthopedics. 2012;35(2):85, 158–60.Google Scholar
  41. 41.
    Dimitrakopoulou A, Schilders EM, Talbot JC, Bismil Q. Acute avulsion of the fibrocartilage origin of the adductor longus in professional soccer players: a report of two cases. Clin J Sport Med. 2008;18(2):167–9.CrossRefPubMedGoogle Scholar
  42. 42.
    Vogt S, Ansah P, Imhoff AB. Complete osseous avulsion of the adductor longus muscle: acute repair with three fiberwire suture anchors. Arch Orthop Trauma Surg. 2007;127(8):613–5.CrossRefPubMedGoogle Scholar
  43. 43.
    Tehranzadeh J, Kurth LA, Elyaderani MK, Bowers KD. Combined pelvic stress fracture and avulsion of the adductor longus in a middle-distance runner: a case report. Am J Sports Med. 1982;10(2):108–11.CrossRefPubMedGoogle Scholar
  44. 44.
    Redwine DB, Sharpe DR. Endometriosis of the obturator nerve. A case report. J Reprod Med. 1990;35(4):434–5.PubMedGoogle Scholar
  45. 45.
    Martinoli C, Miguel-Perez M, Padua L, Gandolfo N, Zicca A, Tagliafico A. Imaging of neuropathies about the hip. Eur J Radiol. 2013;82(1):17–26.CrossRefPubMedGoogle Scholar
  46. 46.
    Litwiller JP, Wells RE Jr, Halliwill JR, Carmichael SW, Warner MA. Effect of lithotomy positions on strain of the obturator and lateral femoral cutaneous nerves. Clin Anat. 2004;17(1):45–9.CrossRefPubMedGoogle Scholar
  47. 47.
    Macalou D, Trueck S, Meuret P, Heck M, Vial F, Ouologuem S, et al. Postoperative analgesia after total knee replacement: the effect of an obturator nerve block added to the femoral 3-in-1 nerve block. Anesth Analg. 2004;99(1):251–4.CrossRefPubMedGoogle Scholar
  48. 48.
    McNamee D, Parks L, Milligan K. Post-operative analgesia following total knee replacement: an evaluation of the addition of an obturator nerve block to combined femoral and sciatic nerve block. Acta Anaesthesiol Scand. 2002;46(1):95–9.CrossRefPubMedGoogle Scholar
  49. 49.
    Jo YY, Choi E, Kil HK. Comparison of the success rate of inguinal approach with classical pubic approach for obturator nerve block in patients undergoing TURB. Korean J Anesthesiol. 2011;61(2):143–7.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Wassef M. Interadductor approach to obturator nerve blockade for spastic conditions of adductor thigh muscles. Reg Anesth Pain Med. 1993;18(1):13–7.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Elan Jack Golan
    • 1
  • Srino Bharam
    • 2
  1. 1.Maimonides Medical Center, Department of Orthopaedic SurgeryBrooklynUSA
  2. 2.Orthopaedic SurgeryMount Sinai School of Medicine, Lenox Hill HospitalNew YorkUSA

Personalised recommendations