RSD and Femoral Neuropathy

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From: byrd45 (Original Message) Sent: 11/2/2005 8:59 AM
From: <NOBR>byrd45</NOBR> (Original Message) Sent: 10/18/2005 1:11 PM
Hi Everyone,
This weeks discussionis going to focus on Femoral Neuropathy. Judy I hope this helps and good luck with your appointment. I thought we could learn more about it and I am curious if it can be present along with RSD.Here is some information I have found:
Lateral Femoral Cutaneous Nerve

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- Anatomy:
- LFCN, as its name suggests, is purely sensory;
- it arises from L2 and L3, travels downward lateral to the psoas muscle, crosses the iliacus muscle (deep to fascia),
passes either thru or underneath the lateral aspect of the inguinal ligament, and finally travels onto innervate the lateral thigh;
- it divides into anterior and posterior branches and supplies skin on lateral aspect of thigh;
- in the study by Hospodar et al (JTO 1999), the course of the nerve was variable, but was most commonly found at 10-15 mm from the ASIS and as
far medially as 46 mm from the ASIS;
- in no specimen did the nerve pass lateral to the ASIS (eventhough historically the nerve is thought to pass lateral to the ASIS in 10% of population);
- in all specimens the nerve passed underneath the ilioginal ligament and anterior to the iliacus muscle;

- Meralgia Paresthetica:
- entrapment syndrome of the lateral femoral cutaneous nerve causing burning, numbness, and paresthesias down the
proximal-lateral aspect of the thigh;
- may be idiopathic, be a result of trauma, previous operations, and in some cases may arise from Perthes Disease abduction splints;
- in idiopathic cases, the nerve may be encased in bone by the growing apophysis of the anterior superior iliac spine,
or may be entrapped in fascia either proximal or distal to the ASIS;
- diagnosis is made by:
- reproduction of the pain by deep palpation just below the anterior superior iliac spine and by hip extension;
- relief of pain by localized injection of lidocaine;
- treatment: when diagnosis is not in doubt and the symptoms are severe, consider operative decompression at the site of constriction;

Check out this site... they have a model of the human body and if you click on the nerve it shows you exactly where it is! http://www.neuroguide.com/genitofemoral.html It was interesting...

Anyhow, from the information I read on the net that femoral neuropathy is found mostly in people with Diabetes, following an operation, or after a tramatic injury.
Here is a link that talks about Neuropathies that come from having Diabetes. http://www.emedicine.com/neuro/topic88.htm
Here is what Dr. Hooshmand has to say about Diabetic Neuropathy (femoral neuropathy):
RSD PUZZLE #89
DOES DIABETES CONTRIBUTE TO RSD?

Diabetes causes three different types of peripheral nerve dysfunction. One is called mononeuropathy, meaning only a single peripheral nerve is involved. The commonest form of it is femoral neuropathy. The second is called polyneuropathy meaning multiple nerves are involved in a symmetrical fashion causing numbness, pain, and weakness in the hands, feet, or both. The third is called mononeuropathy multi-plex, meaning single nerves in different parts of the body are involved secondary to diabetes. for example, the sensory or motor nerves to the right foot is damaged along with a single nerve in the left hand such as ulnar or median nerve.

The mononeuropathy and mononeuropathy multi-plex are usually caused by disturbance of circulation of the blood vessels that provide oxygen and nutrition to the peripheral nerves. The polyneuropathy is usually caused by nutritional disturbance such as excessive alcohol intake, or long standing deprivation of the nerve from sugar.

None of the above mentioned neuropathies in and of themselves can be the cause of RSD. As a matter of fact, even though typical painful nerve damage in the diabetic person is quite common, the incidence of RSD among the diabetics is no higher than in the general population.

On the other hand, a minor trauma, which is usually the cause of RSD, is more likely to cause RSD in an extremity which is already afflicted by the diabetic neuropathy.

The conclusion is that a diabetic is as likely to develop RSD as any other individual. No more, no less. To blame a typical clinical picture of RSD on the finding of diabetic neuropathy on nerve conduction time studies, is nothing but a cop-out. On the other hand, to blame diabetes as the cause of RSD is also misrepresentation.


H. Hooshmand, M.D.

Well from what the good doc says you can have them together. That answers my question. Do you have Femoral Neuropathy along with your RSD? Please add any comments or experiences to this post. Just out of curiosity does any member have Diabetes along with there RSD? As always I would love to hear your thoughts on this.

Love,

Robyn




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From: <NOBR>EMY2628</NOBR> Sent: 10/19/2005 9:11 AM
Hi Robyn,
I do have diabetes along with RSD. I have had diabetes for about 15yrs and RSD for a little over three yrs. Currently there is no neuropathy from the Diabetes, however my diabetes itself has gotten much worse since my original injury and onset of RSD. Due to my very limited mobilty my weight has soared (I was very heavy prior to my injury , but also very active) and my diabetes has also soared out of control. I have gone from taking an oral med for the diabetes to now taking two oral meds a day and at least two injections of insulin a day. Between the immobility and the stress from the pain and the interrupted sleep patterns things are just going crazy with the diabetes. I do notice though that when my sugar is extremely high (I actually have it soar into the 350 to 400 range, like close to coma material, particularly when the pain is at it's worse and sleep has been hard to come by) I find the swelling in my legs to be even worse and that in turn makes the Rsd pain worse due to the added pressure around the injuried limb. Hope this info can be usefull to you!
Eileen


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From: <NOBR>byrd45</NOBR> Sent: 10/20/2005 11:27 AM
Hi Emy,
Wow that has to be so hard on you on top of the RSD! Diabetes is a rough disease and I am so glad you don't have any nerve damage from that as well. Have they managed to get your levels more under control yet? I hope they have or do real soon. My husband was diagnosed a little over a year ago and it is real hard for him to live with also. It is real hard to eliminate or limit all the sugar and carbs from your diet. The diabetes can really mess with your weight to especially when it is out of control like that. Hopefully they will get a handle on things and then maybe that will make it easy to take some of the weight off. I have gained alot of weight since getting RSD 50 pounds in four years. I have also been heavy before the RSD but because I was active my weight wasn't as out of control as it has been with the RSD. It is making it hard to move like I want and makes the pain worse also. Neurontin helped me put on 40 of the pounds. Now that I am being weined off my body is finally letting me lose weight. Twenty-three pounds so far which I figure is at least a start. Don't feel bad about the weight gain. It is hard to lose when your body is fighting you like that. I hope the Diabetes gives you less problems in the future! Thanks for your post any information is always helpful. Since there is still a lack of information about RSD it helps to compare experiences so we can learn from each other. I hope you are having a good week and talk to you soon.
Love,
Robyn