Nerve Entrapment Syndromes

Abstract

Painful conditions affecting the innervation of the groin (ilioinguinal, iliohypogastric genitofemoral, lateral femoral cutaneous, and obturator nerves) are frequent and often follow surgical interventions on the inguinal region. Although referred to in general as “entrapment neuropathies,” these conditions are often a reflection of damage to the nerves (or their smaller branches) rather than a true entrapment. The differential diagnosis is crucially important, since pain from an entrapped nerve is treated very differently from pain from a “damaged” nerve. The different conditions would be best described as “inguinal entrapment neuropathy” and “inguinal neuralgia.”

In mild or time-limited conditions, this differential might not be crucial. Chronic severe cases might represent a combination of true entrapment syndromes overlapping with “neuropathic” pain syndromes. These cases, although fortunately uncommon, can represent a formidable diagnostic and therapeutic challenge. In many of these instances, excessively aggressive treatments can actually worsen the conditions. Surgical re-explorations, decompressions, neurectomies, and neurostimulation procedures have a role in their management.