Variations of the obturator nerve and implications in obturator nerve entrapment treatment: an anatomical study.
Local anesthetic nerve block
Neurolysis
Obturator nerve
Obturator nerve entrapment
Journal
Surgical and radiologic anatomy : SRA
ISSN: 1279-8517
Titre abrégé: Surg Radiol Anat
Pays: Germany
ID NLM: 8608029
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
received:
07
12
2022
accepted:
01
07
2023
medline:
28
9
2023
pubmed:
11
7
2023
entrez:
10
7
2023
Statut:
ppublish
Résumé
Obturator nerve entrapment or idiopathic obturator neuralgia is an unfamiliar pathology for many physicians which can lead to diagnostic errancy. This study aims to identify the potential compression areas of the obturator nerve to improve therapeutic management. 18 anatomical dissections of lower limbs from 9 anatomical cadavers were performed. Endopelvic and exopelvic surgical approaches were utilized to study the anatomical variations of the nerve and to identify areas of entrapment. On 7 limbs, the posterior branch of the obturator nerve passed through the external obturator muscle. A fascia between the adductor brevis and longus muscles was present in 9 of the 18 limbs. The anterior branch of the obturator nerve was highly adherent to the fascia in 6 cases. In 3 limbs, the medial femoral circumflex artery was in close connection with the posterior branch of the nerve. Idiopathic obturator neuropathy remains a difficult diagnosis. Our cadaveric study did not allow us to formally identify one or more potential anatomical entrapment zones. However, it allowed the identification of zones at risk. A clinical study with staged analgesic blocks would be necessary to identify an anatomical area of compression and would allow targeted surgical neurolysis.
Identifiants
pubmed: 37429990
doi: 10.1007/s00276-023-03202-y
pii: 10.1007/s00276-023-03202-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1227-1232Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.
Références
Bard H, Berthelot J-M, Demondion X, Vuillemin V (2009) Les syndromes canalaires du bassin. In: Rodineau J (ed) Pathologies du complexe pelvi-fémoral du sportif. Elsevier, Paris, pp 138–158
doi: 10.1016/B978-2-294-70944-9.50014-2
Bradshaw C, McCrory P, Bell S, Brukner P (1997) Obturator nerve entrapment: a cause of groin pain in athletes. Am J Sports Med 25(3):402–408. https://doi.org/10.1177/036354659702500322
doi: 10.1177/036354659702500322
pubmed: 9167824
Garcia-Rueda MF, Nossa-Almanza SA, Jimenez-Ramirez JD et al (2023) Terminal nerve entry points’ locations to muscles of the thigh for selective peripheral neurectomy in the adult population: a cadaveric study. Surg Radiol Anat 45:3–9. https://doi.org/10.1007/s00276-022-03047-x
doi: 10.1007/s00276-022-03047-x
pubmed: 36522468
Guillouche P (2005) Bases anatomiques des névralgies obturatrices. Mémoire réalisé dans le cadre du certificat d’anatomie, d’imagerie et de morphogénèse. Université de Nantes. Available via https://docplayer.fr/22912806-Bases-anatomiques-des-nevralgies-obturatrices.html . Accessed 10 May 2023
Harvey G, Bell S (1999) Obturator neuropathy. An anatomic perspective. Clin Orthop Relat Res 363:203–211 (PMID: 10379324)
doi: 10.1097/00003086-199906000-00027
Kendir S, Akkaya T, Comert A, Sayin M, Tatlisumak E, Elhan A, Tekdemir I (2008) The location of the obturator nerve: a three-dimensional description of the obturator canal. Surg Radiol Anat 30(6):495–501. https://doi.org/10.1007/s00276-008-0358-x . (PMID: 18478175)
doi: 10.1007/s00276-008-0358-x
pubmed: 18478175
Kumka M (2010) Critical sites of entrapment of the posterior division of the obturator nerve: anatomical considerations. J Can Chiropr Assoc 54(1):33–42 (PMID: 20195424; PMCID: PMC2829684)
pubmed: 20195424
pmcid: 2829684
Magora F, Rozin R, Ben-Menachem Y, Magora A (1969) Obturator nerve block: an evaluation of technique. Br J Anaesth 41(8):695–698. https://doi.org/10.1093/bja/41.8.695
doi: 10.1093/bja/41.8.695
pubmed: 5810129
Rigaud J, Labat JJ, Riant T, Bouchot O, Robert R (2006) (2006) TO53 - Diagnostic, prise en charge et traitement conservateur cœlioscopique des névralgies obturatrices. Douleurs: Eval - Diagn- Trait 7(1):104. https://doi.org/10.1016/S1624-5687(06)77899-4
doi: 10.1016/S1624-5687(06)77899-4
Rigaud J, Labat JJ, Riant T, Guerineau M, Bouchot O, Robert R (2009) Névralgies obturatrices : prise en charge et résultats préliminaires de la neurolyse laparoscopique. Prog En Urol 19(6):420–426. https://doi.org/10.1016/j.purol.2009.01.017
doi: 10.1016/j.purol.2009.01.017
Siwiński D (2005) Neuropathy of the obturator nerve as a source of pain in soccer players. Chir Narzadow Ruchu Ortop Pol 70(3):201–204
pubmed: 16294695
Yatsunami M, Tai T, Irie Y, Ogawa K, Miyauchi R (2004) A morphological study on the human obturator externus muscle with reference to anomalous muscle and anomalous fasciculus originating from the obturator externus muscle. Okajimas Folia Anat Jpn 80(5–6):103–114. https://doi.org/10.2535/ofaj.80.103
doi: 10.2535/ofaj.80.103
pubmed: 15134328