Postoperative femoral motor neuropathy: diagnosis and treatment without neurologic consultation or testing.
OBJECTIVE
To review the diagnosis and treatment of postoperative femoral motor neuropathy without neurologic consultation or testing.


METHODS
A retrospective review of 6 consecutive patients with postoperative femoral motor neuropathy following gynecologic surgery. Diagnosis was made on clinical evaluation: history of falling during postoperative ambulation, quadriceps weakness, straight leg raise weakness, diminished knee jerk response, and no evidence of psoas hematoma or abscess. Neurologic consultation, electromyography, nerve conduction study and radiologic imaging, such as computed tomography, were not obtained. Instead, a physical therapy consultation was obtained for a knee orthotic and rehabilitation.


RESULTS
Four postoperative femoral motor neuropathies developed following 3,014 cases of major gynecologic surgery (0.1%). Two additional cases were seen in consultation. The median age was 57 years. All patients fell while attempting ambulation on postoperative day 1. Recovery occurred at a median of 3 months (1-4). At a median follow-up of 4 years, no patient had developed additional neurologic sequelae. A history of prior postoperative femoral motor neuropathy was noted in 2 of 6 patients (33%).


CONCLUSIONS
This was the first study of diagnosis and treatment of postoperative femoral motor neuropathy following gynecologic surgery without neurologic consultation or testing. Because of the significant expense of neurologic consultation and testing, patients with postoperative femoral motor neuropathy can have the condition diagnosed by the gynecologist and be referred directly to physical therapy without adversely affecting outcome. This also was the first study to elicit a prior history offemoral neuropathy in 33% of patients. Thus, a prior history may be a risk factor for recurrence.
Fanning
James
J
Department of Obstetrics and Gynecology, Summa Health System, Northeastern Ohio Universities College of Medicine, Akron 44309, USA. fanningj@summa-health.org
Carol
Tiffany
T
Miller
Dawn
D
Flora
Robert
R
D000058:Accidental Falls; D005260:Female; D005267:Femoral Nerve / Q000503:physiopathology; D020428:Femoral Neuropathy / Q000175:diagnosis* / Q000628:therapy*; D005833:Genital Neoplasms, Female / Q000601:surgery; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D009431:Neural Conduction; D010386:Pelvic Neoplasms / Q000601:surgery; D010388:Pelvis / Q000601:surgery; D026741:Physical Therapy Modalities; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome