Ilioinguinal Nerve: Difference between revisions


 

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Furthermore, ilioinguinal nerve entrapment may also occur due to the presence of sutures in close proximity, leading to sensory disturbances along the nerve’s path, a condition known as nerve entrapment<ref>Whiteside JL, Barber MD, Walters MD, Falcone T. Anatomy of ilioinguinal and iliohypogastric nerves in relation to trocar placement and low transverse incisions. American journal of obstetrics and gynecology. 2003 Dec 1;189(6):1574-8.</ref>.

Furthermore, ilioinguinal nerve entrapment may also occur due to the presence of sutures in close proximity, leading to sensory disturbances along the nerve’s path, a condition known as nerve entrapment<ref>Whiteside JL, Barber MD, Walters MD, Falcone T. Anatomy of ilioinguinal and iliohypogastric nerves in relation to trocar placement and low transverse incisions. American journal of obstetrics and gynecology. 2003 Dec 1;189(6):1574-8.</ref>.

Ilioinguinal neuralgia one of the common causes for chronic lower abdominal and anterior [[Chronic Pelvic Pain|pelvic pain]].

Ilioinguinal neuralgia one of the common causes for chronic lower abdominal and anterior [[Chronic Pelvic Pain|pelvic pain]].

Inguinodynia that is a chronic or persistent groin pain

Inguinodynia is a chronic or persistent groin pain

== Assessment ==

== Assessment ==

”’Physical Examination”’

”’Physical Examination”’

The ilioinguinal nerve usually its manifestation will cause cutaneous manifestation in the nerve distribution without weakness like; sharp or burning sensation that worsening with lifting or bending. Tenderness point may be observed near the ASIS (anterior superior iliac spine), but it‘s not a definitive diagnostic sign. In addition, the patient may adopt a flexed posture while walking or sit with one leg extended to minimize nerve compression in the groin, and activities or movement that involve hip extension may aggravate the symptoms. For confirmation some diagnostic procedures may be carried out:

The ilioinguinal nerve its cutaneous in the nerve distribution without weaknesssharp or burning sensation that with lifting or bending. may be observed near the ASIS (anterior superior iliac spine), it not a definitive diagnostic sign. , may adopt a flexed posture while walking or sit with one leg extended to nerve compression in the groinor hip extension may the symptoms. For confirmation some diagnostic procedures may be carried out:

[[Ultrasound Scans|Diagnostic ultrasound]] we can track the nerve when it becomes superficial down to the superficial inguinal ring<ref>Gofeld M, Christakis M. Sonographically guided ilioinguinal nerve block. Journal of ultrasound in medicine. 2006 Dec;25(12):1571-5.</ref> a guided injection using ultrasound or [[CT Scans|CT scan]] is very helpful for diagnosis.  

[[Ultrasound Scans|Diagnostic ultrasound]] we can track the nerve when it becomes superficial down to the superficial inguinal ring<ref>Gofeld M, Christakis M. Sonographically guided ilioinguinal nerve block. Journal of ultrasound in medicine. 2006 Dec;25(12):1571-5.</ref> a guided injection using ultrasound or [[CT Scans|CT scan]] is very helpful for diagnosis.  

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=== Medical Treatment ===

=== Medical Treatment ===

Nerve block: nerve block guided b imaging ultrasound proved to be effective for treatment of ilioinguinal neuralgia and approximately 55–70% showed a beneficial analgesic post-inguinal hernia surgery<ref>Wong AK, Ng AT. [https://link.springer.com/article/10.1007/s11916-020-00913-4#Sec6 Review of ilioinguinal nerve blocks for ilioinguinal neuralgia post hernia surger]y. Current Pain and Headache Reports. 2020 Dec;24:1-5.</ref>.

Nerve block: nerve block guided imaging ultrasound proved to be effective for treatment of ilioinguinal neuralgia and approximately 55–70% showed a beneficial analgesic post-inguinal hernia surgery<ref>Wong AK, Ng AT. [https://link.springer.com/article/10.1007/s11916-020-00913-4#Sec6 Review of ilioinguinal nerve blocks for ilioinguinal neuralgia post hernia surger]y. Current Pain and Headache Reports. 2020 Dec;24:1-5.</ref>.

[[NSAIDs]], anti-inflammatory, antidepressants, opioids, and antiepileptics<ref>Elsakka KM, Das JM, Allam AE. I[https://www.ncbi.nlm.nih.gov/books/NBK538256/#:~:text=The%20ilioinguinal%20nerve%20is%20a,it%20reaches%20the%20iliac%20crest lioinguinal Neuralgi]a. InStatPearls [Internet] 2022 Oct 10. StatPearls Publishing.</ref> for inguinal neuralgia and inguinodynia.

[[NSAIDs]], anti-inflammatory, antidepressants, opioids, and antiepileptics <ref>Elsakka KM, Das JM, Allam AE. I[https://www.ncbi.nlm.nih.gov/books/NBK538256/#:~:text=The%20ilioinguinal%20nerve%20is%20a,it%20reaches%20the%20iliac%20crest lioinguinal Neuralgi]a. InStatPearls [Internet] 2022 Oct 10. StatPearls Publishing.</ref>.

Radiofrequency ablation is effective for long-term pain relief and poses a low risk of neuroma formation.

Radiofrequency ablation is effective for long-term pain relief and poses a low risk of neuroma formation.

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Extraperitoneal excision of the nerve for entrapment-caused cases and is often considered the preferred treatment.

Extraperitoneal excision of the nerve for entrapment-caused cases and is often considered the preferred treatment.

For cases of generalized refractory inguinodynia, triple neurectomy that involves removing the proximal branches of the ilioinguinal, genitofemoral, or illiohypogastric nerves, is a more definitive treatment<ref>Elkins N, Hunt J, Scott KM. Neurogenic pelvic pain. Physical Medicine and Rehabilitation Clinics. 2017 Aug 1;28(3):551-69.</ref>.

For cases of refractory inguinodynia, triple neurectomy that involves removing the proximal branches of the ilioinguinal, genitofemoral, or illiohypogastric nerves, is a more definitive treatment<ref>Elkins N, Hunt J, Scott KM. Neurogenic pelvic pain. Physical Medicine and Rehabilitation Clinics. 2017 Aug 1;28(3):551-69.</ref>.

=== Physical Therapy Intervention ===

=== Physical Therapy Intervention ===

* [[Scar Management|Scare tissue mobilization]] and soft tissue mobilization/ [[Myofascial Release|myofascial release]] if there was a scar from a previous surgery near to the nerve.

* [[Scar Management|Scare tissue ]] and soft tissue / [[Myofascial Release|myofascial release]] if there was a scar from a previous surgery near to the nerve.

* [[Transcutaneous Electrical Nerve Stimulation (TENS)|Transcutaneous electric nerve stimulation]] and [[acupuncture]] <ref>Taghavi R, Tabasi KT, Mogharabian N, Asadpour A, Golchian A, Mohamadi S, Kabiri AA. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3546210/ The effect of acupuncture on relieving pain after inguinal surgeries.] The Korean journal of pain. 2013 Jan 31;26(1):46-50.</ref>can control symptoms of the ilioinguinal neuralgia<ref>Hahn L. [https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/j.1600-0412.2011.01194.x#b10 Treatment of ilioinguinal nerve entrapment–a randomized controlled trial.] Acta obstetricia et gynecologica scandinavica. 2011 Sep;90(9):955-60.

* [[Transcutaneous Electrical Nerve Stimulation (TENS)|Transcutaneous electric nerve stimulation]] and [[acupuncture]] <ref>Taghavi R, Tabasi KT, Mogharabian N, Asadpour A, Golchian A, Mohamadi S, Kabiri AA. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3546210/ The effect of acupuncture on relieving pain after inguinal surgeries.] The Korean journal of pain. 2013 Jan 31;26(1):46-50.</ref>can control symptoms of the ilioinguinal neuralgia<ref>Hahn L. [https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/j.1600-0412.2011.01194.x#b10 Treatment of ilioinguinal nerve entrapment–a randomized controlled trial.] Acta obstetricia et gynecologica scandinavica. 2011 Sep;90(9):955-60.

The ilioinguinal nerve is a mixed nerve that originates from the lumbar plexus. It emerges near the outer edge of the psoas major muscle and travels downward through the front of the abdominal wall. It stays beneath the peritoneum and passes in front of the quadratus lumborum muscle, continues downwards and obliquely across its surface, then it passes over the anterior surface of the iliacus muscle until it reaches the iliac crest. From there, it traverses through the transversus abdominis and the internal oblique muscles. As it continues, it becomes visible near the groin area, passing through the superficial inguinal ring just in front of the spermatic cord in males[1].

Root[edit | edit source]

Originate from the anterior rami from L1 nerve roots in the lower back, in some cases it receives contribution from T12 or l2 in other cases upon its origin.

Branches[edit | edit source]

Ilioinguinal nerve gives motor branches to the transversus abdominis and the internal oblique muscles when it passes through the posterior abdominal wall.

After existing though superficial inguinal ring it gives sensor branches, anterior labial nerve in females and anterior scrotal nerve in male.

Motor[edit | edit source]

The motor innervation to transversus abdominis and the internal oblique muscles

Sensory[edit | edit source]

Anterior labial nerve in females gives cutaneous innervation to anterior one-third of the labium majora, mons pubis, and root of clitoris.

Anterior scrotal nerve in males gives sensory innervation to skin of the anterior 1/3 of the scrotum and the root of the penis

In addition cutaneous innervation to the superior medial thigh.

[2]

Ilioinguinal nerve injuries/ neuropathy frequently occur following abdominal surgery, abdominal wall trauma, accidently during surgery because of traumatic trochar from laparoscopic surgeries, post hysterectomy or during inguinal hernia repairs. However, when the motor branches of the nerve are affected, it can result in weakened transversus abdominis and internal oblique muscles, potentially leading to the development of inguinal hernias[3].

Furthermore, ilioinguinal nerve entrapment may also occur due to the presence of sutures in close proximity, leading to sensory disturbances along the nerve’s path, a condition known as nerve entrapment[4].

Ilioinguinal neuralgia is one of the common causes for chronic lower abdominal and anterior pelvic pain.

Inguinodynia is a chronic or persistent groin pain, defined as pain beyond three months after inguinal hernia surgery[5].

Physical Examination

The ilioinguinal nerve typically manifests its symptoms through cutaneous manifestations in the nerve distribution without causing weakness. These symptoms often include a sharp or burning sensation that worsens with lifting or bending. While tenderness points may be observed near the ASIS (anterior superior iliac spine), it is not a definitive diagnostic sign. Additionally, patients may adopt a flexed posture while walking or sit with one leg extended to minimise nerve compression in the groin. Activities or movements involving hip extension may exacerbate the symptoms. For confirmation some diagnostic procedures may be carried out:

Diagnostic ultrasound we can track the nerve when it becomes superficial down to the superficial inguinal ring[6] a guided injection using ultrasound or CT scan is very helpful for diagnosis.

Electrodiagnostic study to exclude other causes like; radiculopathy from lumbar or lumbar plexus injury or to support the diagnosis[7].

Medical Treatment[edit | edit source]

Nerve block: nerve block guided imaging ultrasound proved to be effective for treatment of ilioinguinal neuralgia and approximately 55–70% showed a beneficial analgesic post-inguinal hernia surgery[8].

NSAIDs, anti-inflammatory, antidepressants, opioids, and antiepileptics for inguinal neuralgia and inguinodynia[9].

Radiofrequency ablation is effective for long-term pain relief and poses a low risk of neuroma formation.

Surgical Intervention[edit | edit source]

It can be carried after failure of all conservative treatment, and it is always preferred to be done not before 6- 12 after the initial surgery that caused neuralgia.

Extraperitoneal excision of the nerve for entrapment-caused cases and is often considered the preferred treatment.

For cases of generalised refractory inguinodynia, triple neurectomy that involves removing the proximal branches of the ilioinguinal, genitofemoral, or illiohypogastric nerves, is a more definitive treatment[10].

Physical Therapy Intervention[edit | edit source]

  1. Reinpold W, Schroeder AD, Schroeder M, Berger C, Rohr M, Wehrenberg U. Retroperitoneal anatomy of the iliohypogastric, ilioinguinal, genitofemoral, and lateral femoral cutaneous nerve: consequences for prevention and treatment of chronic inguinodynia. Hernia. 2015 Aug;19:539-48.
  2. Kenhub – Learn Human y. Ilioinguinal Nerve – Course & Innervation – Human Anatomy | Kenhub. Available from: http://www.youtube.com/watch?v=vL_px_7QDTg[last accessed 18/12/2023]
  3. Cardosi RJ, Cox CS, Hoffman MS. Postoperative neuropathies after major pelvic surgery. Obstetrics & Gynecology. 2002 Aug 1;100(2):240-4.
  4. Whiteside JL, Barber MD, Walters MD, Falcone T. Anatomy of ilioinguinal and iliohypogastric nerves in relation to trocar placement and low transverse incisions. American journal of obstetrics and gynecology. 2003 Dec 1;189(6):1574-8.
  5. Barbosa CD, Oliveira DC, de-Melo-Delgado NM, Mafra JG, Santos RS, Moreira WC. Inguinodynia: review of predisposing factors and management. Revista do Colégio Brasileiro de Cirurgiões. 2021 Jan 8;47.
  6. Gofeld M, Christakis M. Sonographically guided ilioinguinal nerve block. Journal of ultrasound in medicine. 2006 Dec;25(12):1571-5.
  7. Cho HM, Park DS, Kim DH, Nam HS. Diagnosis of ilioinguinal nerve injury based on electromyography and ultrasonography: a case report. Annals of rehabilitation medicine. 2017 Aug 31;41(4):705-8.
  8. Wong AK, Ng AT. Review of ilioinguinal nerve blocks for ilioinguinal neuralgia post hernia surgery. Current Pain and Headache Reports. 2020 Dec;24:1-5.
  9. Elsakka KM, Das JM, Allam AE. Ilioinguinal Neuralgia. InStatPearls [Internet] 2022 Oct 10. StatPearls Publishing.
  10. Elkins N, Hunt J, Scott KM. Neurogenic pelvic pain. Physical Medicine and Rehabilitation Clinics. 2017 Aug 1;28(3):551-69.
  11. Taghavi R, Tabasi KT, Mogharabian N, Asadpour A, Golchian A, Mohamadi S, Kabiri AA. The effect of acupuncture on relieving pain after inguinal surgeries. The Korean journal of pain. 2013 Jan 31;26(1):46-50.
  12. Hahn L. Treatment of ilioinguinal nerve entrapment–a randomized controlled trial. Acta obstetricia et gynecologica scandinavica. 2011 Sep;90(9):955-60.

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