Ilioinguinal Nerve: Difference between revisions


 

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== Description ==

== Description ==

[[File:Lumbar Plexus Gray.png|thumb|265x265px]]

[[File:Lumbar Plexus Gray.png|thumb|265x265px]]

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|transversus abdominis]] and the [[Internal Abdominal Oblique|internal oblique]] muscles. As it continues, it becomes visible near the [[Femoral Triangle|groin]] area, passing through the superficial [[Inguinal Canal|inguinal ring]] just in front of the spermatic cord in males.

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|transversus abdominis]] and the [[Internal Abdominal Oblique|internal oblique]] muscles. As it continues, it becomes visible near the [[Femoral Triangle|groin]] area, passing through the superficial [[Inguinal Canal|inguinal ring]] just in front of the spermatic cord in males.

=== Root  ===

=== Root  ===

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In addition cutaneous innervation to the superior medial thigh.

In addition cutaneous innervation to the superior medial thigh.

== Clinical relevance  ==

== Clinical relevance  ==

Ilioinguinal nerve injuries frequently occur following abdominal surgery, abdominal wall trauma, accidently during surgery because of traumatic trochar from laparoscopic surgeries, 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.

Ilioinguinal nerve injuriesfrequently occur following abdominal surgery, abdominal wall trauma, accidently during surgery because of traumatic trochar from laparoscopic surgeries, 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.

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]].

== Assessment ==

== Assessment ==

[[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>.  

[[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>.  

[[Electrodiagnosis|Electrodiagnostic stud]]<nowiki/>y to exclude other causes like; radiculopathy from lumbar or [[Lumbar Plexus|lumbar plexus]] injury<ref>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.</ref>.

[[Electrodiagnosis|Electrodiagnostic stud]]<nowiki/>y to exclude other causes like; radiculopathy from lumbar or [[Lumbar Plexus|lumbar plexus]] injury<ref>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.</ref>.

== Treatment ==

== 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 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>.

== Resources  ==

== Resources  ==

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

Inguinodynia that is a chronic or persistent groin pain

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 ma be carried out:

Diagnostic ultrasound we can track the nerve when it becomes superficial down to the superficial inguinal ring[5].

Electrodiagnostic study to exclude other causes like; radiculopathy from lumbar or lumbar plexus injury[6].

Medical Treatment[edit | edit source]

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[7].

NSAIDs, anti-inflammatory, antidepressants, opioids, and antiepileptics[8] for inguinal neuralgia and inguinodynia.

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

Physical Therapy Intervention[edit | edit source]

  • Transcutaneous electric nerve stimulation, myofascial release, and acupuncture can control symptoms of the ilioinguinal neuralgia.
  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. Gofeld M, Christakis M. Sonographically guided ilioinguinal nerve block. Journal of ultrasound in medicine. 2006 Dec;25(12):1571-5.
  6. 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.
  7. 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.
  8. Elsakka KM, Das JM, Allam AE. Ilioinguinal Neuralgia. InStatPearls [Internet] 2022 Oct 10. StatPearls Publishing.

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