Generality
Cruralgia is a painful condition that affects the front and / or inner face of the thigh, to be precise the area covered and innervated by the crural nerve.
In addition to pain, cruralgia can be characterized by numbness, tingling, burning and / or weakness in the affected limb.
The diagnosis of cruralgia is based on: physical examination, medical history, a neurological examination and a series of instrumental tests, such as CT, nuclear magnetic resonance and electromyography.
The treatment of cruralgia includes a causal therapy - that is focused on treating the causes - and a symptomatic therapy - whose purpose is to alleviate the symptoms.
What is cruralgia?
Cruralgia is the medical term that indicates the presence of pain along the anterior and / or internal face of the thigh, exactly in the area crossed and innervated by the crural nerve.
Cruralgia is also known as crural neuralgia or frontal sciatica .
WHAT IS THE CURAL NERVE?
Resulting from the lumbar plexus, the crural nerve (or femoral nerve ) is an important and voluminous peripheral nerve of the lower limbs; along its path from the abdomen to the inner side of the foot, this nerve passes through the antero-medial part of the thigh and the medial aspect of the leg.
Having both a motor function and a sensory function, the crural nerve contains the nerve fibers of the spinal roots L2, L3 and L4 (NB: the L indicates that the spinal roots emerge from the lumbar vertebrae number 2, number 3 and number 4).
Image modified from the website: Cursoenarm.net
Along its course, it gives rise to several branches (or branches): the so-called abdominal branches of the crural nerve, the so-called branches of the anterior division of the crural nerve and, finally, the so-called branches of the posterior division of the crural nerve.
At the motor level, the crural nerve controls the hip flexor muscles and the knee extensor muscles. On a sensitive level, however, it controls the sensitivity of the anteromedial portion of the thigh, the medial side of the leg and the medial side of the foot.
Epidemiology
Cruralgia most frequently affects people over the age of 50.
Causes
In general, cruralgia is the consequence of damage, compression or irritation of the crural nerve or of the crural nerve roots.
In most cases, damage, compression and irritation of the crural nerve derive from:
- Direct traumas to the nerve structure in question or to its roots;
- A hernia of the intervertebral disc at the level of the lumbar vertebrae L2, L3 or L4. It is one of the main causes of cruralgia;
- The presence, in the immediate vicinity of the crural nerve or its roots, of a tumor mass or a large hematoma.
More rarely, damage, compression and irritation depend on the presence of bony irregularities (secondary to vertebral fractures, osteoporosis, arthrosis with formation of osteophytes, etc.) or the presence of a narrowing of the vertebral canal ( lumbar spinal stenosis ).
RISK FACTORS
For a human being, they are risk factors of cruralgia:
- The presence of a herniated intervertebral disc;
- Suffering from osteoarthritis and / osteoporosis;
- Being a victim of a vertebral fracture;
- Present a lumbar spinal stenosis;
- Develop a tumor or hematoma near the crural nerve, near one of its branches or near its roots.
Deepening: what is the herniated disc?
The herniated disc is a fairly common spinal disease, which mainly affects people between 30 and 50 years.
The herniated disc is the exit, from its natural seat, of the pulpy nucleus contained within the intervertebral disc; the intervertebral disc is the fibrocartilaginous junction that, located between vertebra and vertebra, absorbs the stresses and weights of the vertebral column.
Episodes of herniated disc may derive from: particular stresses that wear out the containment structure of the pulp disk; excessive strain on the spine; spinal trauma; spinal stiffness due to aging; other less common conditions.
The most characteristic symptom of a herniated disc is pain.
At a later stage of the disease, motor and / or sensory deficits may be added to the pain.
Treatment of the herniated disc may be conservative or surgical. It is conservative for less severe cases; it is instead surgical for severe cases and for those who have seen conservative therapy fail.
Symptoms, signs and complications
The most characteristic symptom of cruralgia is pain in the front and / or inside of the thigh.
This pain can appear suddenly - for example after an effort - or progressively.
In the most serious cases, to the painful sensation at the level of the thigh, other ailments can be added at the level of the painful area, disorders which generally consist in: sense of numbness, burning sensation, tingling and weakness in the affected limb.
MOTOR EFFECTS OF A CURAL NERVE PROBLEM
At motor level, damage, compression and irritation of the crural nerve can cause atrophy of the quadriceps muscle and loss of extensive knee capacity and hip flexion capacity.
The motor effects depend on the point in which damage, compression or irritation of the crural nerve occurs.
SENSITIVE EFFECTS OF A PROBLEM IN THE CRURAL NERVE
At sensory level, damage, compression and irritation of the crural nerve can lead to loss of skin sensitivity in the anteromedial compartment of the thigh and / or loss of skin sensitivity in the inner side of the leg and foot.
As with the motor effects, the sensory effects depend on where the damage, compression or irritation of the crural nerve is located.
CRURALGIA AND BACK PAIN
Cruralgia is sometimes associated with back pain . In medicine, the association between cruralgia and back pain is called lombocruralgia .
COMPLICATIONS
When it is particularly intense, the pain of cruralgia is an obstacle to the performance of the most mundane daily activities. This can have repercussions on the mood of patients, who may develop low mood and mild depressive states.
Diagnosis
In general, the diagnostic procedure to which a patient with suspected cruralgia must undergo includes:
- A thorough physical examination and a careful medical history . They are used by the doctor to understand what the symptoms are, how and when they occurred, what features they present, etc .;
- A neurological evaluation . It serves to understand what is the health of the crural nerve and of the other nerves of the human body, which, in case of damage, compression or irritation, may have the same symptoms as cruralgia (differential diagnosis);
- A series of instrumental examinations, including X-rays, CT, nuclear magnetic resonance and electromyography . Above all, they serve to understand the causes of cruralgia. For example, if the cruralgia is consequent to the presence of a tumor, a CT scan or a nuclear magnetic resonance allow to identify the tumor mass, specifying also its exact position and size.
Therapy
The treatment of cruralgia provides, first of all, a causal therapy - that is, a therapy aimed at treating the triggering causes - and, secondly, a symptomatic therapy - that is, a therapy whose purpose is to improve the symptom picture.
CAUSAL THERAPY
Causal therapy varies depending on the condition that triggered cruralgia.
For example, in the presence of a cruralgia due to a tumor, the therapy consists in the removal, through surgical intervention, of the tumor mass that compresses / irritates the crural nerve; otherwise, in the presence of a cruralgia due to a herniated disc, the treatment consists of all those conservative and / or surgical remedies indicated to resolve the leakage of an intervertebral disc.
In general, the effectiveness of causal therapy depends on the treatability of triggering causes: in fact, there are more easily treatable conditions than others.
SYMPTOMATIC THERAPY
The most indicated symptomatic therapy, in case of cruralgia, consists of: rest from physical activity (not immobility though!) And taking non-steroidal analgesics and anti-inflammatory drugs (NSAIDs). Analgesics are pain-relieving drugs, while non-steroidal anti-inflammatory drugs are drugs that soothe inflammation.
In cases where the painful sensation is very intense and / or the NSAIDs are not very effective, doctors also consider it essential to administer corticosteroids, by injection; corticosteroids are very powerful anti-inflammatory drugs, whose prolonged use can have unpleasant side effects (eg: osteoporosis, diabetes, cataracts or obesity).
Prevention
Not for all forms of cruralgia there is a real prevention.
Specified this, it is worth remembering which are the main points for the prevention of the main cause of cruralgia, ie the herniated disc.
- Maintaining a good muscle tone, especially those muscles that doctors recognize as " core ". The " core " is the functional part of the human body, given by the set of abdominal, oblique, lumbar and paravertebral muscles;
- Stretching to improve the flexibility of the lumbosacral tract and the ischio-crural muscles;
- Acquisition of the correct technique of lifting a weight (upright chest and flexed knees);
- Proper eating habits, body weight control, regular physical activity, well-being-oriented lifestyle.
Prognosis
In general, the less severe forms of cruralgia from the clinical point of view have a better prognosis, compared to the more severe forms of cruralgia from the clinical point of view.
It is a fact that the treatment of cruralgia at the beginning is more likely to succeed.
