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Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
Anatomy and Related Etiology of Groin Pain
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Anatomy and Related Etiology of Groin Pain

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  • 1. ANATOMY AND RELATED ETIOLOGY OF GROIN PAIN George S. Ferzli MD, FACS Anne Erickson, CMI Tabulae Sceletie Musculorum Corporis Humani Barnhard S. Albinus, London, 1747. Jan Wanderlaar, artist.
  • 2. <ul><li>A 28 year old woman with </li></ul><ul><li>right-sided groin pain </li></ul><ul><li>approaches a surgeon : </li></ul>Albrecht Durer, Vier Bucher von menschlicher Proportion, Nurenberg, 1528. <ul><li>She has already been seen by: </li></ul><ul><ul><li>Primary Care </li></ul></ul><ul><ul><li>Gynecologist (vaginal ultrasound) </li></ul></ul><ul><ul><li>Gastroenterologist (EGD and </li></ul></ul><ul><ul><li>colonoscopy) </li></ul></ul><ul><ul><li>Neurologist (MRI) </li></ul></ul><ul><ul><li>Orthopedic (hip X-ray) </li></ul></ul><ul><ul><li>Urologist (pelvic ultrasound) </li></ul></ul>
  • 3. DIFFERENTIAL DIAGNOSIS <ul><li>INFECTIOUS DISEASE </li></ul><ul><li>Herpes zoster </li></ul><ul><li>HIV / tuberculosis </li></ul><ul><li>Lyme disease </li></ul><ul><li>Psoas abscess </li></ul><ul><li>DERMATOLOGY </li></ul><ul><li>Lymphadenitis </li></ul><ul><li>Psoriasis / burn </li></ul><ul><li>Sebaceous cyst / </li></ul><ul><li>hioradenitis </li></ul><ul><li>Thrombophlebitis / </li></ul><ul><li>cellulitis </li></ul><ul><li>VASCULAR </li></ul><ul><li>Abscess hematoma </li></ul><ul><li>Post vein stripping </li></ul><ul><li>Pseudoaneurysm </li></ul><ul><li>Vascular graft </li></ul><ul><li>RHEUMATOLOGY </li></ul><ul><li>Connective tissue disease </li></ul><ul><li>Iliopsoas bursitis </li></ul><ul><li>Osteitis pubis </li></ul><ul><li>SLE </li></ul><ul><li>ORTHOPEDIC </li></ul><ul><li>hip disorders: </li></ul><ul><li>Acetabular labral tears </li></ul><ul><li>Avascular necrosis </li></ul><ul><li>Chondritis dissecans </li></ul><ul><li>Legge-Calve Perthes dis. </li></ul><ul><li>Osteoarthritis </li></ul><ul><li>Pelvic stress fractures </li></ul><ul><li>Slipped fem. cap. epiphysis </li></ul><ul><li>Snapping hip syndrome </li></ul><ul><li>Synovitis </li></ul><ul><li>NEUROLOGY </li></ul><ul><li>Lumbosacral </li></ul><ul><li>disorders </li></ul><ul><li>Neurofibromatosis </li></ul><ul><li>GYNECOLOGY </li></ul><ul><li>C-section </li></ul><ul><li>Cervical cancer </li></ul><ul><li>Endometriosis </li></ul><ul><li>Tubal / ovarian </li></ul><ul><li>disorders </li></ul><ul><li>UROLOGY </li></ul><ul><li>Cystitis </li></ul><ul><li>Epididymitis </li></ul><ul><li>Nephrolithiasis </li></ul><ul><li>Prostatitis </li></ul><ul><li>Torsion of testes </li></ul><ul><li>Urethral extravasation </li></ul><ul><li>Urinary tract infection </li></ul><ul><li>Vas granuloma / fibrosis </li></ul><ul><li>SURGERY </li></ul><ul><li>Compensation (workman’s) </li></ul><ul><li>Hernia </li></ul><ul><li>Recurrent hernia </li></ul><ul><li>Post hernia </li></ul><ul><ul><li>Open </li></ul></ul><ul><ul><ul><li>neuropathic </li></ul></ul></ul><ul><ul><ul><li>non-neuropathic </li></ul></ul></ul><ul><ul><li>Laparoscopic </li></ul></ul><ul><ul><ul><li>neuropathic </li></ul></ul></ul><ul><ul><ul><li>non-neuropathic </li></ul></ul></ul><ul><li>NEUROSURGERY </li></ul><ul><li>Disc disease </li></ul><ul><li>Spinal injuries, </li></ul><ul><li>inflammation, tumors </li></ul><ul><li>Spondylolisthesis </li></ul><ul><li>Spondylolysis </li></ul><ul><li>SPORTS MEDICINE </li></ul><ul><li>“ Sports hernia” </li></ul><ul><li>(adductor strains) </li></ul><ul><li>Gilmore’s groin </li></ul><ul><li>GASTRO-ENTEROLOGY </li></ul><ul><li>Appendicitis / adhesions </li></ul><ul><li>Diverticulitis </li></ul><ul><li>Inflammatory </li></ul><ul><li>retroperitoneal </li></ul><ul><li>phlegmon (pancreatitis) </li></ul><ul><li>Meckel diverticulitis </li></ul><ul><li>Granulomatous colitis </li></ul>
  • 4. <ul><li>Running and kicking sports injuries (football, soccer, hockey, hurdling, skiing etc…) </li></ul>Could groin pain be due to a sports injury?
  • 5. Gilmore’s Groin (sportsman’s hernia) <ul><li>Mechanism: hyper abduction of the thigh </li></ul><ul><li>and hyper extension of the hip with truncal </li></ul><ul><li>rotational movement result in: </li></ul><ul><li>Attenuation or laddering of the ext. oblique </li></ul><ul><li>Separation of the conjoin tendon from the </li></ul><ul><li>inguinal lig. </li></ul><ul><li>Laxity of the transversalis fascia </li></ul><ul><li>Strain on pubic symphysis </li></ul><ul><li>Tears in adductor muscles near pubic origins </li></ul><ul><li>Treatment involves repair of the floor and </li></ul><ul><li>adductor longus tenotomy. </li></ul>
  • 6. Differential diagnosis <ul><li>Has ruled everything out except: </li></ul><ul><li>Hernia </li></ul><ul><li>Open right hernia repair is </li></ul><ul><li>recommended. </li></ul><ul><li>All risks, complications and </li></ul><ul><li>recurrences are discussed at length. </li></ul>De humani corpus fabrica libri septem. Andreas Vesalius, Basel, 1543.
  • 7. <ul><li>Patient requests surgery concommittant with laparoscopic tubal ligation. </li></ul><ul><li>Hernia operation is performed through the lateral aspect of the Pfannenstiel Cesarean section scar. </li></ul><ul><li>During the operation, a right indirect hernia is found - </li></ul><ul><li>the sac and round ligament are submitted to pathology. </li></ul>
  • 8. <ul><li>Litigation </li></ul>Albrecht Durer, Vier Bucher von menschlicher Proportion, Nurenberg, 1528. <ul><li>Right groin pain </li></ul><ul><li>Bladder frequency </li></ul><ul><li>Pain on right lateral side </li></ul><ul><li>extending from buttock to foot </li></ul>One year later, she files a lawsuit based on these symptoms: <ul><li>Numbness in right labia majora, </li></ul><ul><li>clitoris and mons causing sexual </li></ul><ul><li>distress </li></ul>
  • 9. The charge: <ul><li>“ Deviation from </li></ul><ul><li>Standard of Care” for </li></ul><ul><li>“ severing the </li></ul><ul><li>iliohypogastric and </li></ul><ul><li>ilioinguinal nerves”. </li></ul>
  • 10. FRIDAY <ul><li>Malpractice insurance company lawyers advise an </li></ul><ul><li>out-of court settlement or the surgeon would face a </li></ul><ul><li>multimillion dollar lawsuit (malpractice insurance covered </li></ul><ul><li>up to one million dollars) against a plaintiff-sympathetic </li></ul><ul><li>jury in Federal Court with no chance for appeal. </li></ul>
  • 11. <ul><li>During testimony and cross examination the surgeon explains that </li></ul><ul><li>chronic groin pain (CGP) after hernia repair is well described.* </li></ul><ul><li>Reported incidence is 10%, although different studies have placed it </li></ul><ul><li>between 0-60%. </li></ul><ul><li>Risk factors associated with CGP that have been identified include: </li></ul><ul><li>Recurrent hernia repair </li></ul><ul><li>Insurance status </li></ul><ul><li>Preoperative pain </li></ul><ul><li>Day surgery </li></ul>MONDAY <ul><li>Young age </li></ul><ul><li>Surgeon’s experience </li></ul><ul><li>Surgical technique </li></ul><ul><li>Severe early post-operative pain </li></ul>* Kumar S, Wilson RG, Nixon SJ and Macintyre IMC. Chronic pain after groin hernia surgery. BJM 2002, 89, 1476-1479
  • 12. Genitofemoral causalgia was first reported by Magee in 1942*. It is often debilitating and reflects chronic neuralgia including paresthesia, hypesthesia and dysesthesia. * Magee RK. Genitofemoral causalgia (a new syndrome). CMAJ 1942, 46: 326-9.
  • 13. Related Dermatome Regions <ul><li>T 11,12 (thoracic region) </li></ul><ul><li>ilioinguinal and iliohypogastric nerves </li></ul><ul><li>L 1,2,3,4,5 (lumbar plexus) </li></ul><ul><li>genitofemoral and lat. femoral cutaneous nerves </li></ul><ul><li>S 1,2,3 (sacral plexus) </li></ul><ul><li>pudendal nerve </li></ul>Albrecht Durer, Vier Bucher von menschlicher Proportion, Nurenberg, 1528.
  • 14. The ilioinguinal nerve (T12 and L1) supplies sensory innervation to the proximal and medial thigh. In the female innervation is supplied to abdominal skin of the mons pubis and labium majus. In the male, the ilioinguinal nerve innervates the root of the penis and upper scrotum. The iliohypogastric nerve supplies similar sensory innervation to that of the ilioinguinal nerve. Iliohypogastric n. Ilioinguinal n. Cross innervation
  • 15. Surgeon’s testimony continues <ul><li>Main innervation of external genitalia is </li></ul><ul><li>provided by the genitofemoral (L1,2) and </li></ul><ul><li>pudendal nerves (S2,3,4.) </li></ul>
  • 16. Genitofemoral nerve innervation (L1,2) The genital branch of the genitofemoral nerve supplies sensation to the mons pubis and labium majus. In the male, sensation is supplied to the scrotum and motor fibers to the cremasteric muscle. Genital branch, genitofemoral nerve
  • 17. Pudendal nerve innervation of female external genitalia (S2,3,4)
  • 18. Surgeon’s testimony continues <ul><li>He routinely identifies the nerves, protects them </li></ul><ul><li>(without stretching), doesn’t use cautery in their </li></ul><ul><li>vicinity and does not incorporate them into suture </li></ul><ul><li>material. </li></ul><ul><li>Nerve entrapment, excessive scar formation or </li></ul><ul><li>mechanical pressure from mesh are possible </li></ul><ul><li>etiologies. </li></ul>
  • 19. <ul><li>Despite sound, anatomic-based and unwavering </li></ul><ul><li>testimony in front of a jury (6 women and 2 men), </li></ul><ul><li>the insurance company increases pressure on </li></ul><ul><li>the surgeon for an out-of-court settlement, offering </li></ul><ul><li>the plaintiff $450,000. </li></ul>
  • 20. TUESDAY <ul><li>During her testimony and cross examination, the patient </li></ul><ul><li>complains that quality and quantity of sex has diminished, </li></ul><ul><li>compromising marriage. </li></ul><ul><li>Her husband testifies that long walks and romance </li></ul><ul><li>are gone because of wife’s groin pain. </li></ul>
  • 21. TUESDAY <ul><li>Expert witness * for the prosecution states that the surgeon: </li></ul><ul><li>Deviated from Standard of Care </li></ul><ul><li>Caused irreversible damage by severing the </li></ul><ul><li>ilioinguinal and iliohypogastric nerves </li></ul><ul><li>Definitely not a case of nerve entrapment </li></ul><ul><li>Should have performed the operation laparoscopically </li></ul>* Admitted to have never observed the patient–his conclusions were based on a 17 page diary that the plaintiff had prepared for him.
  • 22. <ul><li>Insurance company faxes </li></ul><ul><li>consent form and demands </li></ul><ul><li>surgeon settle out-of-court. </li></ul><ul><li>They propose a settlement </li></ul><ul><li>of $750,000. </li></ul>
  • 23. WEDNESDAY <ul><li>Expert witness for the defense (surgeon) testifies: </li></ul>
  • 24. Groin pain could be neuropathic: <ul><li>Neuroma formation </li></ul><ul><li>Perineural fibrosis </li></ul><ul><li>Partial or complete nerve </li></ul><ul><li>severance </li></ul><ul><li>Nerve entrapment by </li></ul><ul><li>staple or suture </li></ul><ul><li>Nerve entrapment </li></ul><ul><li>by mesh (meshalgia) </li></ul>
  • 25. Nerves prone to injury during laparoscopic repair: <ul><li>Lateral femoral </li></ul><ul><li>cutaneous nerve </li></ul><ul><li>Femoral branch of </li></ul><ul><li>the genitofemoral </li></ul><ul><li>nerve </li></ul><ul><li>Femoral nerve </li></ul>
  • 26. Lateral femoral cutaneous nerve innervation (L2,3) <ul><li>Sensory innervation </li></ul><ul><li>to anterolateral thigh </li></ul><ul><li>Injury may result in </li></ul><ul><li>a severe burning </li></ul><ul><li>sensation along the </li></ul><ul><li>anterolateral aspect </li></ul><ul><li>of the thigh </li></ul>
  • 27. Femoral branch of genitofemoral nerve-innervation (L1,2) The femoral branch supplies sensory innervation to the anterolateral thigh.
  • 28. Femoral nerve innervation (L2,3) <ul><li>Sensory innervation </li></ul><ul><li>to anterolateral thigh </li></ul><ul><li>Injury may result in </li></ul><ul><li>atrophy of the </li></ul><ul><li>quadriceps muscle </li></ul>
  • 29. Pain could be non-neuropathic and related to: <ul><li>Excessive scar formation </li></ul><ul><li>Mesh pressure or bulk- </li></ul><ul><li>forming mesh material </li></ul><ul><li>Mesh(algia) </li></ul><ul><li>Staple(algia) </li></ul>
  • 30. <ul><li>Pressure on surgeon increases to settle out of court (legal settlement consent forms arrive via FEDEX at the surgeon’s home.) </li></ul><ul><li>Trial counsel is convinced surgeon cannot prevail against lay jury. </li></ul>
  • 31. THURSDAY <ul><li>Jury asks to review all the previous visual </li></ul><ul><li>information for a second time and deliberates </li></ul><ul><li>From 9am until 4:10pm. </li></ul>
  • 32. The ilioinguinal nerve (T12 and L1) supplies sensory innervation to the proximal and medial thigh. In the female innervation is supplied to abdominal skin of the mons pubis and labium majus. In the male, the ilioinguinal nerve innervates the root of the penis and upper scrotum. The iliohypogastric nerve supplies similar sensory innervation to that of the ilioinguinal nerve. Iliohypogastric n. Ilioinguinal n. Cross innervation
  • 33. Pudendal nerve innervation of female external genitalia (S2,3,4)
  • 34. Genitofemoral nerve innervation (L1,2) The genital branch of the genitofemoral nerve supplies sensation to the mons pubis and labium majus. In the male, sensation is supplied to the scrotum and motor fibers to the cremasteric muscle. Genital branch, genitofemoral nerve
  • 35. Groin pain could be neuropathic: <ul><li>Neuroma formation </li></ul><ul><li>Perineural fibrosis </li></ul><ul><li>Partial or complete nerve </li></ul><ul><li>severance </li></ul><ul><li>Nerve entrapment by </li></ul><ul><li>staple or suture </li></ul><ul><li>Nerve entrapment </li></ul><ul><li>by mesh (meshalgia) </li></ul>
  • 36. Pain could be non-neuropathic and related to: <ul><li>Excessive scar formation </li></ul><ul><li>Mesh pressure or bulk- </li></ul><ul><li>forming mesh material </li></ul><ul><li>Mesh(algia) </li></ul><ul><li>Staple(algia) </li></ul>
  • 37. THURSDAY Jury Verdict 4:10pm <ul><li>Reasonable doubt as to the cause of </li></ul><ul><li>the woman’s symptoms was raised </li></ul><ul><li>by the issue of nerve entrapment </li></ul><ul><li>from accumulating scar tissue. </li></ul><ul><li>Standard of Care was not violated </li></ul><ul><li>and the surgeon was exonerated. </li></ul>William Cheselden, Osteographia, London 1733.
  • 38. <ul><li>… groin pain can cause litigation </li></ul><ul><li>and litigation can cause groin pain. </li></ul>William Cheselden, Osteographia, London 1733.
  • 39. An indepth knowledge of anatomy and the multiple etiologies of groin pain is essential. De humani corpus fabrica libri septem. Andreas Vesalius, Basel, 1543.
  • 40. References <ul><li>Elementi di anatomias </li></ul><ul><li>fisiologica applicata </li></ul><ul><li>alle belle arti </li></ul><ul><li>figurative.Francesco </li></ul><ul><li>Bertinatti,Turin, 1837. </li></ul><ul><li>Mecco Leone, artist. </li></ul><ul><li>Gilmore's groin repair in athletes. Brannigan AE;Kerin MJ;McEntee GP J Ortho. and Sports PT 2000 Jun;30:329-32 </li></ul><ul><li>A1-stage surgical treatment for postherniorrhaphy neuropathic pain. Parviz K. Amid,MD,FACS Arch Surg 2002; 137:100-104 </li></ul><ul><li>Diagnosis and treatment of genitofemoral and ilioinguinal neuralgia Starling JR, Harms BA. World J Surg 1989 ;13:586-591 </li></ul><ul><li>Managment of severe lower abdominal or inguinal pain in high performance athletes Meyers WC, Foley DP , Garret WE,Lohnes JH, Mandelebaum BR Am J Sports Med. 2000 ; 28(4):616-7 </li></ul><ul><li>Groin pain in Athletes Jeblanc KE, Leblanc KA Hernia.2003 Jun;7(2):68-71 </li></ul><ul><li>Chronic pain and quality of life following open inguinal hernia repair. Poobalan AS,Bruce J, King PM, Chambers WA, Krukowski ZH, Smith WC. BR J Surg. 2001 Aug;88(8);1122-6 </li></ul><ul><li>Outcome of patients with severe chronic pain following repair of groin hernia. Courtney CA, Duffy K, Serpell MG, O'Dwyer PJ. BR J Surg.2002 Oct;89(10):1310-4 </li></ul><ul><li>Surgical management of groin pain of neural origin. Lee CH, Dellon, AL. J Am Coll Surg. 2000 Aug; 191 (2): 137-42. </li></ul><ul><li>Anatomic basis of chronic groin pain with special reference to sports hernia. Akita K, Niga S, Yamato Y, Muneta T, Sato T. Surg Radiol Anat. 1999 ; 21 (1): 1-5. </li></ul><ul><li>Anatomic variability of the ilioinguinal and genitofemoral nerve: implications for the treatment of groin pain. Ebner, RM and Dellon AL Plast Reconstr Surg . 2001 Nov; 108 (6):1618-23 </li></ul><ul><li>Ultrasound of the inguinal floor for evaluation of hernias. Lilly MC, Arregui ME. Surgical Endoscopy 2002 16:659-662. </li></ul><ul><li>Kumar S, Wilson RG, Nixon SJ and Macintyre IMC. Chronic pain after groin hernia surgery. BJM 2002, 89, 1476-1479. </li></ul><ul><li>Magee, RK. Genitofemoral causalgia (a new syndrome). CMA J 1942 , 46: 326-9 </li></ul><ul><li>Images from: National Library of Medicine, Bethesda, MD online at: </li></ul><ul><li>historical anatomies@ nlm . nih .gov </li></ul>
  • 41. Questions: <ul><ul><li>1. Which of the following statements about innervation of the </li></ul></ul><ul><ul><li>groin is incorrect? </li></ul></ul><ul><ul><ul><li>a. The ilioinguinal nerve arises from T12 and L1 and supplies sensory innervation </li></ul></ul></ul><ul><ul><ul><li>to the proximal and medial thigh, root of penis and upper scrotum or the mons </li></ul></ul></ul><ul><ul><ul><li>pubis and labium majus. </li></ul></ul></ul><ul><ul><ul><li>b. The genitofemoral nerve originates from L1 and L2 and it divides into the genital </li></ul></ul></ul><ul><ul><ul><li>and femoral branches. The genital branch supply motor fibers to the cremasteric </li></ul></ul></ul><ul><ul><ul><li>muscle and sensation to the scrotum (mons pubis and labium majus in women). </li></ul></ul></ul><ul><ul><ul><li>c. The iliohypogastric nerve originates from T12 and L1. The sensory innervation </li></ul></ul></ul><ul><ul><ul><li>field of this nerve is similar to that of the ilioinguinal nerve. </li></ul></ul></ul><ul><ul><ul><li>d. The lateral femoral cutaneous nerve arises from L2 and L3, and supplies sensory </li></ul></ul></ul><ul><ul><ul><li>innervation to the anterior and lateral aspects of the thigh. </li></ul></ul></ul><ul><ul><ul><li>e. The femoral branch of the genitofemoral nerve provides sensory innervation to </li></ul></ul></ul><ul><ul><ul><li>the posterolateral aspect of the upper thigh. </li></ul></ul></ul><ul><li>N.B. (e) is the correct answer </li></ul>
  • 42. 2. Groin pain can result from all the following except: a. Vas deferens fibrosis post hernia b. Herpes zoster infection c. Reflex sympathetic dystrophy d. Rolled up, bulk forming mesh material e. Torsion of the appendix testes N.B. (e) is the correct answer <ul><li>Questions: </li></ul>
  • 43. 3. Chronic post herniorrhaphy neuropathic groin pain is the result of all the following except: a. Neuroma formation b. P perineural fibrosis c. Entrapment by staples, sutures or prosthetic material d. Nerve damage from stretching, contusion, crushing, electrical damage, partial or complete division e. Periosteal reaction N.B. e. is the correct answer <ul><li>Questions: </li></ul>
  • 44. 4. In comparison to open mesh (tension-free) hernia repair, the nerves prone to injury during laparoscopic hernia repair are: a. Ilioinguinal and iliohypogastric nerves b. Ilioinguinal and genital branch of the genitofemoral nerve c. Ilioinguinal and lateral femoral cutaneous nerves d. Femoral branch of the genitofemoral nerve and iliohypogastric nerve e. Femoral branch of the genitofemoral nerve and lateral femoral cutaneous nerve N.B. (e) is the correct answer <ul><li>Questions: </li></ul>
  • 45. 5. Which of the following statements is incorrect? a. Femoral nerve injury may result in atrophy of the quadriceps muscle b. Lateral femoral cutaneous nerve injury may result in severe burning sensation along the anterolateral aspect of the thigh c. Peripheral communication between the ilioinguinal, iliohypogastric and genital branch of genitofemoral nerve is very common and results in an overlap of their sensory innervation d. A mesh placed taut and fixed with too many staples during laparoscopic preperitoneal hernia repair may result in “meshalgia” or “staplealgia” e. Sport related groin pain may result from injury to the abductor muscles N.B. e. is the correct answer <ul><li>Questions: </li></ul>

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