Femoral nerve excursion with knee and neck movements in supine, sitting and side-lying slump: An in vivo study using ultrasound imaging. (October 2018)

• Record Type: Journal Article
• Authors: Sierra-Silvestre, Eva; Bosello, Francesca; Fernández-Carnero, Josué; Hoozemans, Marco J.M.; Coppieters, Michel W.
• Is Part Of: Musculoskeletal science and practice. Volume 37(2018)
• Page Start: 58
• Page End: 63
• Publication Date: 2018-10
• Subjects: Neuropathy -- Neuropathic pain -- Neurodynamics -- Sonography; Manipulation (Therapeutics) -- Periodicals; Physical therapy -- Periodicals; Neuromuscular diseases -- Treatment -- Periodicals; Musculoskeletal system -- Diseases -- Periodicals; Manipulation (Therapeutics); Neuromuscular diseases -- Treatment; Physical therapy; Manipulation, Orthopedic; Musculoskeletal Diseases -- therapy; Neuromuscular Diseases -- therapy; Physical Therapy Modalities; Electronic journals; Periodicals; 615.82
• DOI: 10.1016/j.msksp.2018.06.007
• Languages: English
• ISSNs: 2468-8630

Abstract

Abstract: Background: Neurodynamic assessment and management are advocated for femoral nerve pathology. Contrary to neurodynamic techniques for other nerves, there is limited research that quantifies femoral nerve biomechanics. Objectives: To quantify longitudinal and transverse excursion of the femoral nerve during knee and neck movements. Design: Single-group, experimental study, with within-participant comparisons. Methods: High-resolution ultrasound recordings of the femoral nerve were made in the proximal thigh/groin region in 30 asymptomatic participants. Scans were made during knee flexion in supine and a semi-seated position, and during neck flexion in side-lying slump (SlumpFEMORAL ). Healthy participants were assessed to reveal normal nerve biomechanics, not influenced by pathology. Data were analysed with one-sample and paired t-tests. Reliability was assessed with intraclass correlation coefficients (ICC). Results: Longitudinal and transverse excursion measurements were reliable (ICC≥0.87). With knee flexion, longitudinal femoral nerve excursion was significant and larger in supine than in sitting (supine (mean (SD)): 3.6 (2.0) mm; p < 0.001; sitting: 1.1 (1.6) mm; p = 0.001; comparison : p = 0.001). There was also excursion in a medial direction (supine: 1.4 (0.3) mm; p < 0.001; sitting: 0.7 (0.6) mm; p < 0.001) and anterior direction (supine: 0.2 (0.2) mm; p < 0.001; sitting: 0.1 (0.2) mm; p = 0.06). Neck flexion in SlumpFEMORAL did not result in longitudinal (0.0 (0.3) mm; p = 0.55) or anteroposterior (0.0 (0.1) mm; p = 0.10) excursion, but resulted in medial excursion (1.1 (0.5) mm; p < 0.001). Conclusion: Although the femoral nerve terminates proximal to the knee, femoral nerve excursion in the proximal thigh occurred with knee flexion; Neck flexion in SlumpFEMORAL resulted in medial excursion. Highlights: Longitudinal and transverse excursions of the femoral nerve can be measured reliably with ultrasound imaging. Although the femoral nerve terminates proximal to the knee, it slides 3.5 mm in the upper thigh with knee flexion. Neck flexion in SlumpFEMORAL is associated with excursion of the femoral nerve in a medial, but not longitudinal direction.