Topography and evidence of a separate "fascia plate" for the femoral nerve inside the iliopsoas – A dorsal approach. Issue 5 (25th December 2020)

• Record Type: Journal Article
• Authors: Kulow, Charlotte; Reske, Andreas; Leimert, Mario; Bechmann, Ingo; Winter, Karsten; Steinke, Hanno
• Is Part Of: Journal of anatomy. Volume 238:Issue 5(2021)
• Page Start: 1233
• Page End: 1243
• Publication Date: 2020-12-25
• Subjects: femoral nerve -- iliopsoas muscle -- Methylene blue -- nerve sheath -- paraneural sheath -- psoas fascia; Anatomy -- Periodicals; 571.3
• DOI: 10.1111/joa.13374
• Languages: English
• ISSNs: 0021-8782

Abstract

Abstract: The femoral nerve stretch test is an essential part of clinical neurological examinations. This test is performed alongside Magnetic Resonance Imaging (MRI) to determine if there is any evidence of nerve root irritation, usually as a consequence of disc prolapse. The test occasionally gives false positive results. Why such false positives can occur, is subject to continued research, however, no obvious reason has yet emerged. We hypothesize that connectives of the femoral nerve may explain such a phenomenon. To see these connectives, we approached the femoral nerve from dorsal in 12 cases. With the use of ink injection into the subparaneural compartment of the femoral nerve and dissections, a thin transparent structure can clearly be seen that is separate from the epineurium, perineurium, and a paraneural sheath. A continuation of the paraneural sheath produces a fascia plate approximately 1.5 cm in width and with a thickness of around 3 mm, which not only circumnavigates the nerve but projects into the surrounding tissues. Our qualitative observations show that not only does this femoral nerve fascia plate exists, but it also contains nerves and vessels. Furthermore, we show that the femoral nerve is connected to the myofascial complex of the iliopsoas, and in a separate fascia plate from the iliopsoas fascia. This plate is a hitherto neglected connective which extends as far as the spinal dura mater. Evidence from our plastinates and histological sections suggests that when tension is applied to the femoral nerve during the femoral nerve stretch test, tension is also applied to the femoral nerve fascia plate. The femoral nerve fascia plate could be a specific factor that contributes to pain resulting in a false positive femoral nerve stretch test. Abstract : The femoral nerve stretch test (FNST) is an essential part of clinical neurological examinations. False positives can occur during this test. Why this happens remains unclear. We show that the femoral nerve is connected to the myofascial complex of the iliopsoas, in a separate fascia plate apart from the iliopsoas fascia. This femoral nerve fascia plate contains vessels and nerves and is connected in such a way that it may itself be responsible for pain and the giving of a false positive FNST.