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Anatomy of the Ilioinguinal nerve
The ilioinguinal nerve branches off the first lumbar nerve, in the lower spine, and travels through the second and third abdominal muscles.
This nerve is responsible for communication with the iliohypogastric nerve and is involved in both sensation and function of the lower abdominal and anterior pubic regions in both males and females.
Because of its long and relatively unprotected path, the nerve can be easily damaged by surgery or by subsequent scar tissue formation following a lower abdominal surgery, such as for hernia repair or a cesarean section, resulting in symptoms including pain, numbness abnormal sensation in the area, altered function, and altered physiology.
How does ilioinguinal neuropathy develop?
Ilioinguinal neuropathy is caused by damage to or dysfunction of the ilioinguinal nerve.
Damage to the nerve can occur as a result of surgery, due to a trauma to the abdomen or pelvis, or due to physiological changes, such as muscle or fascia tightness resulting in nerve entrapment; nerve damage can result in persistent pain, loss of sensation or altered sensation in the areas innervated by the ilioinguinal nerve, and physiological changes, including atrophy and hair loss.
Ilioinguinal neuropathy is a common cause of pain in the lower abdominal and anterior pelvic regions due to the nerve’s long and relatively exposed path.
Neuropathy of this nerve is more frequently caused by abdominal surgery, and less commonly the result of a stretch injury, such as due to pregnancy, nerve entrapment, such as due to a muscle or fascia tightness, or as a result of concurrent health issues affecting the nerves.
What are the symptoms?
Pain is the most common symptom of ilioinguinal neuropathy; the pain is often described as burning, sharp, shooting, or throbbing. Pain may be felt in the abdomen, the lower back, the groin, or the upper thigh. It can be present periodically, or be more persistent.
Pain is commonly felt more strongly when lying down. In addition to pain, some other symptoms of ilioinguinal neuropathy include:
• Numbness or altered sensation
• Hair loss or atrophy in the innervated areas
• Loss of function, such as muscle weakness
What are the risk factors associated with ilioinguinal neuropathy?
The primary risk factor for ilioinguinal neuropathy is surgery in the lower abdomen, such as a hernia repair, cesarean section, hysterectomy, appendectomy, or other lower abdominal procedures.
The neuropathy can develop as a direct result of direct trauma from the surgery or can develop due to scar tissue formation subsequent to the procedure.
Some other causes of ilioinguinal neuropathy include trauma to the abdomen, disruption of the aponeurosis of the oblique muscles (a thin membrane that covers the muscle) which can be caused by sudden lower body movement such as that used by hockey players, a stretch injury resulting from conditions like pregnancy, or various soft tissue abnormalities that can compress the ilioinguinal nerve.
Other factors that can contribute to the development of ilioinguinal neuropathy include autoimmune conditions that cause nerve inflammation, metabolic conditions such as diabetes, and even prolonged sitting.
How is ilioinguinal neuropathy diagnosed?
Diagnosis of ilioinguinal neuropathy will involve a medical appointment to get an accurate medical history and perform a physical examination.
A medical history will help the physician determine if you have risk factors for developing ilioinguinal neuropathy, such as a metabolic or autoimmune condition, recent abdominal surgery, recent trauma, or lifestyle factors that may contribute to developing the condition (such as prolonged sitting or cycling).
A physical exam will assess for tenderness or provocation of symptoms with certain movements and can help identify the source of your symptoms.
After a physical examination, diagnostic testing may be recommended to rule out other possible causes for your symptoms, including lumbosacral radiculopathy or damage to another nerve in the same vicinity as the ilioinguinal nerve.
These tests may include:
• Ultrasound – an imaging test that uses sound waves to create a picture (also known as a sonogram) of organs, tissues, and other structures inside the body. Unlike X-rays, ultrasounds don’t use any radiation.
• Electromyography – Measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle. The test is used to help detect neuromuscular abnormalities. During the test, one or more small needles (also called electrodes) are inserted through the skin into the muscle.
• Magnetic resonance neurography (MRN) – This is a modification of magnetic resonance imaging (MRI) that focuses on imaging the nerves. The technique used in MRN produces a detailed image of a nerve from the signal that comes from the nerve itself rather than from surrounding tissues or from fat in the nerve lining. This test allows for the nerves to be seen in an even more precise and detailed manner than MRI which may assist in detecting any specific complications to the internal state of the nerves.
• Quantitative Sensory Testing (QST) – Calibrated stimuli are applied to capture perception and pain thresholds to see somatosensory functioning. A QST battery is used which imitates natural thermal or mechanical stimuli. The aim is to acquire symptom patterns of sensory loss (for the functioning of the thick and thin nerve fibers) as well as a gain of function (hyperalgesia, allodynia, hyperpathia) with simultaneous detection of cutaneous and deep tissue sensibility.
• Nerve or skin biopsy – Nerve biopsy is the excision of a small piece of nerve for examination. Through a small incision, a sample of the nerve is removed and examined under a microscope. A nerve biopsy may be performed to identify nerve degeneration, identify inflammatory nerve conditions (neuropathies), or confirm specific diagnoses.
What are the potential causes of Ilioinguinal Neuropathy?
• Metabolic factors such as high blood glucose, duration of diabetes diagnosis, abnormal blood
fat levels and, possibly, low levels of insulin
• Neurovascular factors leading to damage to the blood vessels that carry oxygen and nutrients to nerves. Patients who have recently had surgery in the abdomen area are at risk because of this. Other contributing factors include sitting on a bicycle seat, or something similar, for extended periods.
• Autoimmune factors that cause inflammation in nerves
• Mechanical injuries such as blunt abdominal trauma or lower external oblique aponeurosis disruption.
• Surgery- Lower abdominal surgeries can result in ilioinguinal neuropathy, either due to direct trauma to the nerve during the procedure or as a result of scar tissue formation subsequent to the surgery. Some of these procedures include inguinal hernia repair, traumatic trochar from laparoscopic surgery, appendectomy, hysterectomy, abdominoplasty, and orchiectomy.
• Pregnancy, which can cause a stretch injury to the nerve.
• Femoral catheterization- A procedure that inserts a narrow tube into the femoral artery (groin), threaded through the arterial system, and into the arteries that surround and supply blood to the heart.
• Idiopathic nerve entrapment due to changes in connective tissue (such as the fascia) surrounding the nerve, causing compression of the nerve
How is ilioinguinal neuropathy treated?
After a diagnosis of ilioinguinal neuropathy, the approach to your treatment will be dependent on numerous factors, including the severity of your pain and limitations, concurrent health factors, and your response to various treatment options.
Some options for managing this condition include:
• Acetaminophen to reduce pain
• NSAIDs (non-steroidal anti-inflammatory drugs) to reduce pain and inflammation
• Other oral medications specific to treating neuropathic pain or inflammation
• Physiotherapy
• Acupuncture and Acupressure
• Massage therapy
• Occupational therapy (including improving the ergonomics of your workstation, if applicable)
• Cryotherapy
• Exercise
• Dietary changes to improve weight and reduce inflammation
• Smoking cessation
What do we do at WMC?
At the Wilderman Medical Clinic, we offer a variety of interventional and non-interventional pain management options, including:
Interventional pain management for ilioinguinal neuropathy:
• Nerve block injections for ilioinguinal neuropathy
• Cortisone injections for ilioinguinal neuropathy
Non-interventional pain management for osteoarthritis of the thoracic facet joints:
• Psychotherapy
• Kinesiology education sessions
What other treatments are available?
Radiofrequency ablation (or RFA) may be a suitable treatment option for those who experience temporary relief from ilioinguinal neuropathy following nerve block injections.
This procedure applied heat at a very specific site in order to destroy a portion of the nerve tissue that is transmitting pain signals to the brain, resulting in a long-lasting reduction of pain.
This procedure does carry the risk of potentially damaging adjacent tissues, however, and does cause irreversible damage to the nerve.
Decompression surgery may also be a treatment alternative, depending on the cause of your neuropathy; however, it is important to keep in mind the potential complications that can result from any surgical procedure.
If scar tissue from the surgery forms, resulting in re-compression of the ilioinguinal nerve, the neuropathy symptoms may return.
Works cited
Elsakka KM, M Das J, Allam AE. Ilioinguinal Neuralgia. [Updated 2022 Oct 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538256/
Ilioinguinal nerve. July 6, 2020. Retrieved from https://www.healthline.com/human-body-maps/ilioinguinal-nerve#1.
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