Nerve Injuries Around the Hip

Nerve injuries around the hip can have variable clinical presentations depending on the location of the lesion, the sensorimotor function of the nerve, and the severity of the injury. Nerve injury can be classified as neurapraxia, axonotmesis, and neurotmesis, which correlates to ascending levels of severity. Hip arthroscopy can result in nerve injury due to portal placement, traction, compression, and tension during surgery. History, physical examination, imaging, and electrodiagnostic studies aid in the diagnosis and the classification of neural injury. Basic knowledge of electrodiagnostic studies and their utility for each mononeuropathy is beneficial in determining location and severity of the injury, as well as prognosis for recovery. The timing of the electrodiagnostic study is critical to the proper interpretation of results. The etiology of the nerve injury often directs management. There are three principles of mononeuropathy treatment: facilitation of nerve healing, relief of symptoms, and restoration of function. Ultimately, recovery from a nerve injury occurs over time, and setting realistic expectations for recovery is an important part of management. Each specific mononeuropathy of the hip has distinct clinical features. This chapter will cover the anatomic, etiologic, clinical presentation, and diagnostic features of the following nerves of the hip: iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, obturator, femoral, sciatic, superior gluteal, inferior gluteal, and pudendal.