- 1 What is cruralgia and lumbocruralgia?
- 2 What are the causes of cruralgia?
- 3 What are the causes of crural nerve compression?
- 4 What are the symptoms of lombocruralgia?
- 5 How to diagnose cruralgia?
- 6 What is the treatment for cruralgia?
- 7 Natural remedies for cruralgia
- 8 How long does it last? The prognosis
What is cruralgia and lumbocruralgia?
Lombocruralgia (or crural neuralgia) means pain that extends from the spine along the course of the crural nerve (the femoral).
It is very similar to sciatica , but it hits the crural instead of the sciatic nerve.
The symptoms are at the lumbar level, outside of the hip, groin and the anterior aspect of the thigh.
Unlike sciatica, lumbocruralgia does not cause symptoms to the foot.
The crural nerve is the largest of the lumbar plexus and is divided into several branches:
- The muscular trunk innervates the muscles: quadriceps femoris, sartorius and pectin
- The shunt of the skin extends over the anterior, medial and lateral part of the thigh
- The saphenous nerve runs along the thigh and leg in the antero-medial region
- The articular branches innervate the hip joint.
Pain and other symptoms can be caused by compression or irritation of the crural nerve that can no longer carry the signals from the spinal cord to the periphery and vice versa, the brain interprets this nervous irritation as pain.
Between one vertebra and another, there is an intervertebral disc composed of a gelatinous material inside (nucleus pulposus) and a fibrous tissue of hyaline cartilage on the outside (fibrous ring).
The latter consists of many concentric circles joined together and composed of fibers with different orientation between them.
It is as if each fibrous ring were made in layers, each one must support and allow the movement of the spine. If one or more layers fissure, the inner nucleus pulposus leaves partially (bulging) or it can pass around the ring and presses on the spinal cord ( hernia ).
The crural nerve arises from the spinal cord at the level of the nerve roots of L2-L3, L3-L4 and L4-L5, a compression can cause cruralgia.
The appearance of lumbocruralgia may be acute or slow and progressive, may begin after an incorrect flexion or for no apparent reason.
Lumbocruralgia is much rarer than sciatica because the disc between L5-S1 is in a place subject to greater stress than the other discs, at this level a protrusion or hernia causes sciatica.
In most cases, the symptoms are only on one side, a case of bilateral cruralgia is very rare.
During pregnancy it is easier to suffer from cruralgia because the intervertebral discs have an increase in the load due to the weight of the baby and the pressure of the uterus in the spine.
What are the causes of cruralgia?
The causes of cruralgia are many, we must first clarify that this symptom does not affect only patients with hernia or protrusion, in contrast, in most cases the source is visceral or caused by adhesions of the connective tissue, hip arthrosis , etc.
Patients who underwent abdominal surgery may suffer from groin pain and radiated lower back pain , in which case the intervertebral disc does not cause symptoms but is a disorder of muscles, tendons, and ligaments.
What are the causes of crural nerve compression?
The causes of cruralgia are:
1. Flexion and efforts to lift weights or perform heavy manual labor.
2. Posture, especially in the sitting position, we tend to stay bent forward.
3. Sedentary lifestyle, individuals who do not perform physical activities and always maintain a seated position can have two consequences: increased spine rigidity , loss of tone and trophic musculature of the trunk, especially the abdominal and paravertebral muscles.
Under these conditions, a simple movement such as standing up from the chair is sufficient to cause damage to the intervertebral disc and cause compression in the crural nerve.
There are predisposing factors to the onset of the disease:
1. Obesity: An overweight person puts more pressure on the spine and on the discs.
2. Age: bulging, bulging and herniated disc usually occur in patients between the ages of 35 and 55 years, with more than 55 nucleus pulposus of the intervertebral disc tends to dehydrate, therefore the gelatinous liquid does not leave.
What are the symptoms of lombocruralgia?
- Pain in the spine and persistent pain in the left or right abdomen , up to the gluteus
- Pain in the groin within the thigh to the knee
- Paresthesia or hypoaesthesia
- Rigidity and difficulty of movements
- Loss of strength and quadriceps femoral atrophy
- Loss of patellar reflex
Pain can affect only the lumbar spine, or it may be limited in the crural nerve, but in most cases this disorder originates from the spine, then radiates to the groin and thigh in the antero-medial region.
Depending on the exact location of the symptoms we can understand which nerve root is involved, whether L3 or L4 because they affect a well-delimited body part.
A protrusion or disc herniation at the level of the spine, projects the pain in a lower region (L3 hernia can cause low back pain in the L5 zone).
Pain can be felt during movements, especially during extension, because it lengthens the nerve.
Even a sneezing, coughing and straining in the bathroom (Valsalva maneuver) intensifies the symptoms.
In the acute phase, if the pain is very strong or terrible, the patient should stay in bed to have some relief with the knees bent with the hip flexed, so it does not apply tension to the crural nerve.
After the first few days, if the cause is an inflammation , lumbocruralgia becomes less severe and the symptoms tend to regress. If compression is caused by the nucleus pulposus, the pain remains stationary.
How to diagnose cruralgia?
The doctor should consult the patient, check his posture, know if the patient takes painkillers and how he walks.
The test for lumbocruralgia is called Wasserman’s test, it consists of extending the hip and bending the knee in the belly position, in practice, it is necessary to lie down with the belly down, lift and flex the sore knee, this maneuver puts in stretching the nerve crural, if more symptoms occur the test is positive.
The differential diagnosis is made considering that the symptoms can be caused by:
- Infectious diseases such as discitis (inflammation of the disc space)
- Fractures or vertebral collapse
- Tumors such as osteoma, osteosarcoma, acoustic neuromas, meningioma, endometriosis or bone metastases
- Muscular disorders such as hip arthrosis, piriformis syndrome , pubalgia and spondylolisthesis which is rare between L2 and L3
- Herpes zóster
- Inguinal hernia
- Vascular diseases such as femoral artery aneurysm .
The most suitable specialist to diagnose lumbocruralgia is the neurosurgeon or neurologist, if there is an indication for surgery, the patient should go to the physiatrist or orthopedist to define a conservative treatment.
The doctor will check your medical history and symptoms, perform clinical examinations and possibly imaging tests: MRI , CT scans and laboratory tests to rule out other diseases.
What is the treatment for cruralgia?
Treatment is tailored to the symptoms if the patient feels only pain, then it is very likely to have much benefit or the symptoms completely disappear with conservative therapy:
- The McKenzie method is a mechanical therapy that involves exercises that push the intervertebral disc into its anatomical location
- Manual physiotherapy or osteopathic treatments
- Postural rehabilitation gymnastics
- Avoid movements that cause pain and run
- Anti- inflammatories may provide temporary relief, for example, ibuprofen ( Alivium) and diclofenac (Voltaren).
- When an intervertebral disc breaks and exits the material from the internal disk, inflammation occurs with accumulation of inflammatory fluid. The liquid can press on the nerve roots, in these cases the cortisone can decrease the pain because it reduces the inflammation.
If the patient also suffers from severe neurological deficit, such as paresthesia or hypotrophy of the muscles, the treatment is surgery.
After the operation, a rehabilitation period is needed to reduce pain and regain strength and range of motion.
Time and rest may help resolve cruralgia because the intervertebral disc tends to dehydrate and push the nerve roots less, but may take many months or a few years, so the patient must decide whether to wait so long or whether to accelerate cure.
Natural remedies for cruralgia
How long does it last? The prognosis
The recovery time of cruralgia depends on the cause and the treatment performed.
In case of nerve compression, the duration may be a few months.
If the pain is caused by the muscles or connective tissues it is advisable to make a suitable treatment to dissolve muscle contractures and adhesions between the fibers of the connective tissue.
The risk is that the disease will become chronic.