Obturator neuropathy associated with pelvic trauma: a case report
소속
Chungbuk National University Hospital, Department of Rehabilitation Medicine1
저자
Hyeun Suk Seo1*, Min Woo Oh1, Goo Joo Lee1†
Injury to the obturator nerve is rare, largely because the nerve lies protected deep within the pelvis and medial thigh. There have been just several isolated case reports of obturator neuropathy due to compressive causes and entrapment. To our knowledge, this is the rare reported case of obturator neuropathy associated with pelvic trauma .
He is a 47-year-old male interior design constructor with a history of left both acetabular column, anterior acetabular wall and iliac wing and superior and inferior pubic rami fracture due to fall down. Although he got surgical treatment, the left lower extremity motor power especially, hip adduction weakness persisted. There is no definite another sensory symptoms such as tingling sense other than muscle weakness. Left obturator neuropathy, nearly complete axonal injury was observed on the electrodiagnostic study on 2018.8.27
. Pelvic MRI on 2018.9.1 showed edema in left adductor longus, brevis, magus and pectineus muscle with fatty atrophy in adductor muscle group: compatible with left obturator neuropathy
. In the follow up electrodiagnostic study on 2019.10.2, we performed motor nerve conduction study of obturator nerve in garcilis. CMAP was not induced in the left gracilis compared to CMAP in the right gracilis
. Follow up needle electromyography study was similar to the previous study, and gracilis with obturator nerve motor conduction study was also not observed with MUAP
. However, the last follow up electrodiagnostic study on 2019.2.25, needle electromyography study showed improved results
.
Obturator neuropathy is an uncommon mononeuropathy of the lower extremity that usually occurs acutely after a well-defined event. It occurred most often as a perioperative complication or associated with pelvic trauma. This case report suggests that pelvic trauma should be considered in addition to lumbosacral plexopathy as well as obturator neuropathy.
Figure1. Edema in left adductor longus, brevis, magus and pectineus muscle with fatty atrophy in adductor muscle group: compatible with left obturator neuropathy on pelvic MRI on 2018.9.1
