31/01/2026
💥Femoral Nerve ⤵️
🗣️ Femoral Nerve – a small structure with a BIG impact on walking, standing, and daily life!
🔥 Anatomy
Origin: Lumbar plexus (L2, L3, L4 nerve roots)
💥 Pathway:
➡️ from psoas major (lateral border)
➡️ Runs between psoas & iliacus
➡️ Passes beneath inguinal ligament into thigh
➡️ Lies lateral to femoral artery in femoral triangle
💥 Motor supply:
➡️ Quadriceps femoris (knee extension)
➡️ Sartorius, pectineus (partial), iliacus
💥 Sensory supply:
➡️ Anterior thigh (anterior cutaneous branches)
➡️ Medial leg & foot (saphenous nerve branch)
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⚠️ Signs & Symptoms of Femoral Nerve Injury
🗂️ Motor:
✅ Weakness in knee extension (quadriceps)
✅ Difficulty climbing stairs, rising from chair
✅ Instability of knee (may buckle)
🗂️ Sensory:
➡️ Numbness/tingling anterior thigh, medial leg & foot
🗂️ Reflex:
Diminished/absent patellar reflex
🗂️ Pain:
Groin, anterior thigh pain radiating down medial leg
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🎯 Causes
✅ Trauma (pelvic fracture, hip dislocation, stab wound)
✅ Compression (retroperitoneal hematoma, tumor, aneurysm)
✅ Iatrogenic (after abdominal, pelvic, hip surgery)
✅ Diabetic neuropathy (femoral mononeuropathy)
✅ Prolonged lithotomy position (surgical
posture)
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💥 Special Tests
➡️ Femoral Nerve Stretch Test (FNST):
Patient prone → hip extended, knee flexed → pain in anterior thigh = positive
➡️ Patellar Reflex Test:
Tapping patellar tendon → absent/diminished = femoral nerve involvement
➡️ Manual Muscle Testing:
Quadriceps (knee extension weakness)
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💥 Radiological & Other Diagnostic Tests
✅ MRI / CT scan: To detect compression, hematoma, tumor
✅ Ultrasound: For soft tissue or hematoma around nerve
✅ Nerve Conduction Studies (NCS): Reduced conduction velocity in femoral nerve
✅ Electromyography (EMG): Denervation in quadriceps
✅ X-ray pelvis/hip: To rule out fracture or dislocation
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💥 Physiotherapy Management
➡️ Acute Phase
✅ Pain relief → TENS, cryotherapy, gentle positioning
✅ Avoid positions that stretch nerve (excessive hip extension/knee flexion)
✅ Supportive devices (knee brace if instability)
➡️ Strengthening
✅ Isometric quadriceps (e.g., quad sets)
✅Straight leg raises (progress gradually)
✅ Closed chain exercises (mini squats, sit-to-stand)
✅ Functional training (stairs, walking)
➡️ Stretching
✅ Gentle stretching of hip flexors & quadriceps once recovery begins
➡️ Gait Training
✅ Use of assistive device (stick, walker) if knee buckling present
✅ Balance & proprioceptive training
➡️ Neuromuscular Re-education
✅ Electrical stimulation for weak quadriceps
✅ Mirror therapy / biofeedback for muscle activation
➡️ Long-Term Goals
✅ Restore full knee extension strength
✅ Improve functional mobility & independence
✅ Prevent secondary complications (falls, muscle atrophy)
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✅ Physio Masud
