Ilioinguinal neuropathy

Clinical-- burning pain in abdomen into inner/upper thigh or into scrotum or labia majora. There may be tenderness slightly medial to anterior iliac spine or a Tinel's sign over the lower abdomen. PEARL if complete palsy is present lower abdomen may bulge mimicking a primary hernia. Patients may walk bent over or have trouble rising from a chair. They may walk flexed forward "like a novice skier." Etiology may be traumatic; blow to abdomen, surgery such as appendectomy or more commonly herniorrhaphy (may have occurred previous suggesting etiology is fibrosis or scar formation around the nerve). Differential includes entrapment of neighboring homologous iliohypogastric nerve, also of T12-L1, or genitofemoral nerve which courses retroperitoneally and can be caused by hematoma or tumor. Diagnosis: with nerve blocks. Treatment: surgical resection helped more than 75 %. The nerve arises from L1 and L2 roots, supplies skin over the upper/medial thigh, the root of the penis, the upper scrotum or labia majora, and also innervates the transversalis and interior oblique muscles. It follows the pattern of an intercostal nerve, winding around the inner trunk to the medial anterior iliac spine.