Iliacus stretching for symptomatic relief of femoral mononeuropathy

A case of a middle-aged, long-term insulin-dependent diabetic gentleman with an acute onset of hip and thigh pain and quadriceps weakness after sneezing is presented. Following an initial differential diagnosis of nerve root and/or femoral nerve compression, magnetic resonance imaging (MRI) failed to reveal any evidence of nerve root compression or intrapelvic pathology. On this basis, the diagnosis was subsequently modified to femoral mononeuropathy. As his symptoms were relieved by iliopsoas stretching, the possibility exists that he was suffering primarily from proximal femoral nerve entrapment by iliacus, and a post-mortem example of this anatomical variant is shown. Gentle stretching of hip flexors, especially if it alleviates symptoms, might therefore be considered amongst other conservative measures, where proximal femoral nerve entrapment is suspected.