Martin RobRoy, Martin Hal David, Kivlan Benjamin R
Baylor University Medical Center, Hip Preservation Center, Dallas TX, USA.
Duquesne University, Pittsburgh, PA, USA.
Int J Sports Phys Ther. 2017 Dec;12(7):1163-1173. doi: 10.26603/ijspt20171163.
The purpose of this clinical commentary is to review the anatomy, etiology, evaluation, and treatment techniques for nerve entrapments of the hip region. Nerve entrapment can occur around musculotendinous, osseous, and ligamentous structures because of the potential for increased strain and compression on the peripheral nerve at those sites. The sequela of localized trauma may also result in nerve entrapment if normal nerve gliding is prevented. Nerve entrapment can be difficult to diagnose because patient complaints may be similar to and coexist with other musculoskeletal conditions in the hip and pelvic region. However, a detailed description of symptom location and findings from a comprehensive physical examination can be used to determine if an entrapment has occurred, and if so where. The sciatic, pudendal, obturator, femoral, and lateral femoral cutaneous are nerves that can be entrapped and serve a source of hip pain in the athletic population. Manual therapy, stretching and strengthening exercises, aerobic conditioning, and cognitive-behavioral education are potential interventions. When conservative treatment is ineffective at relieving symptoms surgical treatment with neurolysis or neurectomy may be considered.
本临床评论的目的是回顾髋部区域神经卡压的解剖结构、病因、评估和治疗技术。由于在那些部位周围神经可能受到更大的牵张和压迫,神经卡压可发生在肌腱、骨性和韧带结构周围。如果正常的神经滑动受阻,局部创伤的后遗症也可能导致神经卡压。神经卡压可能难以诊断,因为患者的主诉可能与髋部和骨盆区域的其他肌肉骨骼疾病相似且并存。然而,症状位置的详细描述和全面体格检查的结果可用于确定是否发生了卡压以及卡压的部位。坐骨神经、阴部神经、闭孔神经、股神经和股外侧皮神经可能被卡压,并成为运动员人群髋部疼痛的一个来源。手法治疗、伸展和强化锻炼、有氧运动和认知行为教育是可能的干预措施。当保守治疗无法缓解症状时,可考虑进行神经松解或神经切除术的手术治疗。
5级。