Purpose: Meralgia paraesthetica is usually caused by entrapment of the lateral femoral cutaneous nerve (LFCN) at the inguinal ligament. We present our experience with 114 patients who underwent surgical management for meralgia paraesthetica.

Material: We reviewed 114 patients (48 men, 66 women, five bilateral cases) who underwent surgery for meralgia paraesthetica between 1987 and 1999; local anaesthesia was used for neurolysis in most cases. We identified five aetiologies: idiopathic (n=69, three bilateral), abdominal surgery (n=19), iliac graft harvesting (n=12, one bilateral), hip surgery (n=7), trauma (n=7, one bilateral).

Methods: We analysed outcome at more than two years follow-up for the entire series and by aetiology using a standard 12-point evaluation scale accounting for residual pain, sensorial disorders, and patient satisfaction.

Results: The overall results were good, mean score 9/12 (range 1–12). Ninety-two patients were very satisfied or satisfied. Among the 27 patients who were not satisfied, five developed recurrence. Mean time to full pain relief was 70 days (range 1 – 364 days). Recovery of thigh sensitivity was noted at 128 days (range 1 – 364).

Discussion: The essential criteria of poor prognosis were duration of the meralgia before surgery and its aetiology. Neurolysis of an LFCN injured by trauma or iliac graft harvesting provided less satisfactory results (scores 7 and 6 respectively) than for idopathic meralgia paraesthetica or abdominal-surgery injury (scores 9 and 10 respectively). Eight of the neurolysis procedures in this series did not provide satisfactory results (score 5).

Conclusion: Neurolysis appears to be the surgical treatment of choice for mearlgia paraesthetica. In skilled hands, neurolysis can be performed under local anaesthesia, although certain difficulties can be encountered: obesity, modified anatomy due to prior operations, nerve variability (frequent). Knowledge of these different elements is essential not only to achieve neurolysis but also prevent iatrogenic injury.

Purpose: Mucoid pseudocysts are infrequent benign tumours affecting all peripheral nerves near joints. Reported for the first time in 1891, these cysts raise an unresolved question as to their nature. Identifying the origin of these cysts could have an impact on management and the risk of recurrence.

Material and methods: Twenty-three patients (21 men two women), mean age 38 years, were followed for a mean six years. The mucoid cyst was located at the level of the common fibular at the neck of the fibula in 16 cases, the tibial nerve at the knee in one, the medial nerve in one, the ulnar nerve in three and the supra-scapular nerve in two. Pain was local in 18 patients, irradiated to the concerned territory in 20. In 17 patients, the nerve lesion was discovered due to development of motor deficit. An EMG was performed in all cases, an ultrasound exploration in 15, a CT scan in seven and an MRI in ten. All patients underwent surgery with neurolysis under microscopy for intraneural cysts. A pedicle communicating with the joint was search for during each intervention.

Results: An articular communication was found in 17 cases. Mean delay to recovery of motor force was five months with recovery of normal sensitivity in 16 cases at seven months. Total lack of recovery was noted in one patient. There was one recurrence requiring tibiofibular arthrodesis.

Discussion: Three theories have been put forward. Besides the cystic degeneration of certain schwannomas, degeneration of the nerve sheath connective tissue, the joint theory appears to be the most probable. The presence of a pedicle linking the cyst to the joint in more than 60% of the cases, the periarticular situation of the nerves involved and sometimes the migration along an articular nerve as well as the mucoid content of the cysts is in favour of an articular origin. The notion of recurrrence after complete minute resection is also in favour of a joint disease.

Conclusion: A mucoid cyst is a likely diagnosis for neruological lesions lying near a joint. Search for an articular communication both before and during the surgical procedure is important to limit the risk of recurrence.

Purpose: Radial paralysis is a major complication of humeral shaft fractures. In most cases, the paralysis is regressive but in certain patients surgical repair is required to achieve full neurological recovery. We reviewed retrospectively our patients to determine the causes of non-recovery and evaluate the efficacy of different treatments.

Material and methods: Thirty patients were operated between 1990 and 1997 for radial nerve paralysis that was observed immediately after trauma or developed secondarily. Mean follow-up after surgery was 6.3 years. There were 22 men and 8 women, 16 right side and 14 left side. Mean delay from injury to surgery was four months (0–730 days). Elements that could be involved in radial paralysis were noted: type of fracture, level of the fracture, treatment, approach, material used. There were ten cases with non-union. Neurological recovery at three years was assessed with muscle tests and with the Alnot criteria. An electrical recording was also made in certain patients. Surgery involved neurolysis in 23 cases, nerve grafts in five and tendon transfers in two.

Results: Outcome was very good and good in 22 patients, good in one and could not be evaluated in one (tendon transfer). There were three failures (two neurolysis and one graft) and two patients were lost to follow-up. After neurolysis, mean delay to recovery was seven months; it was 15 months after nerve grafts. Recovery always occurred proximally to distally.

Discussion: Radial paralysis after femoral shaft fracture regresses spontaneously in 76% to 89% of the cases, depending on the series. There is a predominance in the 20 to 30 year age range. Several factors could be involved in radial paralysis (fracture of the distal third of the humerus, spiral fracture, plate fixation, nonunion). The anterolateral approach allows a better exposure of the nerve. Unlike other authors, we do no advocate exploration of the injured nerve during surgical treatment of the fracture because it is most difficult to determine the potential for recovery of a continuous nerve.

Conclusion: The risk of radial nerve paralysis is greatest for spiral fracture of the distal third of the humerus. In such cases, it may be useful to explore the nerve during the primary procedure and insert a plate. For other cases, we prefer to wait for spontaneous nerve recovery. If reinnervation is not observed at 100 days, we undertake exploration.