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Case report
peer-reviewed

Split Femoral Nerve Due to Psoas Tertius Muscle: A Review with Other Cases of Variant Muscles Traversing the Femoral Nerve



Abstract

Leg pain from lumbar disc herniation is a common presentation. However, certain muscular and peripheral nerve variants may present similarly and represent an unrecognized etiology of femoral nerve dysfunction. Such cases might affect the outcome of specific treatment regimes. Therefore, recognition of these variations in anatomy may be useful to the clinician when treating the patient with medically refractory lower limb pain. Some reports have reported variant slips of the psoas and iliacus muscles, which may split the femoral nerve causing a potential risk for nerve entrapment. Herein, we report a very unusual variant of the psoas muscles, the psoas tertius, which pierced the femoral nerve into two parts. Additionally, the literature of other similar muscle variants is reviewed. Clinicians should be aware of anatomical muscular variants of the posterior abdominal wall and the propensity of such anomalies to result in distortion of regional neural structures. In this regard, the anatomy of the psoas tertius should be known.



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Case report
peer-reviewed

Split Femoral Nerve Due to Psoas Tertius Muscle: A Review with Other Cases of Variant Muscles Traversing the Femoral Nerve


Author Information

Shehzad Khalid Corresponding Author

Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies

Joe Iwanaga

Seattle Science Foundation

Marios Loukas

Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies

R. Shane Tubbs

Neurosurgery, Seattle Science Foundation


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Case report
peer-reviewed

Split Femoral Nerve Due to Psoas Tertius Muscle: A Review with Other Cases of Variant Muscles Traversing the Femoral Nerve


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Case report
peer-reviewed

Split Femoral Nerve Due to Psoas Tertius Muscle: A Review with Other Cases of Variant Muscles Traversing the Femoral Nerve

Shehzad Khalid">Shehzad Khalid , Joe Iwanaga">Joe Iwanaga, Marios Loukas">Marios Loukas, R. Shane Tubbs">R. Shane Tubbs

  • Author Information
    Shehzad Khalid Corresponding Author

    Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies

    Joe Iwanaga

    Seattle Science Foundation

    Marios Loukas

    Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies

    R. Shane Tubbs

    Neurosurgery, Seattle Science Foundation


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: August 09, 2017

    DOI

    10.7759/cureus.1555

    Cite this article as:

    Khalid S, Iwanaga J, Loukas M, et al. (August 09, 2017) Split Femoral Nerve Due to Psoas Tertius Muscle: A Review with Other Cases of Variant Muscles Traversing the Femoral Nerve. Cureus 9(8): e1555. doi:10.7759/cureus.1555

    Publication history

    Received by Cureus: July 18, 2017
    Peer review began: July 28, 2017
    Peer review concluded: July 28, 2017
    Published: August 09, 2017

    Copyright

    © Copyright 2017
    Khalid et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Leg pain from lumbar disc herniation is a common presentation. However, certain muscular and peripheral nerve variants may present similarly and represent an unrecognized etiology of femoral nerve dysfunction. Such cases might affect the outcome of specific treatment regimes. Therefore, recognition of these variations in anatomy may be useful to the clinician when treating the patient with medically refractory lower limb pain. Some reports have reported variant slips of the psoas and iliacus muscles, which may split the femoral nerve causing a potential risk for nerve entrapment. Herein, we report a very unusual variant of the psoas muscles, the psoas tertius, which pierced the femoral nerve into two parts. Additionally, the literature of other similar muscle variants is reviewed. Clinicians should be aware of anatomical muscular variants of the posterior abdominal wall and the propensity of such anomalies to result in distortion of regional neural structures. In this regard, the anatomy of the psoas tertius should be known.



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Create a free account to continue reading this article.

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Shehzad Khalid, M.D.

Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies

For correspondence:
shezdk@gmail.com

Joe Iwanaga, Ph.D., Assistant Professor

Seattle Science Foundation

Marios Loukas

Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies

R. Shane Tubbs, Ph.D., Professor

Neurosurgery, Seattle Science Foundation

Shehzad Khalid, M.D.

Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies

For correspondence:
shezdk@gmail.com

Joe Iwanaga, Ph.D., Assistant Professor

Seattle Science Foundation

Marios Loukas

Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies

R. Shane Tubbs, Ph.D., Professor

Neurosurgery, Seattle Science Foundation