The pseudoradicular syndrome. Lower extremity peripheral nerve entrapment masquerading as lumbar radiculopathy

Of approximately 4,000 patients with complaints of lower extremity pain who were referred to our center for evaluation of suspected lumbar radiculopathy, 36 were found to have peripheral nerve entrapments as the sole cause of their leg pain. Nine patients had femoral nerve entrapments just proximal to the inguinal ligament. Seven patients had saphenous nerve entrapments about the knee. Twenty patients had peroneal nerve entrapments at or above the popliteal space. Nine patients had tibial nerve entrapments in the popliteal space. The diagnosis was established on the basis of electrophysiologic studies coupled with the results of selective spinal and peripheral nerve blocks. Seven patients with saphenous nerve lesions, 12 patients with peroneal nerve lesions, nine patients with tibial nerve lesions, and four patients with femoral nerve lesions, for a total of 32 (71%) cases underwent surgical exploration and external neurolysis. Forty-four percent of the cases had a positive nerve root tension sign, and 44% (20/45) had spinal range of motion abnormalities. Back pain complaints were noted in 49% (22/45) of the cases. The pseudoradicular syndrome should be considered in cases of undiagnosed persistent leg pain. Peripheral nerve lesions should be ruled out prior to considering lumbar spine surgery.