Ann Rehabil Med.  2017 Aug;41(4):705-708. 10.5535/arm.2017.41.4.705.

Diagnosis of Ilioinguinal Nerve Injury Based on Electromyography and Ultrasonography: A Case Report

• Cho HM
• Park DS
• Kim DH
• Nam HS

• KMID: 2389418
• DOI: http://doi.org/10.5535/arm.2017.41.4.705

Abstract

Being located in the hypogastric area, the ilioinguinal nerve, together with iliohypogastric nerve, can be damaged during lower abdominal surgeries. Conventionally, the diagnosis of ilioinguinal neuropathy relies on clinical assessments, and standardized diagnostic methods have not been established as of yet. We hereby report the case of young man who presented ilioinguinal neuralgia with symptoms of burning pain in the right groin and scrotum shortly after receiving inguinal herniorrhaphy. To raise the diagnostic certainty, we used a real-time ultrasonography (US) to guide a monopolar electromyography needle to the ilioinguinal nerve, and then performed a motor conduction study. A subsequent US-guided ilioinguinal nerve block resulted in complete resolution of the patient's neuralgic symptoms.

Keyword

Ilioinguinal neuralgia; Electromyography; Ultrasonography

MeSH Terms

Burns
Diagnosis*
Electromyography*
Groin
Herniorrhaphy
Needles
Nerve Block
Neuralgia
Scrotum
Ultrasonography*

Figure

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  Fig. 1 Herniorrhaphy site of the patient (white arrow).

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  Fig. 2 Ilioinguinal motor conduction study. (A) Ultrasound image of the ilioinguinal nerve and monopolar needle between the internal abdominal oblique muscle and transverses abdominis muscle (red arrow, tip of monopolar needle; yellow arrow, ilioinguinal nerve; EO, external abdominal oblique muscle; IO, internal abdominal oblique muscle; TA, transversus abdominis muscle). (B) Demonstration of conduction study (A, needle electrode; B, probe; C, recording electrode; D, reference electrode; E, ground electrode).

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  Fig. 3 Motor conduction study of ilioinguinal nerve. (A) Compound muscle action potential (CMAP) of left internal abdominal oblique muscle (latency, 4.8 ms; amplitude, 0.9 mV). (B) CMAP of right internal abdominal oblique muscle (no response).

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  Fig. 4 Abnormal spontaneous activities in needle electromyography at the most caudal segment of the right internal abdominal oblique muscle.

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  Fig. 5 Ultrasonography of lower abdominal muscle. (A) Left side (normal), (B) right side (red arrow, diffuse fibrotic change of muscles). IO, internal abdominal oblique muscle; TA, transversus abdominis muscle.

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