Lumbosacral plexus entrapment syndrome. Part one: A common yet little-known cause of chronic pelvic and lower extremity pain

Abstract

Lumbosacral plexus entrapment syndrome (LPES) is a little-known but common cause of chronic lumbopelvic and lower extremity pain. The lumbar plexus, including the lumbosacral tunks emerge through the fibers of the psoas major, and the proximal sciatic nerve beneath the piriformis muscles. Severe weakness of these muscles may lead to entrapment plexopathy, resulting in diffuse and non-specific pain patterns throughout the lumbopelvic complex and lower extremities (LPLE), easily mimicking other diagnoses and is therefore likely to mislead the interpreting clinician. It is a pathology very similar to that of thoracic outlet syndrome, but for the lower body. This two-part manuscript series was written in an attempt to demonstrate the existence, pathophysiology, diagnostic protocol as well as interventional strategy for LPES, and its efficacy.Piriformis syndrome; Nerve entrapment; Double-crush; Pain, Chronic; Fibromyalgia Citation: Larsen K, Chien GCC. Lumbosacral plexus entrapment syndrome. Part one: A common yet little-known cause of chronic pelvic and lower extremity pain. Anaesth pain & intensiv care 2019;23(2):124-137

Lumbosacral plexus entrapment syndrome. Part two: Symptomology and rehabilitative trials

“…Lumbosacral plexus entrapment syndrome is a problem whose nature is very similar, almost identical, to lumbosacral plexus entrapment syndrome thoracic outlet syndrome, as it is caused by entrapment of the lumbosacral plexuses as they emerge through the psoas major or beneath the piriformis muscles, 1 and may thus result in multifocal entrapment neuropathies. [5][6][7][8][9][10][11][12][13][14] The symptoms of lumbosacral plexus entrapment syndrome may present in quite misleading ways, seemingly unrelated, also similar to TOS and often distal to the main site of entrapment.…”

“…[5][6][7][8][9][10][11][12][13][14] The symptoms of lumbosacral plexus entrapment syndrome may present in quite misleading ways, seemingly unrelated, also similar to TOS and often distal to the main site of entrapment. [1][2][3][4] In this regard, clinical suspicion as well as knowledge of appropriate provocative tests, are all necessary in order to confirm its presence. Specificity is often a problem with manual testing protocols, but the risk of misdiagnosis may be mitigated by considering several diagnostic criteria rather than just one single test, similar to what is proposed by Selmonosky in his diagnostic triad for TOS, 15-17 or the diagnostic cluster for sacroiliac joint dysfunction, 18 which involves five tests.…”

“…As we aimed do demonstrate in this article series' first part, 1 lumbosacral plexus entrapment syndrome (LPES) is a problem in which the lumbar and sacral plexuses become entrapped within the psoas major and by the piriformis muscles due to severe weakness or myotrauma, often resulting in diffuse pain "syndromes" in the lumbopelvic and lower extremity (LPLE) regions. The nature of LPES is similar to that of thoracic outlet syndrome (TOS), often mimicking other, peripheral etiologies of pain which may easily be misinterpreted as unrelated the pathology at hand, such as fibromyalgia.…”

“…The nature of LPES is similar to that of thoracic outlet syndrome (TOS), often mimicking other, peripheral etiologies of pain which may easily be misinterpreted as unrelated the pathology at hand, such as fibromyalgia. [1][2][3][4] The primary purpose of this trial was to establish whether or not an association between the inclusive diagnostic criteria outlined in this article series' first part, as well as the proposed strengthening protocols for the psoas major, piriformis and pectineus muscles, were also associated with factual patient recovery. This, both to to assess the specificity of the diagnostic criteria as well as the strengthening protocol's efficacy in the detection and treatment of LPES.…”