Cruralgia

Cruralgia is a medical term describing leg pain caused by irritation or injury to the crural nerves, most commonly the femoral nerve (nerve roots typically from L2 to L4). The characteristic presentation is deep, aching or burning pain in the anterior thigh, which may radiate to the knee or, via the saphenous nerve, to the medial leg. When the femoral nerve is involved, some patients may also experience weakness of hip flexion or knee extension.

Causes of cruralgia include compression or trauma to the femoral nerve in the pelvis or groin (for example by tumors, psoas pathology, inguinal hernia, or post-surgical scarring), entrapment around the iliopsoas muscle, inflammatory or infectious processes, and less commonly radiculopathy from L2–L4 spine disease. Less often, systemic neuropathies such as diabetic neuropathy can contribute to cruralgic pain.

Diagnosis relies on clinical assessment and targeted testing. A neurological exam examines quadriceps strength, patellar reflex, and sensation over the anterior thigh and medial leg. Imaging such as MRI of the lumbar spine helps identify radiculopathy, while pelvic imaging may reveal femoral nerve compression. Nerve conduction studies and electromyography can help distinguish femoral neuropathy from radiculopathy or other causes of leg pain.

Treatment focuses on alleviating symptoms and addressing the underlying cause. Noninvasive measures include analgesics and anti-inflammatory drugs, neuropathic pain agents (for example, gabapentinoids or certain antidepressants), and physical therapy. If there is a compressive lesion or tumor, surgical or interventional procedures may be indicated. Diagnostic or therapeutic nerve blocks may aid management in some cases. Prognosis depends on the etiology and duration of symptoms; neuropathic pain can become persistent if the underlying cause is not promptly treated.