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Navigating the Complexities of Groin Pain Management: The Articular Branch of the Obturator Nerve

Updated: Jan 20

Deborah Westergaard, MD

Pain Experts

Please excuse the rudimentary representation of the nerve in the image below. Utilizing freehand drawing allows me to bypass copyright constraints while still conveying the necessary anatomical details.

The Critical Role of the Articular Branch of the Obturator Nerve in Groin Pain

In the nuanced world of pain management, the articular branch of the obturator nerve stands out as a significant, yet often overlooked, contributor to groin pain. Originating from the lumbar plexus, this nerve extends its reach beyond the medial thigh, providing an articular branch to the hip joint and playing a vital role in pain transmission, especially in hip joint pathologies.

A Resident's Formative Experience with Complex Nerve Blocks in the Late 1980s

In the late 1980s, during my anesthesiology residency at Parkland Hospital, I encountered a defining challenge. Faced with performing multiple nerve blocks for a knee amputation on a patient who couldn't tolerate general anesthesia, I was left to my own devices — it was just me and my textbook. This experience was not just about managing the obturator nerve using a primitive landmark method but involved a comprehensive blockade of the leg's nerves. I learned the critical importance of nerve anatomy and the art of nerve blocks in pain management but without the benefit of advanced imaging techniques that we are so fortunate to access in 2024.

Dr. Paul Tortland's Insights on the Articular Branch of the Obturator Nerve

It is also important to credit Dr. Paul Tortland for bringing attention on his recent Linked In post given to the articular branch of the obturator nerve as a cause of groin pain. His insights have been instrumental in recognizing and addressing this specific source of pain, further enriching the field of pain management.

The Use of Hydrodissection in Nerve Entrapment

Additionally, nerve hydrodissection has revolutionized the approach to nerve entrapment. This minimally invasive method involves injecting fluid around an entrapped nerve, like the articular branch of the obturator, potentially providing significant relief by alleviating compression.

Dr. Chris Centeno's Contributions to Non-Operative Orthopedics

In the broader landscape of non-operative orthopedics, the pioneering work of Dr. Chris Centeno deserves notable mention. His innovative approaches have inspired many physicians and significantly advanced the field, offering minimally invasive alternatives to traditional surgical procedures and introducing me to nerve hydrodissection.

Understanding the Multifaceted Nature of Groin Pain

Groin pain can arise from various sources, including muscular strains, hip osteoarthritis, hernias, and hip labral tears, (to name a few) each requiring a distinct approach. This highlights the necessity of a comprehensive evaluation and a tailored treatment strategy in pain management.

Mastering Pain Management Through Experience and Innovation

For individuals seeking top-tier medical care, a deep understanding of conditions like obturator nerve entrapment and the availability of advanced treatment options like hydrodissection are vital. My personal experience in the late 1980s, dealing with the challenge of multiple nerve blocks for a knee amputation, was a defining moment in my career. It emphasized the importance of hands-on experience, anatomical knowledge, and innovative techniques in effective pain management.

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               Deborah Westergaard, MD

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