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Meralgia Paraesthetica

Essentials

  • Entrapment of the lateral femoral cutaneous nerve in the inguinal area
  • Seen especially in middle-aged overweight persons.
  • Symptoms include numbness, paraesthesias and burning pain in the anterior and lateral aspects of the thigh, which is aggravated by all movements of the hip region.
  • The diagnosis is clinical; machine-assisted diagnostic investigations are needed in special cases only.
  • High tendency of spontaneous recovery

Epidemiology

  • Incidence 4.3/10 000 person years
  • Occurs most commonly in the age of 30 to 40 years, more common in men.

Aetiology

  • The nerve entrapment is mostly located under the inguinal ligament, approximately 2 cm medially of the anterior superior iliac spine, but the location may vary according to the individual anatomical passage of the nerve.
  • In more than 30% of people the nerve has an aberrant course.
  • Symptoms are worsened by
    • mechanical factors at the areas of the nerve passage: overweight, pregnancy, tight clothing
    • metabolic factors: diabetes, alcohol
    • iatrogenic factors: hip and back surgery
  • The aetiological factor is not necessarily found.
  • May be bilateral.

Diagnosis

  • Hyperextension of the thigh with the knee flexed increases the pain.
  • Compression of the entrapment site causes radiating pain into the thigh.
  • The clinical picture does not include motor symptoms.
  • Root compression is ruled out by using the straight leg rising test (Lasègue's test) and testing hip movements to rule out osteoarthritis-induced limitation.
  • Electroneurophysiological tests may be used if necessary in patients with severe symptoms; the interpretation may be problematic in obese patients.
  • Diagnostic local nerve block

Differential diagnosis

  • Trochanteric pain Trochanteric Pain
  • Insertion pain of the quadriceps muscle
  • Radicular symptom from the lumbar spine (L3)
  • Neuropathy (prolonged meralgia may, however, also cause neuropathic pain)

Treatment

  • Often resolves spontaneously when mechanical pressure is diminished Treatment for Meralgia Paraesthetica.
  • Elimination of provoking factors (reduction of weight, avoidance of tight clothing)
  • NSAIDs and cold packs, stretching exercises of hip flexors
  • In a prolonged painful condition, drugs intended for the treatment of neuropathic pain can be used (tricyclic antidepressants, gabapentin, pregabalin)
  • Glucocorticoid + local anaesthetic injections into the entrapment site; the injection can be repeated at a few weeks' intervals according to treatment response. The glucocorticoid may also be injected at multiple sites along the nerve in order to increase the effect.
  • Nerve decompression by surgery may be considered if the condition is prolonged and shows no signs of spontaneous recovery.

    References

    • Cheatham SW, Kolber MJ, Salamh PA. Meralgia paresthetica: a review of the literature. Int J Sports Phys Ther 2013;8(6):883-93. [PubMed]

Related Keywords

ATC Code:

N03AX12

H02BX01

M01AB01

M01AB02

M01AB05

M01AB08

M01AB15

M01AB51

M01AB55

M01AC01

M01AC02

M01AC06

M01AE01

M01AE02

M01AE03

M01AE11

M01AE17

M01AE51

M01AE52

M01AG01

M01AG02

M01AX01

M01AX17

N02AJ08

N02BA01

N02BA51

N02BA57

N03AX16

N06AA02

N06AA04

N06AA06

N06AA07

N06AA09

N06AA10

N06AA12

N06AA21

Primary/Secondary Keywords