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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.
  • L4-L5 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 (knee extension weakness) (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]