Meralgia Paraesthetica

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See also: Meralgia Paraesthetica written for patients

Meralgia paraesthetica comes from the Greek words meros (thigh) and algos (pain).[1] Meralgia paraesthetica is usually an entrapment syndrome of the lateral femoral nerve. It may be iatrogenic after medical or surgical procedures, or result from a neuroma. The segmental origin is L2/L3 and it is a purely sensory nerve with no motor fibres.[2]

Lateral cutaneous nerve of the thigh - anatomy

The nerve originates from the L2/L3 segments and travels down, lateral to the psoas muscle. It crosses the iliacus muscle deep to the fascia and then passes through or under the lateral part of the inguinal ligament. It runs superficially and divides into anterior and posterior branches to innervate the lateral thigh. The course of the nerve can be variable. One study of cadaveric specimens found a range of 2-5 cm lateral to the anterior superior iliac spine.[3]

An incidence has been estimated at 4.3 per 10,000 person years. It occurs most commonly in people between the ages of 30 to 40 years. The condition is thought to be much rarer in children.[5] It has a higher predilection in men than in women.

Risk factors[6]

Meralgia paraesthetica can occur in pregnancy, obesity and if there is tense ascites.[7] It may be a result of trauma, previous surgery or, in some cases, may arise from abduction splints used to treat Perthes' disease, also called Calvé-Legg-Perthes disease. Various sports and physical activities have been implicated, including gymnastics, baseball, soccer, bodybuilding and strenuous exercise.[4]Lying for long periods of time in the fetal position and lying prone after lumbar spine surgery have also been identified as possible causes. Risk factors can arise in the most unlikely scenarios. A spate of meralgia was found to be due to the body armour worn by American soldiers in Iraq.[8] It occurs more commonly in those with diabetes than in the general population.[4]Most cases are idiopathic.

Entrapment causes burning or numbness down the upper lateral aspect of the thigh. In children and adolescents the presentation is severe pain causing marked restriction of activities.[9] It may be bilateral.[10]

The pain can be reproduced by deep palpation just below the anterior superior iliac spine (pelvic compression) and also by extension of the hip.[11] There is altered sensation over the anterolateral aspect of the thigh.[12]There is no motor weakness.[13]

Very often the diagnosis is slow to be made. Pain in the lateral thigh can arise from the back or hip.[4]It is important to consider the possibility of the diagnosis and to try deep palpation medial to the anterior superior iliac spine and extension of the hip. Injection with local anaesthetic appears to be a good test.

Other conditions that may need to be ruled out include:[14, 15]

  • Diabetic lumbosacral plexopathy.
  • Lumbar degenerative disc disease.
  • Lumbar facet arthropathy.
  • Lumbar spondylolysis and spondylolisthesis.
  • Mononeuritis multiplex.
  • Neoplastic lumbosacral plexopathy.

Rarely, pressure on the lateral cutaneous femoral nerve can arise from a mass in the retroperitoneal space - eg, tumours, iliacus haematoma.[16]

  • The pelvic compression test is highly sensitive and the diagnosis can often be made with this test alone.[11]
  • Injection of the nerve with local anaesthetic will abolish the pain. Find the spot where deep pressure reproduces the pain and infiltrate below there. The nerve is quite superficial.[17]
  • Nerve conduction studies may be used before operation.[18]
  • MRI neurography of the lateral cutaneous nerve has recently been employed to assist in diagnosis.[4]

Other tests to rule out differential diagnoses might include fasting blood glucose, MRI of the lumbar spine and radiographs for possible pelvic fracture or cancer.

The evidence base for the treatment of meralgia paraesthetica is weak, and randomised controlled trials are needed.[19]

  • In the case of obesity, loss of weight may cure the condition but is not guaranteed. It should resolve after pregnancy and tapping of ascites should help.[20, 21]
  • Idiopathic meralgia paraesthetica usually improves with non-operative modalities, such as removal of compressive agents, non-steroidal anti-inflammatory drugs (NSAIDs), anticonvulsants or tricyclics and, if necessary, local corticosteroid injections.[22]
  • One study has reported successful use of pulsed radiofrequency neuromodulation.[23]
  • Transcutaneous electrical nerve stimulation (TENS) has been found helpful, especially when combined with pregabalin.[24]Other physical therapies reported in being helpful in relieving chronic symptoms include mobilisation/manipulation for the pelvis, myofascial therapy for the rectus femoris and iliopsoas, transverse friction massage of the inguinal ligament, stretching exercises for the hip and pelvic musculature,and pelvic stabilisation/abdominal core exercises.[4]
  • One study has reported the use of Kinesio® tape (an elastic strapping used in physical therapies) applied to the area where symptoms were experienced.[25]
  • The use of ultrasound-guided perineural injections is being explored.[26]
  • If the pain is severe, operative decompression should be considered. A supra-inguinal or infra-inguinal approach may be used.[4]

Most cases are self-limiting.[27]

Paraesthesia tends to resolve over time but the numbness can persist.[28]

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Further reading & references

  • Houle S; Chiropractic management of chronic idiopathic meralgia paresthetica: a case study. J Chiropr Med. 2012 Mar 11(1):36-41. doi: 10.1016/j.jcm.2011.06.008.
  1. Harney D, Patijn J; Meralgia paresthetica: diagnosis and management strategies. Pain Med. 2007 Nov-Dec 8(8):669-77.
  2. Dharmasaroja P, Dharmasaroja P; Meralgia paresthetica-like syndrome may be caused by transient lumbar nerve root injury without definite compression: a case report. J Med Assoc Thai. 2010 Dec 93 Suppl 7:S307-10.
  3. Kosiyatrakul A, Nuansalee N, Luenam S, et al; The anatomical variation of the lateral femoral cutaneous nerve in relation to the anterior superior iliac spine and the iliac crest. Musculoskelet Surg. 2010 May 94(1):17-20. doi: 10.1007/s12306-010-0054-y. Epub 2010 Feb 5.
  4. Cheatham SW, Kolber MJ, Salamh PA; Meralgia paresthetica: a review of the literature. Int J Sports Phys Ther. 2013 Dec 8(6):883-93.
  5. Fernandez-Mayoralas DM, Fernandez-Jaen A, Jareno NM, et al; Meralgia paresthetica in the pediatric population: a propos of 2 cases. J Child Neurol. 2010 Jan 25(1):110-3. Epub 2009 May 20.
  6. Lateral Femoral Cutaneous Nerve; Wheeless' Textbook of Orthopaedics, 2008
  7. Mondelli M, Rossi S, Romano C; Body mass index in meralgia paresthetica: a case-control study. Acta Neurol Scand. 2007 Aug 116(2):118-23.
  8. Fargo MV, Konitzer LN; Meralgia paresthetica due to body armor wear in U.S. soldiers serving in Iraq: a case report and review of the literature. Mil Med. 2007 Jun 172(6):663-5.
  9. Edelson R, Stevens P; Meralgia paresthetica in children. J Bone Joint Surg Am. 1994 Jul 76(7):993-9.
  10. Shetty VD, Shetty GM; Persistent bilateral anterior hip pain in a young adult due to meralgia paresthetica: a case report. Cases J. 2008 Dec 15 1(1):396. doi: 10.1186/1757-1626-1-396.
  11. Nouraei SA, Anand B, Spink G, et al; A novel approach to the diagnosis and management of meralgia paresthetica. Neurosurgery. 2007 Apr 60(4):696-700
  12. Parisi TJ, Mandrekar J, Dyck PJ, et al; Meralgia paresthetica: relation to obesity, advanced age, and diabetes mellitus. Neurology. 2011 Oct 18 77(16):1538-42. doi: 10.1212/WNL.0b013e318233b356. Epub 2011 Oct 5.
  13. Pearce JM; Meralgia paraesthetica (Bernhardt-Roth syndrome). J Neurol Neurosurg Psychiatry. 2006 Jan 77(1):84.
  14. Freeman TL et al; Lower Limb Mononeuropathy. In: Cuccurullo S, editor. Physical Medicine and Rehabilitation Board Review. New York: Demos Medical Publishing 2004.
  15. Feinberg J, Sethi S; Sciatic neuropathy: case report and discussion of the literature on postoperative sciatic neuropathy and sciatic nerve tumors. HSS J. 2006 Sep 2(2):181-7. doi: 10.1007/s11420-006-9018-z.
  16. Yi TI, Yoon TH, Kim JS, et al; Femoral neuropathy and meralgia paresthetica secondary to an iliacus hematoma. Ann Rehabil Med. 2012 Apr 36(2):273-7. doi: 10.5535/arm.2012.36.2.273. Epub 2012 Apr 30.
  17. Grossman MG, Ducey SA, Nadler SS, et al; Meralgia paresthetica: diagnosis and treatment. J Am Acad Orthop Surg. 2001 Sep-Oct 9(5):336-44.
  18. Russo MJ, Firestone LB, Mandler RN, et al; Nerve conduction studies of the lateral femoral cutaneous nerve. Implications in the diagnosis of meralgia paresthetica. Am J Electroneurodiagnostic Technol. 2005 Sep 45(3):180-5.
  19. Khalil N, Nicotra A, Rakowicz W; Treatment for meralgia paraesthetica. Cochrane Database Syst Rev. 2008 Jul 16 (3):CD004159.
  20. Chung KH, Lee JY, Ko TK, et al; Meralgia paresthetica affecting parturient women who underwent cesarean section -A case report-. Korean J Anesthesiol. 2010 Dec 59 Suppl:S86-9. doi: 10.4097/kjae.2010.59.S.S86. Epub 2010 Dec 31.
  21. Atamaz F, Hepguler S, Karasu Z, et al; Meralgia paresthetica after liver transplantation: a case report. Transplant Proc. 2005 Dec 37(10):4424-5.
  22. Patijn J, Mekhail N, Hayek S, et al; Meralgia Paresthetica. Pain Pract. 2011 May-Jun 11(3):302-8. doi: 10.1111/j.1533-2500.2011.00458.x.
  23. Philip CN, Candido KD, Joseph NJ, et al; Successful treatment of meralgia paresthetica with pulsed radiofrequency of the Pain Physician. 2009 Sep-Oct 12(5):881-5.
  24. Barbarisi M, Pace MC, Passavanti MB, et al; Pregabalin and transcutaneous electrical nerve stimulation for postherpetic neuralgia treatment. Clin J Pain. 2010 Sep 26(7):567-72. doi: 10.1097/AJP.0b013e3181dda1ac.
  25. Kalichman L, Vered E, Volchek L; Relieving Symptoms of Meralgia Paresthetica Using Kinesio Taping: A Pilot Study. Arch Phys Med Rehabil. 2010 May 27.
  26. Tagliafico A, Serafini G, Lacelli F, et al; Ultrasound-guided treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy): technical description and results of treatment in 20 consecutive patients. J Ultrasound Med. 2011 Oct 30(10):1341-6.
  27. Ferra Verdera M, Ribera Leclerc H, Garrido Pastor JP; [2 cases of paresthetic meralgia of the femoral cutaneous nerve]. Rev Esp Anestesiol Reanim. 2003 Mar 50(3):154-6.
  28. Houle S; Chiropractic management of chronic idiopathic meralgia paresthetica: a case study. J Chiropr Med. 2012 Mar 11(1):36-41. doi: 10.1016/j.jcm.2011.06.008.
Original Author:
Dr Laurence Knott
Current Version:
Dr Laurence Knott
Peer Reviewer:
Dr Adrian Bonsall
Document ID:
2453 (v23)
Last Checked:
12 March 2014
Next Review:
11 March 2019

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