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Meralgia Paresthetica

Bernhardt Roth Syndrome

Also known as lateral femoral cutaneous nerve entrapment, meralgia paresthetica is a benign condition caused by the compression of this nerve at any point along its course.


Presentation

It can present with a burning sensation, paraesthesia, or hyperesthesia over the distribution of the nerve on the anterolateral aspect of the thigh. The patients usually rub the area as they describe the pain. The sensory loss is quite distinct and borders can be demarcated easily. The presentation is usually restricted to sensory symptoms due to the pure sensory nature of the nerve [6].

Neurologic exam usually reveals abnormal sensations of pinprick and touch in the distribution of the nerve. The rest of the lower limb examination (motor and tendon reflexes) is normal.

Fever
  • Patients with recurrent fever and MP should be evaluated by imaging examinations including computed tomography to search for appendicitis.[ncbi.nlm.nih.gov]
  • Infections- (typhoid fever) or intoxications (lead poisoning) or with cold (intensive cooling through too cold Douches) have been proved. … It is interesting, that in two of my patients (a Smelter and a Smith) the legs especially, suffer after a sudden[doi.org]
  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Case 3-2019: A 70-Year-Old Woman with Fever, Headache, and Progressive Encephalopathy Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura Randomized[nejm.org]
Chills
  • . … It is interesting, that in two of my patients (a Smelter and a Smith) the legs especially, suffer after a sudden chill …“Sensibility to be proved objective, remained severely restricted in the distribution zone of the N. cutaneous femoris externus[doi.org]
Wound Infection
  • Two cases each of recurrence, seroma, wound infection, and 1 case of hematoma requiring revision were encountered as complications. CONCLUSIONS: The suprainguinal retroperitoneal approach is a viable first-choice option for the surgical relief of MP.[ncbi.nlm.nih.gov]
Thigh Pain
  • A 9-year-old girl presented to the pain clinic with a 6-week history of right anterolateral thigh pain first noticed after a nontraumatic cheerleading practice.[ncbi.nlm.nih.gov]
  • Unexplained, chronic anterolateral thigh pain and paresthesias warrant careful investigation for the possibility of MP.[thenerve.net]
  • These should only be conducted when outer thigh pain is completely gone. Considerations While exercises are important to recovery, the most immediate response to meralgia paresthetica should be rest.[ipcphysicaltherapy.com]
Hip Pain
  • In three morbidly obese patients (mean weight 169 kg), severe hip pain developed immediately after gastroplasty. The differential diagnosis included thrombophlebitis, osteoarthritis and lumbar disc protrusion.[ncbi.nlm.nih.gov]
  • I have found your report on hip pain (“Evaluation and management of hip pain: An algorithmic approach,” J Fam Pract 2003; 52(8):607–617) very interesting for my daily clinical practice as a neurologist.[mdedge.com]
  • Additional symptoms included left groin and anterior hip pain. Diagnosed with MP at nine months post onset. Condition unresolved with subsequent treatment by medication and physical therapy.[kinetacore.com]
  • pain that presents with neurological, urogenital, or gastrointestinal symptoms should prompt a more focused evaluation to rule out MP. 10 Although symptoms may vary between patients, the differential diagnosis of MP is limited, and it usually can be[practicalpainmanagement.com]
  • Persistent bilateral anterior hip pain in a young adult due to meralgia paresthesica: a case report. Cases J 2008;1(1):396-8. [ Links ] 21. Baron R, Binder A, Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment.[scielo.br]
Muscular Atrophy
  • (In Virchows Archiv, 1893, he also described a familial form of spinal progressive scapulohumeral muscular atrophy known as Vulpian-Bernhardt spinal muscular atrophy).[doi.org]
Cesarean Section
  • Prior hip surgery, hernia surgery, bone graft harvest, cesarean sections are some of the most common.[neuropaxclinic.com]
  • Hip replacement, iliac crest bone grafting, appendectomy, inguinal lymph node dissection, aortofemoral bypass, uterine surgery, cesarean section, and quadriceps surgery have all been implicated as causative for meralgia paresthetica.[emedicine.com]
  • Meralgia paresthetica affecting parturient women who underwent cesarean section - A case report. Korean J Anesthesiol 2010;59(Suppl):86-9. [ Links ] 17. Ahsan MR, Curtin J. Meralgia paresthetica following total hip replacement.[scielo.br]
Paresthesia
  • Meralgia paresthetica (MP) is generally caused by entrapment of the lateral femoral cutaneous nerve (LFCN), and presents with pain and paresthesia in the anterolateral thigh.[ncbi.nlm.nih.gov]
Dysesthesia
  • At this time, we located the anterior superior iliac spine and reproduced concordant dysesthesia. Pulsed radiofrequency was then undertaken at 42 degrees C for 120 seconds followed by dexamethasone and bupivicaine.[ncbi.nlm.nih.gov]
Neuralgia
  • OBJECTIVES: To assess the incidence of postoperative lateral femoral cutaneous nerve (LFCN) neuralgia and to investigate its risk factors and clinical outcomes.[ncbi.nlm.nih.gov]
  • Question My doctor has suggested that I may have a condition called 'neuralgia parathetica' (possibly spelt 'meralgia') and I would like some more information about it, including how I can help to relieve the discomfort that I suffer from.[netdoctor.co.uk]
  • If the pain is eliminated after the injection, it proves that the nerve is causing the pain and the diagnosis is made of lateral femoral cutaneous neuralgia. This injection is usually done under ultrasound guidance.[completepaincare.com]
  • […] elsewhere classified ( R00 - R94 ) Diseases of the nervous system G50-G59 2019 ICD-10-CM Range G50-G59 Nerve, nerve root and plexus disorders Type 1 Excludes current traumatic nerve, nerve root and plexus disorders - see Injury, nerve by body region neuralgia[icd10data.com]
Peripheral Neuropathy
  • Meralgia paresthetica is a focal peripheral neuropathy involving the lateral femoral cutaneous nerve and is rarely observed in pediatric practice. Previous reports have highlighted its occurrence within the context of a regional bony malignancy.[ncbi.nlm.nih.gov]
  • Other potential reasons can be listed as complex regional pain syndrome (reflex sympathetic dystrophy) or peripheral neuropathy (diabetes, vitamin B deficiency, alcoholism, and hypothyroidism).[omicsonline.org]
Anterior Thigh Pain
  • Although MP was diagnosed late, decompression of the LFCN resulted in immediate and permanent relief of chronic anterior thigh pain.[thenerve.net]
  • Meralgia paresthetica: a long-standing performance-limiting cause of anterior thigh pain in a soccer player. Am J Sports Med. 2003; 31(5):787-789. Ahsan MR, Curtin J. Meralgia paresthetica following total hip replacement.[healio.com]
  • Meralgia paresthetica: a long ‐ standing performance ‐ limiting cause of anterior thigh pain in a soccer player. Am J Sports Med. 2003;31(5):787 ‐ 789 31. Otoshi K, Itoh Y, Tsujino A., et al. Case report: meralgia paresthetica in a baseball pitcher.[ilchiro.org]
  • Meralgia paresthetica: a long‐standing performance‐limiting cause of anterior thigh pain in a soccer player. Am J Sports Med. 2003; 31 ( 5 ):787‐789 [ PubMed ] [ Google Scholar ] 10. Otoshi K, Itoh Y, Tsujino A, et al.[ncbi.nlm.nih.gov]

Workup

The diagnosis can be made clinically if the distribution and presentation are classic with absence of other neurologic abnormalities of the lower leg. Other tests may be required to rule out other associated factors.

  • Tests for diabetes: Blood sugar levels, glucose tolerance test and HbA1c levels may be required to rule out diabetes.
  • Imaging: Radiography is not usually important unless there is suspicion of lumber spine problems and the findings are not characteristic. Magnetic resonance imaging is rarely indicated.
  • Nerve conduction studies: The results are variable and technically difficult, especially in obese patients, and are rarely required. Electromyography is not indicated as the nerve is a pure sensory nerve. If done it is almost always normal [7]. These test are only indicated when an alternate diagnosis is suspected such as femoral neuropathy.

Treatment

This condition is usually self-limiting in most patients. Most patients respond to conservative management. The treatment is mainly directed towards reducing the pressure over the area of compression; for instance, in obese patients, weight loss is indicated. 

If the problem persists then drugs such as carbamazepine or gabapentin can be used to reduce the discomfort.

Surgery is rarely used but if indicated, decompression may be done. The success rates are variable. Nerve blocks may also be tried in unresponsive cases. There have been reports of use of radio-frequency ablation in resistant cases.

Treatment of associated factors such as diabetes is also advised [8] [9] [10].

Prognosis

The prognosis is excellent in over 90% of the patients. Improvements are seen if the right causes and associated factors are found and dealt with appropriately. Some patient may have persistent mild loss of sensation that is not uncomfortable.

Etiology

Most of the patients have compression of the nerve on its course as it goes below the inguinal ligament. There are a number of causes or precipitants that may cause compression including tight belts and garments, scars near the Poupart’s ligament and pregnancy. There have been noted associations with obesity and old age. Iatrogenic causes secondary to surgery near the Poupart’s ligament and spinal surgery have been noted [2].

Epidemiology

The incidence has been reported at 4.3 per 10,000 patient years. The incidence is much higher in the diabetic population with rates as high as 240 per 100,000 patient years. There is no gender or race predominance. The incidence rises with advancing age [3].

Sex distribution
Age distribution

Pathophysiology

The anatomy and course of the nerve is important in understanding the condition. The lateral femoral cutaneous nerve has root innervations from L2-3. It runs along the lateral border of the psoas muscle to the lateral part of the inguinal ligament. It then passes in a tunnel made by the Poupart’s ligament and anterior superior iliac spine. It then crosses over into the thigh. This is the most common site of entrapment [4] [5].

Prevention

Advice on avoidance of tight garments and weight loss strategies should be encouraged to prevent the development of meralgia paresthetica and other nerve compression syndromes.

Summary

Meralgia paresthetica (lateral femoral cutaneous nerve entrapment) is the term used to describe the clinical condition comprising of pain, dysesthesia or both of the area supplied by the nerve, particularly the lateral aspect of thigh. It is a benign condition usually caused by pressure on of the nerve [1].

Patient Information

Meralgia paresthetica is a condition when there is abnormal uncomfortable burning sensation, increased touch sensation or reduced sensation on the outer side of the thigh. The condition is not serious and does not indicate an ominous back problems. It is caused by pressure on the nerve that supplies the affected area. The compression may be due to tight clothes, garments or fat in obese people. It is also much more common in diabetics. There is also an association with pregnancy. It may also be caused by surgery around the groin area.

In the majority of the patients, the condition goes away on its own when the inciting event has been dealt with. In those cases that do not respond, drugs may be given to reduce the discomfort. The final step in difficult cases is surgery to relieve the pressure on the nerve.

References

Article

  1. Anderson BC. Office Orthopedics for Primary Care: Diagnosis and Treatment, 3rd Edition, Elsevier Company, Philadelphia 2005.
  2. Parisi TJ, Mandrekar J, Dyck PJ, Klein CJ. Meralgia paresthetica: relation to obesity, advanced age, and diabetes mellitus. Neurology 2011; 77:1538.
  3. Parisi TJ, Mandrekar J, Dyck PJ, Klein CJ. Meralgia paresthetica: relation to obesity, advanced age, and diabetes mellitus. Neurology. Oct 18 2011;77(16):1538-42
  4. Carai A, Fenu G, Sechi E, Crotti FM, Montella A. Anatomical variability of the lateral femoral cutaneous nerve: findings from a surgical series. Clin Anat. Apr 2009;22(3):365-70.
  5. Boyce JR. Meralgia paresthetica and tight trousers. JAMA 1984; 251:1553
  6. Nouraei SA, Anand B, Spink G, O'Neill KS. A novel approach to the diagnosis and management of meralgia paresthetica. Neurosurgery. Apr 2007;60(4):696-700; discussion 700
  7. Seror P, Seror R. Meralgia paresthetica: clinical and electrophysiological diagnosis in 120 cases. Muscle Nerve 2006; 33:650.
  8. Parisi TJ, Mandrekar J, Dyck PJ, Klein CJ. Meralgia paresthetica: relation to obesity, advanced age, and diabetes mellitus. Neurology 2011; 77:1538.
  9. Hurdle MF, Weingarten TN, Crisostomo RA, Psimos C, Smith J. Ultrasound-guided blockade of the lateral femoral cutaneous nerve: technical description and review of 10 cases. Arch Phys Med Rehabil. Cctober 2007;77 (3):1362-4
  10. Fowler IM, Tucker AA, Mendez RJ. Treatment of Meralgia Paresthetica with Ultrasound-Guided Pulsed Radiofrequency Ablation of the Lateral Femoral Cutaneous Nerve. Pain Pract. Dec 7 2011

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Last updated: 2019-06-28 10:54