Meralgia Paresthetica Clinical Presentation

  • Author: Elizabeth A Sekul; Chief Editor: Nicholas Lorenzo, MD   more...
 
Updated: Feb 3, 2012
 

History

  • When the LFCN is entrapped, paresthesias and numbness of the upper lateral thigh area are the presenting symptoms. The paresthesias may be quite painful.
  • Symptoms are typically unilateral. However, they may be bilateral in up to 20% of cases.
  • Walking or standing may aggravate the symptoms; sitting tends to relieve them.
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Physical

  • Examination reveals numbness of the anterolateral thigh in all or part of the area involved with the paresthesias.
  • Occasionally, patients are hyperesthetic in this area.
  • Tapping over the upper and lateral aspects of the inguinal ligament or extending the thigh posteriorly, which stretches the nerve, may reproduce or worsen the paresthesias.
  • Deep palpation just below the anterior superior iliac spine (pelvic compression testing) reproduces the symptoms. A study in 45 patients found that the pelvic compression test had a sensitivity of 95% and a specificity of 93.3% for meralgia paresthetica.[4]
  • Motor strength in the involved leg should be normal.
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Causes

  • Pregnancy, tight clothing, and obesity predispose to compression of the nerve at the inguinal ligament.[5, 6, 7, 3] Tool belts worn by carpenters, duty belts worn by policemen, and body armor worn by soldiers may compress the LFCN.[8]
  • Lying in the fetal position for prolonged periods also has been implicated, as has prone positioning after lumbar spinal surgery.[9]
  • Meralgia paresthetica is more common in diabetics than in the general population.[3]
  • Although rare, impingement of the LFCN by masses (eg, neoplasms, contained iliopsoas hemorrhages) in the retroperitoneal space before it reaches the inguinal ligament can cause the same symptoms.
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Contributor Information and Disclosures
Author

Elizabeth A Sekul  MD, Associate Professor of Pediatrics and Neurology, Medical College of Georgia

Elizabeth A Sekul is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and Child Neurology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Aashit K Shah, MD  Professor of Neurology, Director, Comprehensive Epilepsy Program, Program Director, Clinical Neurophysiology Fellowship, Detroit Medical Center, Wayne State University School of Medicine

Aashit K Shah, MD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, and American Neurological Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Neil A Busis, MD  Chief, Division of Neurology, Department of Medicine, Head, Clinical Neurophysiology Laboratory, University of Pittsburgh Medical Center-Shadyside

Neil A Busis, MD is a member of the following medical societies: American Academy of Neurology and American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Nicholas Lorenzo, MD  Consulting Staff, Neurology Specialists and Consultants

Nicholas Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and American College of Physician Executives

Disclosure: Nothing to disclose.

References

  1. Patijn J, Mekhail N, Hayek S, Lataster A, van Kleef M, Van Zundert J. Meralgia Paresthetica. Pain Pract. May-Jun 2011;11(3):302-8. [Medline].

  2. 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. [Medline].

  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. [Medline]. [Full Text].

  4. 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. [Medline].

  5. Mondelli M, Rossi S, Romano C. Body mass index in meralgia paresthetica: a case-control study. Acta Neurol Scand. Aug 2007;116(2):118-23. [Medline].

  6. Chlebowski S, Bashyal S, Schwartz TL. Meralgia paresthetica: another complication of antipsychotic-induced weight gain. Obes Rev. Apr 1 2009;[Medline].

  7. Moucharafieh R, Wehbe J, Maalouf G. Meralgia paresthetica: a result of tight new trendy low cut trousers ('taille basse'). Int J Surg. Apr 2008;6(2):164-8. [Medline].

  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. Jun 2007;172(6):663-5. [Medline].

  9. Cho KT, Lee HJ. Prone position-related meralgia paresthetica after lumbar spinal surgery : a case report and review of the literature. J Korean Neurosurg Soc. Dec 2008;44(6):392-5. [Medline].

  10. 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. [Medline].

  11. Tumber PS, Bhatia A, Chan VW. Ultrasound-guided lateral femoral cutaneous nerve block for meralgia paresthetica. Anesth Analg. Mar 2008;106(3):1021-2. [Medline].

  12. 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;[Medline].

  13. Tagliafico A, Serafini G, Lacelli F, Perrone N, Valsania V, Martinoli C. Ultrasound-guided treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy): technical description and results of treatment in 20 consecutive patients. J Ultrasound Med. Oct 2011;30(10):1341-6. [Medline].

  14. Grossman MG, Ducey SA, Nadler SS. Meralgia Paresthetica: diagnosis and treatment. Journal of the American Academy of Orthopaedic Sugeons. 2001;9:336-44. [Medline].

  15. Harney D, Patijn J. Meralgia paresthetica: diagnosis and management strategies. Pain Med. Nov-Dec 2007;8(8):669-77. [Medline].

  16. Jablecki CK. Postoperative lateral femoral cutaneous neuropathy. Muscle Nerve. Aug 1999;22(8):1129-31. [Medline].

  17. Seror P, Seror R. Meralgia paresthetica: clinical and electrophysiological diagnosis in 120 cases. Muscle Nerve. May 2006;33(5):650-4. [Medline].

  18. Turner OA, Taslitz N, Ward S. Lateral femoral cutaneous nerve of the thigh (meralgia paresthetica). Handbook of peripheral nerve entrapments. 1990;143-150.

  19. van Slobbe AM, Bohnen AM, Bernsen RM, et al. Incidence rates and determinants in meralgia paresthetica in general practice. J Neurol. Mar 2004;251(3):294-7. [Medline].

  20. Williams FH, Johns JS, Weiss JM, et al. Neuromuscular rehabilitation and electrodiagnosis. 1. Mononeuropathy. Arch Phys Med Rehabil. Mar 2005;86(3 Suppl 1):S3-10. [Medline].

 
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Anatomy of the lateral femoral cutaneous nerve.
Sensory distribution of the lateral femoral cutaneous nerve.
 
 
 
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