eMedicine Specialties > Orthopedic Surgery > Hip

Meralgia Paresthetica: Treatment

Author: Ira Kornbluth, MD, MA, Managing Partner, Spine Medicine and Rehabilitation Therapies
Coauthor(s): Phillip J Marone, MD, MSPH, Clinical Professor, Department of Orthopedic Surgery, Jefferson Medical College
Contributor Information and Disclosures

Updated: Mar 16, 2009

Treatment

Medical Therapy

Devising a strategy to identify and relieve the compressive force should be the first step in the treatment of meralgia paresthetica. For example, a tool belt or tight clothing could induce or exacerbate symptoms. In obese patients, weight loss alone may prove to be very beneficial. Patients should be advised to avoid prolonged sitting because this may increase pressure on the nerve. Abnormal postures and movements should be addressed. Modalities such as heat, ice, and electrical stimulation can be used for symptomatic relief as appropriate.

Use of nonsteroidal anti-inflammatory drugs (NSAIDs), tricyclic antidepressants ([TCAs]; eg, amitriptyline [Elavil]), and anticonvulsant agents (eg, gabapentin [Neurontin]) may be helpful in providing some degree of symptomatic relief. Alternatively, local injections using steroid and local anesthetic preparations may reduce symptoms by decreasing any inflammatory component and disrupting the pain circuit.13,14 In most instances, the injection is performed just inferior to the inguinal ligament and 1 cm medial to the anterior superior iliac spine. However, the physician should recognize that the nerve pathway can vary significantly and should therefore adjust the location of the injection accordingly. Long-term neurotoxic agents such as phenol are not recommended because of the possibility of adverse effects such as dysesthesias.

Surgical Therapy

In cases resistant to conservative measures, surgical options may be considered.

Preoperative Details

Before the procedure, the patient should be counseled about the potential risks and outcomes to be expected. Complications include infection, excess bleeding, failure to relieve symptoms, and the worsening of pain. Surgery may be performed with the patient under local or general anesthesia.

Intraoperative Details

A small incision is made just distal to the site where the lateral femoral cutaneous nerve intersects the inguinal ligament. The nerve is exposed, and any compressive force is identified. Neurolysis, neurolysis with transposition, and transection are the most commonly performed surgical procedures. Which surgical procedure is most effective and which should be attempted first are topics of some debate.15 Commonly, neurolysis or neurolysis with transposition is considered prior to transection because transection results in permanent numbness in the nerve distribution. Transection may be the only option if the nerve has been severely damaged or if multiple branches are affected. On the other hand, the rate of symptom recurrence may be higher with the neurolytic procedures than with transection. In transections, the surgeon should ensure that the proximal portion of the nerve is within the pelvis to minimize the formation of a painful neuroma.

Complete lysis is achieved by freeing the nerve at the tendinous arc from the iliac fascia; anteriorly, at the inguinal ligament; posteriorly, at a sling of fascia; and, distally, at the deep fascia of the thigh along each division.

Postoperative Details

Some surgical site tenderness is expected for a few days and can be managed with analgesics. Range of motion and function should not be restricted after surgery.

Follow-up

The patient should have thorough neurologic examinations immediately after the procedure and serial examinations for several months afterward to evaluate whether the procedure helped alleviate the symptoms of meralgia paresthetica and to identify any complications.

Complications

Meralgia paresthetica is a benign condition; in conservatively treated patients, complications are limited to persistent symptoms despite treatment. No weakness or disabling features should occur from this entity. Surgical complications include bleeding and infection; however, permanent anesthesia of the anterolateral thigh is an expected consequence of transection, and neuromas may develop. NSAIDs have the potential to cause gastrointestinal ulcerations, damage renal and liver function, and exacerbate hypertension. Anticonvulsant medications can precipitate seizures, cause excess fatigue, or induce weight gain. Common effects of tricyclic antidepressants are dry mouth and urinary retention.

More on Meralgia Paresthetica

Overview: Meralgia Paresthetica
Workup: Meralgia Paresthetica
Treatment: Meralgia Paresthetica
Follow-up: Meralgia Paresthetica
Multimedia: Meralgia Paresthetica
References
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References

  1. Craig E. Lateral femoral cutaneous neuropathy. In: Frontera WR, Silver JK, eds. Essentials of Physical Medicine and Rehabilitation. Boston, Mass: Hanley & Belfus; 2001:. 279-82.

  2. Preston DC, Shapiro BE. Lateral femoral cutaneous neuropathy. In: Electromyography and Neuromuscular Disorders: Clinical-Electrophysiologic Correlations. Boston, Mass: Butterworth-Heinemann; 1997:. 477.

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

  4. 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].

  5. 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].

  6. 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].

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  8. de Ridder VA, de Lange S, Popta JV. Anatomical variations of the lateral femoral cutaneous nerve and the consequences for surgery. J Orthop Trauma. Mar-Apr 1999;13(3):207-11. [Medline].

  9. Schestatsky P, Lladó-Carbó E, Casanova-Molla J, Alvarez-Blanco S, Valls-Solé J. Small fibre function in patients with meralgia paresthetica. Pain. Oct 15 2008;139(2):342-8. [Medline].

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  11. Nahabedian MY, Dellon AL. Meralgia paresthetica: etiology, diagnosis, and outcome of surgical decompression. Ann Plast Surg. Dec 1995;35(6):590-4. [Medline].

  12. Shimizu S. A novel approach to the diagnosis and management of meralgia paresthetica. Neurosurgery. Oct 2008;63(4):E820. [Medline].

  13. 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].

  14. 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. Oct 2007;88(10):1362-4. [Medline].

  15. Alberti O, Wickboldt J, Becker R. Suprainguinal retroperitoneal approach for the successful surgical treatment of meralgia paresthetica. J Neurosurg. Oct 31 2008;[Medline].

  16. Williams PH, Trzil KP. Management of meralgia paresthetica. J Neurosurg. Jan 1991;74(1):76-80. [Medline].

  17. van Eerten PV, Polder TW, Broere CA. Operative treatment of meralgia paresthetica: transection versus neurolysis. Neurosurgery. Jul 1995;37(1):63-5. [Medline].

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Further Reading

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Keywords

meralgia paresthetica, lateral femoral cutaneous nerve neuropathy, neuropraxic injury, axonotmesis, neurotmesis, thigh pain, lateral femoral cutaneous nerve compression, leg neuropathy, thigh neuropathy, nerve entrapment syndromes, nerve entrapment of the lower extremity

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Contributor Information and Disclosures

Author

Ira Kornbluth, MD, MA, Managing Partner, Spine Medicine and Rehabilitation Therapies
Ira Kornbluth, MD, MA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Society of Interventional Pain Physicians, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Coauthor(s)

Phillip J Marone, MD, MSPH, Clinical Professor, Department of Orthopedic Surgery, Jefferson Medical College
Phillip J Marone, MD, MSPH is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Medical Association, American Orthopaedic Society for Sports Medicine, and Philadelphia County Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Miguel A Schmitz, MD, Consulting Surgeon, Department of Orthopedics, Klamath Orthopedic and Sports Medicine Clinic
Miguel A Schmitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

B Sonny Bal, MD, Associate Professor, Department of Orthopedic Surgery, University of Missouri School of Medicine
B Sonny Bal, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

William L Jaffe, MD, Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Vice Chairman, Department of Orthopedic Surgery, New York University Hospital for Joint Diseases
William L Jaffe, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, Eastern Orthopaedic Association, and New York Academy of Medicine
Disclosure: Stryker Orthopaedics Consulting fee Speaking and teaching

 
 
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