eMedicine Specialties > Physical Medicine and Rehabilitation > Lower Limb Musculoskeletal Conditions

Meralgia Paresthetica: Differential Diagnoses & Workup

Author: Christopher Luzzio, MD, Clinical Assistant Professor, Department of Neurology, University of Wisconsin at Madison
Contributor Information and Disclosures

Updated: Mar 18, 2009

Differential Diagnoses

Diabetic Lumbosacral Plexopathy
Mononeuritis Multiplex
Fracture, Pelvic
Neoplastic Lumbosacral Plexopathy
Lumbar Degenerative Disk Disease
Lumbar Facet Arthropathy
Lumbar Spondylolysis and Spondylolisthesis

Other Problems to Be Considered

Lumbar plexitis
Lumbar plexopathy
Upper lumbar radiculopathy
Pelvic neoplasm
Polyneuropathy
Retroperitoneal hemorrhage

Workup

Laboratory Studies

  • Indicated laboratory and radiologic studies for lateral femoral cutaneous nerve (LFCN) pathology depend on the suspected etiology and clinical impression. Meralgia paresthetica (MP) caused by obvious benign compressive forces requires no further investigation; however, the following scenarios might necessitate more testing:
    • Magnetic resonance imaging (MRI) to investigate the lumbar plexus
    • Serum tests for diabetes
    • Radiography for possible pelvic fracture or cancer
    • Computed tomography (CT) scanning for retroperitoneal hemorrhage in patients who have undergone anticoagulation therapy
  • Electromyography is very helpful for ruling out radiculopathy, plexopathy, generalized polyneuropathy, or other neuropathic causes for the symptoms. Nerve conduction studies and somatosensory evoked potentials of LFCN have shown abnormalities in patients with MP, but these tests are unreliable and are not necessary for the diagnosis.
  • Caution: Discomfort over the anterolateral thigh may not be representative of LFCN injury. Referred pain can be caused by neoplastic invasion of nearby femoral or pelvic bone. In the author's experience, the pain associated with a neoplasm or bone fracture is deep, boring, and severe. MP discomfort is superficial, with fluctuating dysesthesias, paresthesias, and cutaneous hypersensitivity; it is neuropathic in quality and usually is not disabling.

Procedures

  • For classical meralgia paresthetica (MP), conservative therapy may be initiated without the necessity for invasive procedures. The diagnosis (ie, an MP secondary to trauma, irritation, or compression of the lateral femoral cutaneous nerve [LFCN] near the IL) can be verified by injecting a small quantity of lidocaine at the point of their intersection or at the point of tenderness. The discomfort should resolve transiently.
  • Diagnosis of LFCN often is verified by nerve conduction studies. The LFCN is stimulated antidromically 1-2 cm medial to the ASIS above the IL; the response is recorded 12-20 cm distally over the lateral thigh. Excessively thick soft tissue makes surface stimulation technically difficult or inadequate; the examiner may choose needle stimulation instead. Right and left LFCNs are compared. Study findings are considered abnormal if there are significant side-to-side differences; there may be no response or a 50% drop in amplitude compared with the contralateral nerve. If there is no recordable response on the asymptomatic side, the results obtained when testing the symptomatic thigh are not interpretable. Asymptomatic individuals have widely variable LFCN action potentials in conduction studies.

More on Meralgia Paresthetica

Overview: Meralgia Paresthetica
Differential Diagnoses & Workup: Meralgia Paresthetica
Treatment & Medication: Meralgia Paresthetica
Follow-up: Meralgia Paresthetica
Multimedia: Meralgia Paresthetica
References
Further Reading
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References

  1. Carai A, Fenu G, Sechi E, et al. Anatomical variability of the lateral femoral cutaneous nerve: findings from a surgical series. Clin Anat. Jan 27 2009;22(3):365-370. [Medline].

  2. Otoshi K, Itoh Y, Tsujino A, et al. Case report: meralgia paresthetica in a baseball pitcher. Clin Orthop Relat Res. Sep 2008;466(9):2268-70. [Medline].

  3. Schestatsky P, Llado-Carbo E, Casanova-Molla J, et al. Small fibre function in patients with meralgia paresthetica. Pain. Oct 15 2008;139(2):342-8. [Medline].

  4. Knight RQ, Schwaegler P, Hanscom D, et al. Direct lateral lumbar interbody fusion for degenerative conditions: early complication profile. J Spinal Disord Tech. Feb 2009;22(1):34-7. [Medline].

  5. 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].

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

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

  8. Liveson JA, Ma DM. Lumbar plexus. In: Laboratory Reference for Clinical Neurophysiology. New York, NY: Oxford University Press; 1998:165-8.

  9. Massey EW. Sensory mononeuropathies. Semin Neurol. 1998;18(2):177-83. [Medline].

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

  11. Streiffer RH. Meralgia paresthetica. Am Fam Physician. Mar 1986;33(3):141-4. [Medline].

  12. Travell JG, Simons DG. Tensor fasciae latae muscle and sartorius muscle. In: Myofascial Pain and Dysfunction: The Trigger Point Manual for the Lower Extremities. vol 2. Baltimore, Md: Williams & Wilkins; 1999:230-2.

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Further Reading

Clinical guidelines:
EFNS guidelines on pharmacological treatment of neuropathic pain.
European Federation of Neurological Societies - Medical Specialty Society.  2006 Nov.  17 pages.  NGC:005495

Clinical trials:
 Effectiveness of Lumbar Facet Joint Nerve Blocks
Freedom Lumbar Disc in the Treatment of Lumbar Degenerative Disc Disease

Related eMedicine topics:
Meralgia Paresthetica [Neurology]
Meralgia Paresthetica [Orthopedic Surgery]
Nerve Entrapment Syndromes
Nerve Entrapment Syndromes of the Lower Extremity

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Keywords

meralgia paresthetica, nerve entrapment, paresthesia, meralgia, dysesthesia, thigh pain, lateral femoral cutaneous nerve, Bernhardt-Roth syndrome, lateral femoral cutaneous neuropathy

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Contributor Information and Disclosures

Author

Christopher Luzzio, MD, Clinical Assistant Professor, Department of Neurology, University of Wisconsin at Madison
Christopher Luzzio, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Medical Editor

Everett C Hills, MD, MS, Medical Director, Penn State Hershey Rehabilitation Hospital, Assistant Professor of Orthopaedics and Rehabilitation, Assistant Professor of Neurology, Penn State Milton S. Hershey Medical Center and Penn State University College of Medicine
Everett C Hills, MD, MS is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Congress of Rehabilitation Medicine, American Medical Association, American Society of Neurorehabilitation, Association of Academic Physiatrists, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine
Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists
Disclosure: allergan Honoraria Speaking and teaching

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
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