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Physical Medicine and Rehabilitation for Meralgia Paresthetica

  • Author: Christopher Luzzio, MD; Chief Editor: Consuelo T Lorenzo, MD  more...
 
Updated: Mar 30, 2015
 

Background

Meralgia paresthetica (MP) is pain or an irritating sensation felt over the anterior or anterolateral aspect of the thigh due to injury, compression, or disease of the lateral femoral cutaneous nerve (LFCN) (see the image below). Early investigators of MP include Bernhardt, who first described the condition in 1878; Hagar, who attributed the pain to compression of the LFCN; and Roth, who coined the term meralgia paresthetica (thigh pain).

Basic anatomy of the lateral femoral cutaneous sen Basic anatomy of the lateral femoral cutaneous sensory nerve. The blue region over the anterolateral thigh outlines the area of cutaneous innervation.

Diagnosis of MP is based on history and examination. Nerve conduction studies are used to verify the presence of the neuropathy and rule out other causes for the symptoms. Treatment for uncomplicated or benign forms of MP includes conservative measures initially, followed by surgical intervention for chronic discomfort. Malignant pathologic processes can produce symptoms of MP and must therefore be ruled out before conservative treatments are initiated.

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Pathophysiology

The lateral femoral cutaneous nerve (LFCN) is formed by the fusion of the posterior branches of the second and third lumbar nerves. This purely sensory nerve traverses the retroperitoneum around the lateral circumference of the ileum to the inguinal ligament (IL). Just medial to the anterosuperior iliac spine (ASIS), the LFCN passes underneath the IL and enters the anterior thigh beneath its fascia (see the image below). Ordinarily, a few centimeters distal to the IL, the LFCN divides into anterior and posterior branches. Tributaries of these branches perforate thigh fascia and receive sensory information from portions of the associated dermatomes L2-L3. Typically, this area encompasses the anterior lateral thigh from just below the hip to above the knee. Variations in the anatomy of the LFCN, such as splitting by the inguinal ligament, are hypothesized to predispose it to neuropathic processes.[1, 2]

Basic anatomy of the lateral femoral cutaneous sen Basic anatomy of the lateral femoral cutaneous sensory nerve. The blue region over the anterolateral thigh outlines the area of cutaneous innervation.

A study by Moritz et al found the LFCN to be closer to the ASIS in patients with idiopathic MP than it was in controls. Using high-resolution ultrasonography, the investigators determined that among the study’s 28 patients with MP, the mean distance of the LFCN from the ASIS was 0.52 cm, compared with 1.79 cm in the 15 controls.[3]

Nerve entrapment can occur at 3 potential sites, including (1) beside the spinal column, (2) within the abdominal cavity as the nerve courses along the pelvis, and (3) as the nerve exits the pelvis. The last site is the most common; there, nerve entrapment may involve the sartorius muscle, or it may be caused by simple compression superficially near the iliac crest and ASIS by tight clothing or trauma.

The angulation of the LFCN across the iliac crest results in varying compressive forces with postural repositioning. One opinion is that fibrous bands within the fascia subject the LFCN to deleterious tensile forces. The relatively superficial trajectory of the LFCN as it enters the thigh compartment makes it extremely prone to injury due to compression against underlying bone.

The LFCN is subject to systemic processes that can detrimentally affect any peripheral nerve. Diabetes mellitus, for example, can result in diffuse or focal neuropathies, especially in nerves, such as the LFCN, that are subject to excessive compressive forces.

Movement of the hip changes angulation and tension of the nerve, which can affect symptoms. For example, hip extension may increase angulation and tension on the LFCN, and flexion can decrease these forces.

A Brazilian study involving 14 patients with meralgia paresthetica (MP) and 14 control subjects found evidence that not only are the large myelinated nerve fibers of the LFCN affected in MP, but the small fibers may be as well, with the small fibers suffering a partial loss of function and causing painful symptoms.[4] The investigators suggested that this is particularly true in individuals who have had MP for a longer period of time.

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Epidemiology

Frequency

United States

Considered uncommon but not rare, meralgia paresthetica (MP) is probably underrecognized. Notably, 3 cases are reported per 10,000 general clinic patients. Also, it occurs in an estimated 7-35% of patients referred for leg discomfort. Up to 20% of patients with MP have bilateral symptoms.

Mortality/Morbidity

Isolated meralgia paresthetica (MP) secondary to compression or injury of the nerve unrelated to major trauma or to systemic or malignant processes is not associated with mortality or significant morbidity.

Sex

Meralgia paresthetica is more common in males than in females.

Age

Meralgia paresthetica is observed in all age groups, but the condition most commonly occurs in middle-aged adults.

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Contributor Information and Disclosures
Author

Christopher Luzzio, MD Clinical Assistant Professor, Department of Neurology, University of Wisconsin at Madison School of Medicine and Public Health

Christopher Luzzio, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michael T Andary, MD, MS Professor, Residency Program Director, 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, Association of Academic Physiatrists

Disclosure: Received honoraria from Allergan for speaking and teaching.

Chief Editor

Consuelo T Lorenzo, MD Medical Director, Senior Products, Central North Region, Humana, Inc

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Additional Contributors

Everett C Hills, MD, MS Assistant Professor of Physical Medicine and Rehabilitation, Assistant Professor of Orthopaedics and Rehabilitation, Penn State Milton S Hershey Medical Center and Pennsylvania State University College of Medicine

Everett C Hills, MD, MS is a member of the following medical societies: American Academy of Disability Evaluating Physicians, Association of Academic Physiatrists, American Academy of Physical Medicine and Rehabilitation, American Association for Physician Leadership, American Congress of Rehabilitation Medicine, American Medical Association, American Society of Neurorehabilitation, Pennsylvania Medical Society

Disclosure: Nothing to disclose.

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. 2009 Jan 27. 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. 2008 Sep. 466(9):2268-70. [Medline].

  3. Moritz T, Prosch H, Berzaczy D, et al. Common anatomical variation in patients with idiopathic meralgia paresthetica: a high resolution ultrasound case-control study. Pain Physician. 2013 May-Jun. 16(3):E287-93. [Medline].

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

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

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

  7. Suh DH, Kim DH, Park JW, et al. Sonographic and electrophysiologic findings in patients with meralgia paresthetica. Clin Neurophysiol. 2013 Jul. 124(7):1460-4. [Medline].

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

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

  10. Emamhadi M. Surgery for Meralgia Paresthetica: neurolysis versus nerve resection. Turk Neurosurg. 2012. 22(6):758-62. [Medline].

  11. de Ruiter GC, Wurzer JA, Kloet A. Decision making in the surgical treatment of meralgia paresthetica: neurolysis versus neurectomy. Acta Neurochir (Wien). 2012 Oct. 154(10):1765-72. [Medline].

  12. 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. 2011 Oct. 30(10):1341-6. [Medline].

  13. Fowler IM, Tucker AA, Mendez RJ. Treatment of meralgia paresthetica with ultrasound-guided pulsed radiofrequency ablation of the lateral femoral cutaneous nerve. Pain Pract. 2012 Jun. 12(5):394-8. [Medline].

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

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

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

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

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

 
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Basic anatomy of the lateral femoral cutaneous sensory nerve. The blue region over the anterolateral thigh outlines the area of cutaneous innervation.
 
 
 
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