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Physical Medicine and Rehabilitation for Meralgia Paresthetica Treatment & Management

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

Rehabilitation Program

Physical Therapy

Meralgia paresthetica (MP) is treated with conservative therapy, such as physical therapy, weight reduction to reduce abdominal girth, heat application, and analgesics (see Medication). Patients should avoid wearing constrictive garments, belts, or braces that impart excessive focal pressure at the IL.[6]

Physical therapy may be recommended as an adjunct to analgesic medications for pain control in patients with MP. In addition to moist heat, other modalities that may be recommended by the physical therapist include transcutaneous electrical nerve stimulation, interferential current, or low-intensity phonophoresis. These modalities are used to help alleviate pain and enable the patient to perform gentle stretching exercises with greater ease. Soft-tissue techniques (eg, trigger point therapy) also may be beneficial for pain and tightness in the hip and thigh muscles. In addition, the physical therapist may instruct the patient in a general fitness program to assist with weight reduction, as well as proper biomechanics and postural reeducation.

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Surgical Intervention

Patients failing conservative measures are referred to a surgeon for consideration of surgical decompression of the lateral femoral cutaneous nerve (LFCN).[8, 9, 10, 11] Successful predictors of excellent surgical results include positive Tinel sign, abnormal EMG, and immediate relief of symptoms following LFCN block. Although surgical transection of the LFCN has been performed for treatment, outcomes for this procedure have not been reported systematically, and some patients report worse dysesthesias.

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Other Treatment

Injection of lidocaine to block the lateral femoral cutaneous nerve (LFCN) at the IL results in only temporary relief of symptoms. This procedure is useful for exploring which patients may respond well to surgical manipulation of the LFCN, once conservative measures have been deemed inadequate and the patient complains of chronic discomfort.

Improvement of symptoms also may occur with correction of leg length discrepancies. Use of shoe lifts or inserts may correct discrepancies sufficiently to minimize hip hyperextension on the affected side.

Trigger point injections of the sartorius muscle may help to relieve symptoms.

Steroid injections at the spinal or inguinal level may provide more chronic relief of symptoms.

In a 2011 study, an experimental therapy for meralgia paresthetica using ultrasound-guided perineural injections (methylprednisolone acetate with mepivacaine) effectively provided significant symptom relief for patients 2 months after injection. Further studies, such as randomized placebo-controlled trials, should be performed.[12, 13]

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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
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  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].

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  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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