Physical Medicine and Rehabilitation for Meralgia Paresthetica Treatment & Management
- Author: Christopher Luzzio, MD; Chief Editor: Consuelo T Lorenzo, MD more...
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.
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.
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.
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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