Meralgia Paresthetica Clinical Presentation

Updated: Jul 31, 2018
  • Author: Elizabeth A Sekul, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
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Presentation

History

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  • When the LFCN is entrapped, paresthesias and numbness of the upper lateral thigh area are the presenting symptoms. The paresthesias may be quite painful.

  • Symptoms are typically unilateral. However, they may be bilateral in up to 20% of cases.

  • Walking or standing may aggravate the symptoms; sitting tends to relieve them.

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Physical

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  • Examination reveals numbness of the anterolateral thigh in all or part of the area involved with the paresthesias.

  • Occasionally, patients are hyperesthetic in this area.

  • Tapping over the upper and lateral aspects of the inguinal ligament or extending the thigh posteriorly, which stretches the nerve, may reproduce or worsen the paresthesias.

  • Deep palpation just below the anterior superior iliac spine (pelvic compression testing) reproduces the symptoms. A study in 45 patients found that the pelvic compression test had a sensitivity of 95% and a specificity of 93.3% for meralgia paresthetica. [4]

  • Motor strength in the involved leg should be normal.

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Causes

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  • Pregnancy, tight clothing, and obesity predispose to compression of the nerve at the inguinal ligament. [5, 6, 7, 3] Tool belts worn by carpenters, duty belts worn by policemen, and body armor worn by soldiers may compress the LFCN. [8]

  • Lying in the fetal position for prolonged periods also has been implicated, as has prone positioning after lumbar spinal surgery. [9]

  • Meralgia paresthetica is more common in diabetics than in the general population. [3]

  • Although rare, impingement of the LFCN by masses (eg, neoplasms, contained iliopsoas hemorrhages) in the retroperitoneal space before it reaches the inguinal ligament can cause the same symptoms.

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