History and Physical Examination

A thorough medical and surgical history is important for the correct diagnosis of meralgia paresthetica, including questioning the patient about the possibility of any relevant trauma.^{[15, 16, 17]}

The physical examination in patients with meralgia paresthetica is remarkable for the findings of altered sensation in the anterolateral thigh, including pain, numbness, burning, hyposensitivity, and tingling. Typically, the symptoms begin insidiously and do not extend below the knee. The pain tends to be sharp or burning but also may be dull or achy.

The examiner should also consider whether any abnormal postures or movements are contributing to the patient's symptoms. Prolonged standing and standing up from a seated position may aggravate the condition.

Motor and reflex examination findings should be normal. If the patient has evidence of motor weakness or low back pain, other diagnoses should be considered because the lateral femoral cutaneous nerve (LFCN) is purely sensory, and a neurologic examination should be conducted.

Trigger points, lumbar radiculopathy, plexopathy, and hip pathology can masquerade as meralgia paresthetica. A positive Tinel sign finding may be elicited near the anterior superior iliac spine (ASIS).

Meralgia paresthetica may affect a very large region of the anterior and lateral thigh. However, the involved area can vary significantly, depending on the site of entrapment and anatomic variations of the nerve. In a large case series of 120 patients, 88 (73%) had symptoms solely in the lateral aspect of the distal thigh; in 11 of the 120 (9.2%), the anterior aspect of the thigh was exclusively involved.^[10]

Workup

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Suh DH, Kim DH, Park JW, Park BK. Sonographic and electrophysiologic findings in patients with meralgia paresthetica. Clin Neurophysiol. 2013 Jul. 124 (7):1460-4. [Medline].
Hanna AS, Ehlers ME, Lee KS. Preoperative Ultrasound-Guided Wire Localization of the Lateral Femoral Cutaneous Nerve. Oper Neurosurg (Hagerstown). 2017 Jun 1. 13 (3):402-408. [Medline].
Chhabra A, Del Grande F, Soldatos T, Chalian M, Belzberg AJ, Williams EH, et al. Meralgia paresthetica: 3-Tesla magnetic resonance neurography. Skeletal Radiol. 2013 Jun. 42 (6):803-8. [Medline].
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Media Gallery

Lateral femoral cutaneous nerve (LFCN) provides sensory innervation to anterolateral thigh. Courtesy of Essentials of Physical Medicine and Rehabilitation, Hanley & Belfus Publishers, 2001, used with permission.
Anatomy of lateral femoral cutaneous nerve (LFCN).
Sensory distribution of lateral femoral cutaneous nerve (LFCN).

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Author

Ira Kornbluth, MD, MA, FAAPMR Managing Partner, SMART Pain Management

Ira Kornbluth, MD, MA, FAAPMR is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Physiatric Association of Spine, Sports and Occupational Rehabilitation, American Society of Interventional Pain Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Phillip J Marone, MD, MSPH Clinical Professor, Department of Orthopedic Surgery and Department of Rehabilitation Medicine, Jefferson Medical College of Thomas Jefferson University

Phillip J Marone, MD, MSPH is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Medical Association, American Orthopaedic Society for Sports Medicine, Philadelphia County Medical Society

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.

B Sonny Bal, MD, JD, PhD, MBA CEO and President, SINTX Technologies, Salt Lake City, UT

B Sonny Bal, MD, JD, PhD, MBA is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: SINTX Technologies.

Chief Editor

William L Jaffe, MD Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Vice Chairman, Department of Orthopedic Surgery, New York University Hospital for Joint Diseases

William L Jaffe, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American College of Surgeons, Eastern Orthopaedic Association, New York Academy of Medicine

Disclosure: Received consulting fee from Stryker Orthopaedics for speaking and teaching.

Additional Contributors

Miguel A Schmitz, MD

Miguel A Schmitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, North American Spine Society

Disclosure: Nothing to disclose.

Sections Surgery for Meralgia Paresthetica
Overview
Presentation
Workup
Treatment
Media Gallery
References

Surgery for Meralgia Paresthetica Clinical Presentation

History and Physical Examination

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