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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Preston DC, Shapiro BE. Femoral neuropathy. Electromyography and Neuromuscular Disorders: Clinical-Electrophysiologic Correlations. 3rd ed. Philadelphia: Elsevier Saunders; 2013. 357-64.
Hanna A. The lateral femoral cutaneous nerve canal. J Neurosurg. 2017 Mar. 126 (3):972-978. [QxMD MEDLINE Link].
Sunderland S. Anatomical features of nerve trunks in relation to nerve injury and nerve repair. Clin Neurosurg. 1970. 17:38-62. [QxMD MEDLINE Link].
de Ridder VA, de Lange S, Popta JV. Anatomical variations of the lateral femoral cutaneous nerve and the consequences for surgery. J Orthop Trauma. 1999 Mar-Apr. 13 (3):207-11. [QxMD MEDLINE Link].
Schestatsky P, Lladó-Carbó E, Casanova-Molla J, Alvarez-Blanco S, Valls-Solé J. Small fibre function in patients with meralgia paresthetica. Pain. 2008 Oct 15. 139 (2):342-8. [QxMD MEDLINE Link].
Mondelli M, Rossi S, Romano C. Body mass index in meralgia paresthetica: a case-control study. Acta Neurol Scand. 2007 Aug. 116 (2):118-23. [QxMD MEDLINE Link].
Fargo MV, Konitzer LN. Meralgia paresthetica due to body armor wear in U.S. soldiers serving in Iraq: a case report and review of the literature. Mil Med. 2007 Jun. 172 (6):663-5. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Seror P, Seror R. Meralgia paresthetica: clinical and electrophysiological diagnosis in 120 cases. Muscle Nerve. 2006 May. 33 (5):650-4. [QxMD MEDLINE Link].
Williams PH, Trzil KP. Management of meralgia paresthetica. J Neurosurg. 1991 Jan. 74 (1):76-80. [QxMD MEDLINE Link].
van Eerten PV, Polder TW, Broere CA. Operative treatment of meralgia paresthetica: transection versus neurolysis. Neurosurgery. 1995 Jul. 37 (1):63-5. [QxMD MEDLINE Link].
Ivins GK. Meralgia paresthetica, the elusive diagnosis: clinical experience with 14 adult patients. Ann Surg. 2000 Aug. 232 (2):281-6. [QxMD MEDLINE Link].
Siu TL, Chandran KN. Neurolysis for meralgia paresthetica: an operative series of 45 cases. Surg Neurol. 2005 Jan. 63 (1):19-23; discussion 23. [QxMD MEDLINE Link].
Grossman MG, Ducey SA, Nadler SS, Levy AS. Meralgia paresthetica: diagnosis and treatment. J Am Acad Orthop Surg. 2001 Sep-Oct. 9 (5):336-44. [QxMD MEDLINE Link].
Nahabedian MY, Dellon AL. Meralgia paresthetica: etiology, diagnosis, and outcome of surgical decompression. Ann Plast Surg. 1995 Dec. 35 (6):590-4. [QxMD MEDLINE Link].
Shimizu S. A novel approach to the diagnosis and management of meralgia paresthetica. Neurosurgery. 2008 Oct. 63 (4):E820. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Park BJ, Joeng ES, Choi JK, Kang S, Yoon JS, Yang SN. Ultrasound-guided lateral femoral cutaneous nerve conduction study. Ann Rehabil Med. 2015 Feb. 39 (1):47-51. [QxMD MEDLINE Link].
de Ruiter GCW, Lim J, Thomassen BJW, van Duinen SG. Histopathologic changes inside the lateral femoral cutaneous nerve obtained from patients with persistent symptoms of meralgia paresthetica. Acta Neurochir (Wien). 2019 Feb. 161 (2):263-269. [QxMD MEDLINE Link].
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Hurdle MF, Weingarten TN, Crisostomo RA, Psimos C, Smith J. Ultrasound-guided blockade of the lateral femoral cutaneous nerve: technical description and review of 10 cases. Arch Phys Med Rehabil. 2007 Oct. 88 (10):1362-4. [QxMD MEDLINE Link].
Klauser AS, Abd Ellah MM, Halpern EJ, Sporer I, Martinoli C, Tagliafico A, et al. Meralgia paraesthetica: Ultrasound-guided injection at multiple levels with 12-month follow-up. Eur Radiol. 2016 Mar. 26 (3):764-70. [QxMD MEDLINE Link].
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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 Grossman 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 College of Surgeons, American Orthopaedic Association, 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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