Approach Considerations
A national cohort study by Schönberg et al indicated that in Germany, between 2005 and 2018, there was a trend toward nonsurgical management of meralgia paresthetica (MP). While, during this period, the in-hospital surgical procedure rate for MP fell from 53% to 37%, that for spinal and local injections, physical therapy, and electrotherapy rose from 23% to 30%. The investigators also saw an increase in the rate of other therapies, including those treating the psychosomatic and psychic components of MP, from 0% to 6%. Although decompressive procedures were the most frequent surgical therapies between 2005 and 2018, their rate fell from 32% to 22% over that time. [16]
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. [2]
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.
Surgical Intervention
Patients failing conservative measures are referred to a surgeon for consideration of surgical decompression of the lateral femoral cutaneous nerve (LFCN). [3, 4, 5, 6, 7, 8] 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.
A study by de Ruiter et al reported that histopathologic changes in the LFCN—including with regard to perineurium thickening, mucoid deposition, and percentage of collagen—occur in patients with persistent meralgia paresthetica (MP) symptoms whether or not they previously underwent neurolysis (decompression). According to the investigators, this indicates that such intraneural changes are largely irreversible in persistent MP and that treatment with neurectomy is an effective alternative to neurolysis. [17]
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 (MP) using ultrasonographically 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. [18, 19]
A study by Klauser et al indicated that ultrasonographically guided steroid injection at three different levels along the LFCN can more effectively treat MP. By 12-month follow-up, 15 out of 20 patients (75%) had obtained complete symptom resolution, with the mean visual analogue scale (VAS) score having been reduced from 82 to 0, while the remaining five patients (25%) had experienced partial symptom resolution, with the mean VAS score having been reduced from 92 to 42. [20]
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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.
