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Meralgia Paresthetica
Normal Anatomy
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The lateral femoral cutaneous nerve arises from the femoral nerve
Has a cutaneous branch only and supplies the upper and lateral part of the thigh
It emerges from the lateral border of psoas major and moves towards the anterior
superioriliac spine, under the inguinal ligament and into the thigh
Variations in normal anatomy and nerve route exist
Pathology
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Entrapment or dysfunction of the lateral femoral cutaneous nerve causing localized
paraesthesia and numbness on the anterolateral aspect of the thigh
Mechanism of Injury
Insidious
 Obesity
 Pregnancy
 Wearing belts, corsets or tight trousers
 Leg length discrepancy
 Lead poisoning
 Alcoholism
 Diabetes mellitus
Iatrogenic (caused by medical examination or treatment)
 Surgery
o Pelvic osteotomy
o Spinal surgery
o Obtaining Iliac crest bone grafts
o Laparoscopic cholecystectomy
o Laparoscopic myomectomy
o Laparoscopic inguinal hernia
Examination
Subjective
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Paraesthesia in the upper and lateral thigh
Unilateral symptoms
Burning, stinging sensation of the skin
Aggravated by pressure over inguinal ligament
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Aggravated by positions of hip extension
Eased by sitting down
Objective
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Tenderness over the lateral inguinal ligament
Hair loss over anterior thigh due to patient rubbing the area
Reduced sensation upper and lateral thigh
May have allodynia over the upper and lateral thigh
Further Investigations
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Nerve conduction study
Management
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Conservative management usually attempted with a good chance of success in 4 – 6 months
Usually involves treating the underlying cause such as weight loss, wearing tight clothes,
belts etc
Physiotherapy not usually considered but can be used in some cases
Conservative
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Local anaesthetic block
Plan B
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Neurolysis of constricting tissue
Neurolysis and transposition of the lateral femoral cutaneous nerve
References
(Harney and Patijn 2007, Patijn, Mekhail et al. 2011, Cheatham, Kolber et al. 2013)
Cheatham, S. W., M. J. Kolber and P. A. Salamh (2013). "Meralgia paresthetica: a review of the
literature." Int J Sports Phys Ther 8(6): 883-893.
Harney, D. and J. Patijn (2007). "Meralgia paresthetica: diagnosis and management strategies." Pain
Med 8(8): 669-677.
Patijn, J., N. Mekhail, S. Hayek, A. Lataster, M. van Kleef and J. Van Zundert (2011). "20. Meralgia
Paresthetica." Pain Practice 11(3): 302-308.
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