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Meralgia Paresthetica
Normal Anatomy
• 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
• 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
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Obesity
Pregnancy
Wearing belts, corsets or tight trousers
Leg length discrepancy
Lead poisoning
Alcoholism
Diabetes mellitus
• Iatrogenic (caused by medical examination
or treatment)
• Surgery
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Pelvic osteotomy
Spinal surgery
Obtaining Iliac crest bone grafts
Laparoscopic cholecystectomy
Laparoscopic myomectomy
Laparoscopic inguinal hernia
Subjective Examination
• Paraesthesia in the upper and
lateral thigh
• Unilateral symptoms
• Burning, stinging sensation of
the skin
• Aggravated by pressure over
inguinal ligament
• Aggravated by positions of hip
extension
• Eased by sitting down
Objective Examination
• 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 Investigation
• Nerve conduction study
Management
• 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
• Local anaesthetic block
Plan B
• Neurolysis of constricting tissue
• Neurolysis and transposition of the lateral femoral cutaneous nerve
References
• 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.