Meralgia paresthetica (lateral femoral cutaneous nerve entrapment)
- Bruce C Anderson, MD
Bruce C Anderson, MD
- Associate Professor of Medicine
- Oregon Health Sciences University
The lateral femoral cutaneous nerve, a pure sensory nerve, is susceptible to compression as it courses from the lumbosacral plexus, through the abdominal cavity, under the inguinal ligament, and into the subcutaneous tissue of the thigh. Meralgia paresthetica is the term used to describe the clinical syndrome of pain, dysesthesia, or both in the anterolateral thigh associated with compression of the nerve . (See "Evaluation of the adult with hip pain".)
ETIOLOGY AND EPIDEMIOLOGY
The majority of meralgia paresthetica cases result from entrapment of the lateral femoral cutaneous nerve as it passes under the inguinal ligament. The most frequent associated conditions are obesity, diabetes mellitus, and older age . Additional associations include large abdomens with overlying panniculus , tight belts or garments around the waist [4-6], scar tissue near the lateral aspect of the inguinal ligament, and pregnancy [7-9].
Injury during local or regional surgery (eg, spine procedures, iliac crest bone harvesting, hip prosthesis, aorto-bifemoral bypass) is another important cause of meralgia paresthetica , accounting for 17 percent of cases in one series of 120 patients . Seat belt injury following motor vehicle accident is a less frequent cause . Meralgia has also been reported after long-distance walking and cycling, possibly as a consequence of local ischemia during repetitive muscle stretching .
In a retrospective population-based study from Minnesota, 262 patients with meralgia paresthetica were compared with 262 normal controls and 262 body mass index-matched controls . The following observations were reported:
●The adjusted incidence of meralgia paresthetica in people with diabetes mellitus was seven-fold greater than that of the general population (247 versus 33 per 100,000 population)
- Anderson BC. Office Orthopedics for Primary Care: Diagnosis and Treatment, 3rd Edition, Elsevier Company, Philadelphia 2005.
- Parisi TJ, Mandrekar J, Dyck PJ, Klein CJ. Meralgia paresthetica: relation to obesity, advanced age, and diabetes mellitus. Neurology 2011; 77:1538.
- Deal CL, Canoso JJ. Meralgia paresthetica and large abdomens. Ann Intern Med 1982; 96:787.
- Boyce JR. Meralgia paresthetica and tight trousers. JAMA 1984; 251:1553.
- Seror P, Seror R. Meralgia paresthetica: clinical and electrophysiological diagnosis in 120 cases. Muscle Nerve 2006; 33:650.
- Park JW, Kim DH, Hwang M, Bun HR. Meralgia paresthetica caused by hip-huggers in a patient with aberrant course of the lateral femoral cutaneous nerve. Muscle Nerve 2007; 35:678.
- Sax TW, Rosenbaum RB. Neuromuscular disorders in pregnancy. Muscle Nerve 2006; 34:559.
- Van Diver T, Camann W. Meralgia paresthetica in the parturient. Int J Obstet Anesth 1995; 4:109.
- van Slobbe AM, Bohnen AM, Bernsen RM, et al. Incidence rates and determinants in meralgia paresthetica in general practice. J Neurol 2004; 251:294.
- Mirovsky Y, Neuwirth M. Injuries to the lateral femoral cutaneous nerve during spine surgery. Spine (Phila Pa 1976) 2000; 25:1266.
- Nahabedian MY, Dellon AL. Meralgia paresthetica: etiology, diagnosis, and outcome of surgical decompression. Ann Plast Surg 1995; 35:590.
- Kho KH, Blijham PJ, Zwarts MJ. Meralgia paresthetica after strenuous exercise. Muscle Nerve 2005; 31:761.
- Williams PH, Trzil KP. Management of meralgia paresthetica. J Neurosurg 1991; 74:76.
- Harney D, Patijn J. Meralgia paresthetica: diagnosis and management strategies. Pain Med 2007; 8:669.
- Sarala PK, Nishihara T, Oh SJ. Meralgia paresthetica: electrophysiologic study. Arch Phys Med Rehabil 1979; 60:30.
- Russo MJ, Firestone LB, Mandler RN, Kelly JJ Jr. Nerve conduction studies of the lateral femoral cutaneous nerve. Implications in the diagnosis of meralgia paresthetica. Am J Electroneurodiagnostic Technol 2005; 45:180.
- Shin YB, Park JH, Kwon DR, Park BK. Variability in conduction of the lateral femoral cutaneous nerve. Muscle Nerve 2006; 33:645.
- Boon AJ, Bailey PW, Smith J, et al. Utility of ultrasound-guided surface electrode placement in lateral femoral cutaneous nerve conduction studies. Muscle Nerve 2011; 44:525.
- Hurdle MF, Weingarten TN, Crisostomo RA, et al. Ultrasound-guided blockade of the lateral femoral cutaneous nerve: technical description and review of 10 cases. Arch Phys Med Rehabil 2007; 88:1362.
- Streiffer RH. Meralgia paresthetica. Am Fam Physician 1986; 33:141.
- Lee CC. Entrapment syndrome of peripheral nerve injuries. In: Youman's Neurological Surgery, 5th, Winn HR. (Ed), Elsevier, Philadelphia 2004. p.3923.
- Khalil N, Nicotra A, Rakowicz W. Treatment for meralgia paraesthetica. Cochrane Database Syst Rev 2012; 12:CD004159.
- de Ruiter GC, Wurzer JA, Kloet A. Decision making in the surgical treatment of meralgia paresthetica: neurolysis versus neurectomy. Acta Neurochir (Wien) 2012; 154:1765.
- Benezis I, Boutaud B, Leclerc J, et al. Lateral femoral cutaneous neuropathy and its surgical treatment: a report of 167 cases. Muscle Nerve 2007; 36:659.
- Philip CN, Candido KD, Joseph NJ, Crystal GJ. Successful treatment of meralgia paresthetica with pulsed radiofrequency of the lateral femoral cutaneous nerve. Pain Physician 2009; 12:881.
- Choi HJ, Choi SK, Kim TS, Lim YJ. Pulsed radiofrequency neuromodulation treatment on the lateral femoral cutaneous nerve for the treatment of meralgia paresthetica. J Korean Neurosurg Soc 2011; 50:151.
- Fowler IM, Tucker AA, Mendez RJ. Treatment of meralgia paresthetica with ultrasound-guided pulsed radiofrequency ablation of the lateral femoral cutaneous nerve. Pain Pract 2012; 12:394.