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Meralgia Paresthetica

Meralgia paresthetica is a nerve entrapment syndrome that can cause burning discomfort, numbness and tingling along the outer side of the front of the thigh. It occurs when the lateral femoral cutaneous nerve (LFCN), which supplies sensation to the skin over the thigh, is compressed or trapped as it travels along the front of the pelvis.

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Who is affected by meralgia paresthetica?

 

Meralgia paresthetica is more common in women than men, with the incidence increasing significantly after the age of 50.

Risk factors for developing meralgia paresthetica include:

  • Age:

    The risk of developing meralgia paresthetica increases with age.
  • Gender:

    Women are more likely to develop this condition than men.
  • Repetitive thigh movements:

    Engaging in activities that require repetitive thigh movements, such as running, cycling, or sitting for long periods, can increase the risk of meralgia paresthetica.
  • Obesity or weight gain:

    Excess weight can put pressure on the LFCN, increasing the risk of compression. Meralgia paresthetica is often seen when individuals rapidly gain weight or if they wear restrictive, tight trousers or a tight belt that can impinge on the nerve as it exits the front of the pelvis.
  • Pregnancy:

    Hormonal changes during pregnancy can increase the risk of meralgia paresthetica.

What are the main symptoms of meralgia paresthetica?

 

The primary symptoms of meralgia paresthetica include:

Burning pain

A burning or aching sensation along the outer side of the thigh, often worse with activity.

Numbness

A loss of sensation or a feeling of pins and needles along the outer side of the thigh.

Tingling

A prickling or tingling sensation along the outer side of the thigh.

Hypersensitivity

Increased sensitivity to touch along the outer side of the thigh.

How is meralgia paresthetica diagnosed?

Diagnosis of meralgia paresthetica typically involves a physical examination, medical history review, and sometimes imaging tests.

  • Physical examination:

    The doctor will carefully examine the thigh, checking for pain and localised tenderness. Specific tests may be performed to assess the distribution of sensory symptoms and rule out other causes of thigh pain, such as hip osteoarthritis and nerve pain stemming from the lumbar spine.
  • Medical history:

    The doctor will inquire about the patient's symptoms, activities, any previous thigh injuries, and medical conditions that could contribute to nerve compression.
  • Imaging tests:

    Ultrasound or MRI may be used to rule out other causes of thigh pain, such as bone or joint abnormalities. Nerve conduction studies or electromyography (EMG) may be performed to assess the function of the LFCN and exclude other nerve disorders, such as a lumbar disc compressing a nerve root in the lower back.

How is meralgia paresthetica treated?

 

Treatment for meralgia paresthetica focuses on managing symptoms, relieving nerve compression, and preventing recurrence.

Non-surgical treatments:

  • Weight management:

    Losing weight can reduce pressure on the LFCN and alleviate symptoms.
  • Activity modification:

    Avoiding activities that aggravate the pain, such as running or cycling, can help reduce nerve compression.
  • Over-the-counter pain relievers:

    Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help alleviate mild to moderate pain and inflammation.
  • Neuropathic analgesia:

    Medications like amitriptyline, nortriptyline or gabapentin can help reduce nerve pain.
  • Physiotherapy:

    Physiotherapy can provide exercises and stretches to improve flexibility, strengthen the muscles around the hip and thigh, and lessen localised compression of the nerve.
  • Corticosteroid injections:

    Corticosteroid injections can be used to reduce inflammation and pain in the region surrounding the lateral femoral cutaneous nerve (LFC nerve).

Corticosteroid injections can be a highly effective way of reducing inflammation and pain as a result of LFC nerve irritation with meralgia paresthetica. At The Joint Injection Clinic, corticosteroid injections are performed after a thorough consent process, whereby the risk and benefits of the procedure are discussed in detail with your doctor.  The experienced medical doctor will then place you in a lying position, face up on the couch.  The skin is cleaned using a cleaning solution to ensure that the procedure is performed under sterile conditions.  The LFC nerve injection is performed with a small dose of steroid, targeting the area surrounding the nerve (perineural tissue), being careful to avoid injecting into the nerve itself. 

The injection itself is normally completed within 30-60 seconds, after which a plaster is applied and post-injection advice is given.  The patient is advised to look out for any signs of infection, specifically to check whether the local area becomes red, hot, tender, swollen or if they develop a fever.  If this occurs then the patient is asked to contact the clinic immediately at which time a formal reassessment will occur and if needed oral antibiotics can be prescribed.  The patient is also warned that following any injection they may notice a short-term worsening or flare in their symptoms after the local anaesthetic has worn off (4-5 hours).  This may last for 3-5 days and the patient is advised to consider icing of the area using an ice pack for 10-15 minutes every hour as required. has worn off (4-5 hours).  This may last for 3-5 days and the patient is advised to consider icing of the area using an ice pack for 10-15 minutes every hour as required.

Surgical treatments:

If non-surgical treatments fail to provide adequate relief, surgery may be considered. Surgical intervention for meralgia paresthetica typically involves decompression of the LFCN, which involves releasing the compressed nerve and allowing it to move freely.

Additional tips for managing meralgia paresthetica pain:

  • Avoid wearing tight clothing or heavy belts.
  • Maintain a healthy weight to reduce pressure on the LFCN.
  • Consider using a pillow between your knees when sleeping on your side.