Meralgia paresthetica
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Meralgia paresthetica is a condition caused by compression or pressure on the lateral femoral cutaneous nerve. Meralgia paresthetica produces discomfort and aching, burning, numbness, or stabbing sensations in the thigh area. This condition is also known as lateral femoral cutaneous nerve entrapment.
Meralgia means “thigh pain,” while paresthetica means “burning pain, tingling, or itching.” Lateral femoral cutaneous nerve supplies sensation to the skin in the thigh. Pressure on this nerve can causes discomfort.
Meralgia paresthetica can occur due to factors like local trauma or certain illnesses such as diabetes, but it is frequently attributed to tight clothing, obesity or weight gain, and pregnancy. To address this condition, treatment options may involve pain relievers or, in rare instances, surgical intervention. Nonetheless, using conservative measures like wearing looser clothing can be beneficial in alleviating meralgia paresthetica.
Symptoms
Meralgia paresthetica symptoms commonly appear on one side of the body, usually near the front of the upper thigh. The symptoms may include:
- Thigh pain, aching, tingling, or numbness
- Burning sensation
- Reduced sense of feeling
- Increased pain sensitivity, such as gently touching the thigh may cause pain
- Pain becomes worse after long durations of walking or standing
If any of the signs and symptoms persist, visit a healthcare provider for proper diagnosis and treatment.
Causes
The compression of the lateral femoral cutaneous nerve (LFCN) causes meralgia paresthetica. The LFCN is a large sensory nerve in the body. It provides feeling to the outer thigh’s surface. It runs from the spinal cord through the pelvic area and down the outside of the thigh. The lateral femoral cutaneous nerve only impacts sensation and has no effect on leg muscle function.
Normally, individuals do not encounter any issues as the nerve travels from the groin to the upper thigh. In meralgia paresthetica, the lateral femoral cutaneous nerve becomes trapped, commonly behind the inguinal ligament.
Compression of the LFCN can be caused by several factors, both external and internal, such as:
- Tight attire, such as belts, corsets, and skinny jeans
- Wearing a large tool belt
- Obesity or gaining weight
- Pregnancy
- Hip injuries or surgery
- Abdominal fluid collection, resulting in increased abdominal pressure
- Nerve injury caused by diabetes, trauma following surgery
- Seat belt injury in a car accident
- A tumor close to the LFCN
Risk factors
Anyone can develop meralgia paresthetica. However, several factors may contribute to increasing one’s risk of this condition, such as:
- Age: This condition tends to develop among people who are between 30 to 60 years of age.
- Obesity: Too much weight gain can put additional strain on the lateral femoral cutaneous nerve which can lead to meralgia paresthetica.
- Pregnancy: An increased pressure on the groin area where the lateral femoral cutaneous nerve traverses is common as the pregnancy progresses.
- Diabetes: People with diabetes are more likely to develop this condition.
Diagnosis
Diagnosing meralgia paresthetica involves conducting a physical examination and obtaining a comprehensive understanding of the patient’s symptoms, medical and surgical history, and lifestyle. Since this condition can be triggered by various factors and conditions, healthcare providers may ask a series of targeted questions to help identify the underlying cause of the symptoms.
During the physical exam, a healthcare provider will typically conduct a hands-on test known as a pelvic compression test. This involves applying pressure to the affected thigh to assess sensation. They may also ask for a description of the pain and instruct the patient to outline the numb or painful region on the thigh. Additionally, other tests such as light touch and reflex assessments may be performed as part of the examination.
To confirm the diagnosis and to rule out other possible reasons of the symptom, several tests may be required, such as:
- Imaging tests: An X-ray of the pelvis and thigh may be requested to exclude the possibility of other medical conditions such as bone tumors. Other imaging procedures like a CT scan or magnetic resonance imaging (MRI) scan might be recommended to examine potential spinal or nerve problems like a herniated disc. Or if the healthcare provider feels that a tumor is causing the pain.
- Electromyography: This test involves inserting a slender needle electrode into the muscle to record its electrical activity. While the results of this test typically appear normal in cases of meralgia paresthetica, it may still be necessary to conduct the test in order to rule out other disorders when the diagnosis is uncertain.
Electromyography is utilized to assess and diagnose muscle and nerve disorders by measuring the electrical discharges generated within the muscles.
- Nerve conduction study: This test may be required to rule out other possible explanations of the symptoms. A comparison of the lateral femoral cutaneous nerves on both sides is performed. During the procedure, patch-style electrodes are applied to the skin to deliver a moderate mild electrical impulse to the nerve. The electrical impulse aids in the diagnosis of damaged nerves.
- Nerve blockade: Meralgia paresthetica can be confirmed by obtaining pain relief through an anesthetic injection into the precise location where the lateral femoral cutaneous nerve enters the thigh. This injection, guided by ultrasound imaging, if necessary, serves as a diagnostic measure to validate the presence of the condition.
- Blood tests: To assess potential underlying causes that can impact nerve function, blood tests may be prescribed. These tests can include checking thyroid hormone levels to identify signs of hypothyroidism, assessing B vitamin levels to detect deficiencies in vitamin B12 or folate, which can affect nerves. Furthermore, a hemoglobin or hematocrit test may be conducted to investigate signs of anemia. Blood tests can also examine lead levels to detect signs of lead poisoning and measure blood glucose levels to identify signs of diabetes.
Treatment
The majority of meralgia paresthetica cases show improvement with conservative treatment and may even resolve spontaneously. The primary objective of treatment is to alleviate nerve compression.
- With conservative treatment, most of persons with meralgia paresthetica recover. Techniques may include:
- Weight loss and maintaining a healthy weight
- Dressing in looser garments
- Using over-the-counter pain medicines such as acetaminophen, ibuprofen, and aspirin
- Medications: Severe pain or symptoms that lasts longer than two months may be relieved with medications, such as:
- Gabapentin, pregabalin, duloxetine, phenytoin, or carbamazepine: These medications may help treat neuropathic pain. Constipation, nausea, dizziness, drowsiness, and lightheadedness are some of the side effects.
- Corticosteroid injections: Injections can alleviate pain by minimizing inflammation. However, there are potential side effects associated with these injections, including joint infection, nerve damage, pain, and discoloration of the skin surrounding the injection site.
- Tricyclic antidepressants: These drugs are effective in helping pain. Drowsiness, dry mouth, constipation, and reduced sexual function are some of the side effects.
- Radiofrequency nerve ablation: This therapy employs radio waves to generate a current, which then heats a targeted section of nerve tissue. By doing so, the heat effectively destroys that specific area of the nerve, preventing it from transmitting pain signals to the brain.
- Surgery: Healthcare providers only suggest surgery for individuals who have attempted alternative treatments but continue to experience symptoms. Surgical intervention will address compression on the lateral femoral cutaneous nerve.
