Meralgia paresthetica or meralgia paraesthetica is

numbness Hypoesthesia or numbness is a common side effect of various medical conditions that manifests as a reduced sense of touch or sensation, or a partial loss of sensitivity to sensory stimuli. In everyday speech this is generally referred to as num ...

or pain in the outer

thigh In human anatomy, the thigh is the area between the hip ( pelvis) and the knee. Anatomically, it is part of the lower limb. The single bone in the thigh is called the femur. This bone is very thick and strong (due to the high proportion of ...

not caused by injury to the

, but by injury to a nerve that extends from the spinal column to the

. This chronic neurological disorder involves a single nerve—the lateral cutaneous nerve of the thigh, which is also called the lateral femoral cutaneous nerve (and hence the syndrome lateral femoral cutaneous neuropathy). The term " meralgia paraesthetica" combines four

Greek Greek may refer to: Greece Anything of, from, or related to Greece, a country in Southern Europe: *Greeks, an ethnic group. *Greek language, a branch of the Indo-European language family. **Proto-Greek language, the assumed last common ancestor ...

roots to mean "thigh pain with anomalous perception". The disorder has also been nicknamed bikini brief syndrome and skinny pants syndrome, because it can be caused by wearing tight clothing.

Signs and symptoms

* Pain on the outer side of the thigh, occasionally extending to the outer side of the knee, usually constant. * A burning sensation, tingling, or

in the same area * Multiple bee-sting like pains in the affected area * Occasionally, aching in the groin area or pain spreading across the

buttocks The buttocks (singular: buttock) are two rounded portions of the exterior anatomy of most mammals, located on the posterior of the pelvic region. In humans, the buttocks are located between the lower back and the perineum. They are composed ...

* Usually more sensitive to light touch than to firm pressure * Hypersensitivity to heat (warm water from shower feels like it is burning the area) * Occasionally, patients may complain of itching or a bothersome sensation rather than pain in the affected area. The entire distribution of the nerve is rarely affected. Usually, the unpleasant sensation(s) affect only part of the skin supplied by the nerve.

Cause

The lateral femoral cutaneous nerve most often becomes injured by entrapment or compression where it passes between the upper front hip bone ( ilium) and the inguinal ligament near the attachment at the

anterior superior iliac spine The anterior superior iliac spine (abbreviated: ASIS) is a bony projection of the iliac bone, and an important landmark of surface anatomy. It refers to the anterior extremity of the iliac crest of the pelvis. It provides attachment for the ing ...

(the upper point of the hip bone). Less commonly, the nerve may be entrapped by other anatomical or abnormal structures, or damaged by

diabetic Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...

or other neuropathy or trauma such as from seat belt injury in an accident. The nerve may become painful over a period of time as weight gain makes underwear, belting or the waistband of pants gradually exert higher levels of pressure. Pain may be acute and radiate into the rib cage, and into the groin, thigh, and knee. Alternately, weight loss or aging may remove protective fat layers under the skin, so the nerve can compress against underwear, outer clothing, and—most commonly— by belting. Long periods of standing or leg exercise that increases tension on the inguinal ligament may also cause pressure. The lateral cutaneous nerve of the thigh can occasionally be damaged during

laparoscopic Laparoscopy () is an operation performed in the abdomen or pelvis using small incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.Medlin ...

hernia repair Hernia repair refers to a surgical operation for the correction of a hernia—a bulging of internal organs or tissues through the wall that contains it. It can be of two different types: herniorrhaphy; or hernioplasty. This operation may be pe ...

, or scarring from the operation can lead to meralgia paraesthetica.

Diagnosis

Diagnosis is largely based on patient description and relevant details about recent surgeries, hip injuries, or repetitive activities that could irritate the nerve. Examination checks for sensory differences between the affected leg and the other leg. Differentiation of meralgia paraesthetica from a second lumbar root lesion remains the greatest problem in diagnosis and relies on the careful delineation of the paraesthetic area, the degree of numbness and a negative MR scan of the lumbar spine. Although the L2 area and the area supplied by the lateral cutaneous nerve correspond well laterally, the second root also contributes to the innervation of the groin and the inner aspect of the thigh. Furthermore, in L2 root lesions the analgesia is very slight because of the overlap between L2 and L3, whereas in lesions of the lateral cutaneous nerve, there is almost full anaesthesia, with a clear-cut border. Accurate diagnosis may require an abdominal and pelvic examination to exclude problems in those areas.

Electromyographic Electromyography (EMG) is a technique for evaluating and recording the electrical activity produced by skeletal muscles. EMG is performed using an instrument called an electromyograph to produce a record called an electromyogram. An electromyo ...

(EMG) nerve-conduction studies may be required. X-rays may be needed to exclude bone abnormalities that might put pressure on the nerve; likewise CT or MRI scans to exclude soft tissue causes such as a tumor.

Treatment

Treatment varies. In most cases, the best treatment is to remove the cause of compression by modifying patient behavior, in combination with medical treatment to relieve inflammation and pain. Whatever the cause, typical treatment takes several weeks to months—depending on the degree of nerve damage. Typical treatment options include: *

Active Release Technique Massage is the manipulation of the body's soft tissues. Massage techniques are commonly applied with hands, fingers, elbows, knees, forearms, feet or a device. The purpose of massage is generally for the treatment of body stress or pain. In Eu ...

(ART) soft tissue treatment * Wearing looser clothing and suspenders rather than belts * Weight loss if obesity is present *

Non-steroidal anti-inflammatory drug Non-steroidal anti-inflammatory drugs (NSAID) are members of a therapeutic drug class which reduces pain, decreases inflammation, decreases fever, and prevents blood clots. Side effects depend on the specific drug, its dose and duration of ...

s (NSAIDs) to reduce inflammatory pain if pain level limits motion and prevents sleep * Reducing physical activity in relation to pain level. Acute pain may require absolute bed rest * Deep tissue massage to reduce tension in the gluteal muscles, most commonly the gluteus maximus. The

tensor fasciae latae The tensor fasciae latae (or tensor fasciæ latæ or, formerly, tensor vaginae femoris) is a muscle of the thigh. Together with the gluteus maximus, it acts on the iliotibial band and is continuous with the iliotibial tract, which attaches to the ...

may also be implicated. For lower pain levels, treatment may involve having the patient: * Seek appropriate physical therapy, such as stretching and massage, which plays a large role in the management of pain * Learn to perform inguinal ligament stretching (from a physical therapist) which can rapidly relieve symptoms * Use rest periods to interrupt long periods of standing, walking, cycling, or other aggravating activity * Lose weight, and exercise to strengthen abdominal muscles * Wear clothing that is loose at the upper front hip area * Apply heat, ice, or electrical stimulationMeralgia Paresthetica * Take nonsteroidal anti-inflammatory medications for 7–10 days * Remove hair in affected area (shave) * Lidocaine patches (after shaving area) * Titanium dioxide patches to interfere with the electrostatic effect of the nerves on the surface of the skin Pain may take significant time (weeks) to stop and, in some cases, numbness persists despite treatment. In severe cases, the physician might perform a local nerve block at the inguinal ligament, using a combination of local anaesthetic ( lidocaine) and corticosteroids to provide relief that may last several weeks. Pain modifier drugs for neuralgic pain (such as

amitriptyline Amitriptyline, sold under the brand name Elavil among others, is a tricyclic antidepressant primarily used to treat cyclic vomiting syndrome (CVS), major depressive disorder and a variety of pain syndromes from neuropathic pain to fibromyalgi ...

carbamazepine Carbamazepine (CBZ), sold under the trade name Tegretol among others, is an anticonvulsant medication used primarily in the treatment of epilepsy and neuropathic pain. It is used as an adjunctive treatment in schizophrenia along with other m ...

gabapentin Gabapentin, sold under the brand name Neurontin among others, is an anticonvulsant medication primarily used to treat partial seizures and neuropathic pain. It is a first-line medication for the treatment of neuropathic pain caused by diabeti ...

) may be tried, but are often not as helpful in the majority of patients.Meralgia Paresthetica Persistent and severe cases may require surgery to decompress the nerve or, as a last resort, to resect the nerve. The latter treatment leaves permanent numbness in the area.

References

External links