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Meralgia Paresthetica

Meralgia Paresthetica

Burning thigh pain is more commonly seen in individuals in their fourth or fifth decade of life. Compared to males, it affects females more commonly – particularly those with obesity or who are expecting. This is also known as Meralgia Paresthetica.

What is Meralgia Paresthetica

Meralgia Paresthesia is caused by compression of the lateral femoral cutaneous nerve. The Lateral Femoral nerve is one of the most important sensory nerves of the body. However, it is very sensitive to the force of compression, particularly when it passes towards the inguinal ligament from the lumbosacral plexus. According to the American Academy of Orthopaedic Surgeons, the compression of this sensory nerve is often associated with burning sensation, pain, and dysesthesia, in the front of the outer thigh. This condition is also referred to as lateral femoral cutaneous nerve syndrome or Bernhardt Roth syndrome. (3)

Common Causes Of Meralgia Paresthetica

Meralgia Paresthetica is commonly caused by nerve damage or entrapment of the lateral femoral cutaneous nerve. This may be spontaneous or may be caused by an iatrogenic injury. The causes of Meralgia Paresthetica, which are associated with spontaneous pain, include alcohol use for long periods, diagnosis of Diabetes Mellitus, hypothyroidism, or neuropathy of the lateral femoral cutaneous nerve. The causes of Meralgia Paresthetica, which are associated with mechanical pressure on the the femoral cutaneous nerve lfcn), may include wearing tight clothing, seat belt injuries, and even pressure exerted by weight gain or obesity, hernia, pregnancy, or tumours.

On the other hand, the common causes of iatrogenic pain in Meralgia Paresthetica include injuries caused during hip replacement surgery, lower back surgery, spine surgery, inguinal hernia surgery, hip and pelvic area and even bariatric surgery.

How Does Meralgia Paresthetica Develop?

The lateral femoral cutaneous nerve is made upon a combination of the lumbar nerve roots and adjoining peripheral nerves. This lateral cutaneous nerve passes under, above, or through the inguinal ligaments, after which are separated into two branches known as the anterior and posterior divisions. (4)

The nerve entrapment or compression of the Lateral Femoral Cutaneous Nerve is what eventually leads to the development of nerve pain seen in Meralgia Paresthetica. Risk factors that may increase one chance of this nerve compression or entrapment include tumour, pregnancy, and obesity. However, other than the mechanical causes, the metabolic causes of Meralgia Paresthetica are also of clinical importance. These may include alcohol consumption, lead positioning, and diabetes, which may cause injury to the nerve. (5)

Symptoms of Meralgia Paresthetica

Patients with Meralgia Paresthesia often present with symptoms like burning pain, paresthesis, and hypesthesia on the lateral area of the thigh. The symptoms may be bilateral or unilateral; however, they are more commonly unilateral. Patients described the pain to develop over a time of days to weeks, making it subacute. They also are often seen rubbing the outer parts of their thigh, which may start to lose hair over the skin that is constantly rubbed. The nerve pain experienced does not usually change as individuals change their position from standing to sitting and vice versa. However, these symptoms may worsen by sitting for a long period of time and standing for a prolonged period of time. The measures which are often reported to improve the symptoms include flexion of the front hip bone. (6)

Diagnosis of Meralgia Paresthetica

Meralgia Paresthetica has usually diagnosed b a health care professional after a detailed medical history, and physical examination. The doctor’s aim during this time is to find the exact underlying cause of the upper thigh pain. The doctor may also conduct a nerve conduction study. The neurological examination may be conducted on the lower extremity of the body. The physical examination may also include a pinprick test or a light touch conducted over the anterolateral thigh. The neurologic examination may be considered normal if the deep tendon reflexes and motor strength are normal. (7)

The diagnosis may also include manoeuvres like a pelvic compression test, where the patient is structured to lie on the side of the unaffected leg. After this, the examiner applied pressure on the pelvis for 45 seconds. The result may be considered positive if the pressure application reduces the symptoms of the individual. During a positive test, the sensitivity of physical exam of the individual may be at least 95%, while the specificity maybe 93%.

A majority of the patient don’t require x-rays, Magnetic resonance imaging, or EMG. However, they may be recommended for x-rays in the case proper diagnosis of tumours or arthritis. In addition, an ultrasound or MRI may be suggested to diagnose a Retroperitoneal or pelvic tumour. Moreover, blood tests may be recommended in the case of metabolic syndrome being the underlying cause of the pain.

Treatment Options For Meralgia Paresthetica

There is numerous treatment option available for Meralgia Paresthetica. This is a benign condition and is often self-limited – still, it is recommended to get early treatment to avoid experiencing unnecessary pain and discomfort. The treatment for Meralgia Paresthetica is focused on reducing the irritation and compression of the Lateral femoral nerve.

The doctor may first start by educating the patient about the possible underlying causes of the condition. The patients are also counselled about what they should do and avoid to prevent worsening of the pain. This may include tight-fitting clothes, which should be avoided. Moreover, the patient may also be asked to undergo weight loss, as obesity is a common cause of Meralgia Paresthetica. Applying ice and massaging with a cold pack may also improve the overall pain spreading the irritation and inflammation around the nerve.

Individuals with mild to moderate pain may also prescribe over-the-counter pain relievers and anti-inflammatory drugs like ibuprofen and Acetaminophen. They may also be recommended topical ointments containing Capsaicin, Tacrolimus, and Lidocaine. Another form of management for Meralgia Paresthetica symptoms includes physical therapy, which should be conducted under the supervision of a trained physiotherapist.

If the symptoms don’t improve with the more conservative approach mentioned above, the patient may be asked to undergo a neurological examination again. These imaging studies may also be conducted if the symptoms persist for more than two months. After medical advice, some patients may also start taking anti-consultants like phenytoin and corticosteroid injections. (8)

Surgery may be recommended in severe cases where the conservative therapies have failed completely. Surgical procedures for Meralgia Paresthetica include nerve decompression, which a nerve block and helps individuals retain their sensory functions. Individuals may also be recommended to undergo the sectioning technique, resulting in permanent pain relief. However, this is mostly reserved for patients with extreme pain. (9)

Prolotherapy:

In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat the root cause of Meralgia Parasthetica. Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.

Many structures that often trap the lateral femoral cutaneous nerve have a poor blood supply, so they struggle to heal properly on their own.

Prolotherapy involves injecting a natural regenerative solution with small needles into the structures around the lateral femoral cutaneous nerve to provide a direct supply of what is needed to repair them and release the trapped nerve.

As the treatment is helping to treat the root cause of the problem, it is deemed to be a permanent fix and also prevents Meralgia Parasthetica from returning.

Differential Diagnosis of Meralgia Paresthetica

Meralgia Paresthetica may often be confused for several medical conditions below. These include Lumbar Radiculopathy, Sciatica, Scar Tissue Formation, Spinal Cord injury, spinal stenosis, tumours in the pelvis, mass in the abdomen, avulsion fractures, osteoarthritis of the hip, appendicitis, and metastasis of the iliac crest. (10)

Frequently Asked Questions

What happens if Meralgia Paresthetica goes untreated?

If Meralgia Paresthetica is left untreated, it may worsen the pain or even paralysis of affected leg. This is why individuals are recommended to seek medical attention as soon as they experience the symptoms associated with Meralgia Paresthetica. These include tingling, pain, and numbness of the thigh. In addition, if the nerve is left to be compressed for a long time, it can lead to damage and possibly permanent side effects.

How do you calm Meralgia Paresthetica

In order to improve the symptoms associated with Meralgia Paresthetica symptoms, the individual may lightly massage the affected area using ice or a cold pack. They may also experience pain relief by taking over-the-counter pain killers like Acetaminophen and aspirin. Health professionals may also recommend anti-inflammatory agents like ibuprofen. While these may help for immediate improvement in symptoms, other ways like weight loss may lead to a long-term cure for the condition.

What does it mean when the front of your thigh burns?

Burning felt at the front of the thigh nay result from a nerve injury to exposure of the thigh to extreme temperature changes. A condition that is often associated with compression of the nerve of the thigh known as the lateral femoral cutaneous nerve is known as Meralgia Paresthetica. This is amongst the most common causes of burning pain felt at the outer third of the thigh.

What nerve runs down the front of your thigh?

The nerve that runs along the front or outer side of the thigh is the femoral nerve. This nerve is more precisely located in the pelvis, and from there, it runs down to the front of the leg. The role of this nerve is moving the muscles as an individual straightens their legs or moves their hip.

Should I see a doctor for Meralgia Paresthetica?

Whenever an individual experiences symptoms associated with Meralgia Paresthetica like burning pain or paresthesia, they are recommended to consult a health professional. This is particularly required when the symptoms last beyond a few days, with no improvements.

Is sitting good for Meralgia Paresthetica?

While sitting for a short period may not trigger the symptoms of Meralgia Paresthetica, prolonged sitting or standing is considered a risk factors for this condition.

References

  1.   Patijn, J., Mekhail, N., Hayek, S., Lataster, A., van Kleef, M., & Van Zundert, J. (2011). Meralgia Paresthetica. Pain practice: the official journal of World Institute of Pain, 11(3), 302–308. https://doi.org/10.1111/j.1533-2500.2011.00458.x
  2.   van Slobbe, A. M., Bohnen, A. M., Bernsen, R. M., Koes, B. W., & Bierma-Zeinstra, S. M. (2004). Incidence rates and determinants in meralgia paresthetica in general practice. Journal of neurology, 251(3), 294–297. https://doi.org/10.1007/s00415-004-0310-x
  3.   Kaiser R. (2018). Meralgia paresthetica. Meralgia paresthetica. Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti, 97(6), 286–290.
  4.   Grossman, M. G., Ducey, S. A., Nadler, S. S., & Levy, A. S. (2001). Meralgia paresthetica: diagnosis and treatment. The Journal of the American Academy of Orthopaedic Surgeons, 9(5), 336–344. https://doi.org/10.5435/00124635-200109000-00007
  5.   Berini, S. E., Spinner, R. J., Jentoft, M. E., Engelstad, J. K., Staff, N. P., Suanprasert, N., Dyck, P. J., & Klein, C. J. (2014). Chronic meralgia paresthetica and neurectomy: a clinical pathologic study. Neurology, 82(17), 1551–1555. https://doi.org/10.1212/WNL.0000000000000367
  6.   Harney, D., & Patijn, J. (2007). Meralgia paresthetica: diagnosis and management strategies. Pain medicine (Malden, Mass.), 8(8), 669–677. https://doi.org/10.1111/j.1526-4637.2006.00227.x
  7.   Seror, P., & Seror, R. (2006). Meralgia paresthetica: clinical and electrophysiological diagnosis in 120 cases. Muscle & nerve, 33(5), 650–654. https://doi.org/10.1002/mus.20507
  8.   Coffey R, Gupta V. Meralgia Paresthetica. [Updated 2022 May 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557735/
  9.   de Ruiter, G. C., Wurzer, J. A., & Kloet, A. (2012). Decision making in the surgical treatment of meralgia paresthetica: neurolysis versus neurectomy. Acta neurochirurgica, 154(10), 1765–1772. https://doi.org/10.1007/s00701-012-1431-0
  10.   Cheatham, S. W., Kolber, M. J., & Salamh, P. A. (2013). Meralgia paresthetica: a review of the literature. International journal of sports physical therapy, 8(6), 883–893.

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