Paresthetic Meralgia is a condition that causes tingling, numbness or burning in the outer portion of the thigh. This sensation is known as “lateral femoral cutaneous nerve syndrome” and “meralgia paresthetica.”
Although this condition is not life-threatening, it can cause significant discomfort for those affected. This condition, primarily characterized by thigh pain, is often caused by the entrapment of this nerve at the inguinal ligament level. Understanding the intricacies of this condition is crucial for effective management.
This article will discuss Paresthetic Meralgia’s symptoms, causes, diagnosis, and treatment.
What precisely is Paresthetic Meralgia?
The lateral femoral cutaneous nerve is affected by the nerve condition known as paresthetic meralgia. This nerve provides sensation to the outer thigh, including the hip and outer thigh skin.
The nerve is in charge of transmitting temperature, pressure, and pain sensations.
When the nerve is damaged or compressed, Paresthetic Meralgia can result.
The most common cause of MP is the entrapment of the lateral femoral cutaneous nerve. This can result from several factors, including obesity, tight clothing, pregnancy, and other conditions that increase intra-abdominal volume.
What symptoms are associated with Paresthetic Meralgia?
The most common symptom of Paresthetic Meralgia is a sensation of tingling, burning, or numbness in the outer thigh. This sensation may be mild or severe, and the following symptoms may accompany it:
- Pain
- Itching
- Sensitivity to touch
- Weakness in muscle
- Having trouble standing or walking
- Symptoms that worsen when standing or walking
- A sensation that the skin is tight or being compressed
Clinically Relevant Anatomy
Branches and Pathways of the LFCN
The lateral femoral cutaneous nerve (LFCN) plays a pivotal role in Meralgia Paraesthetica. Originating from the L2 and L3 spinal nerves, it traverses the pelvis and branches into two divisions, supplying sensory innervation to the thigh’s skin.
Epidemiology / Etiology
Prevalence in Different Demographics
Meralgia Paresthetica occurrence is not limited by age, though it’s more common in the 30-40 age group. Its prevalence in children, especially those treated for osteoid osteoma, is now being recognized. Studies have shown varying incidence rates among different sexes and races, with some indicating a higher incidence in men.
What causes paresthesia meralgia?
There are numerous causes of Paresthetic Meralgia, including the following:
- Wearing tight clothing or belts that pressure the outer thigh can cause Paresthetic Meralgia by compressing the lateral femoral cutaneous nerve.
- Obesity: Excess weight can exert pressure on the lateral femoral cutaneous nerve, resulting in compression or damage.
- A thigh or hip injury can damage the lateral femoral cutaneous nerve, leading to Paresthetic Meralgia.
- Diabetes can cause nerve damage, including lateral femoral cutaneous nerve damage, resulting in Paresthetic Meralgia.
Meralgia paresthetica can be caused by a variety of factors, including tight clothing, obesity, pregnancy, or injury. In some cases, the cause is unknown.
How does one diagnose Paresthetic Meralgia?
Identifying Paresthetic Meralgia is commonly diagnosed through a physical examination and discussion of symptoms. Your physician may also order the following tests:
- Nerve conduction study: This test measures the electrical activity in your nerves and can help determine whether or not the lateral femoral cutaneous nerve is damaged.
- Electromyography (EMG): This test measures the electrical activity in your muscles and can help determine if Paresthetic Meralgia is accompanied by muscle weakness.
- Your physician may order imaging tests such as an MRI or CT scan to rule out other potential causes of your symptoms.
Differential Diagnosis
| Condition | Clinical Features | Diagnostic Tests |
|---|---|---|
| Lumbar Radiculopathy | Low back pain, sciatica, motor/sensory deficits, diminished reflexes | MRI, electromyography (EMG), nerve conduction study (NCS) |
| Lateral Femoral Cutaneous Nerve Entrapment | Burning, tingling, or numbness on the lateral thigh; exacerbated by prolonged standing, walking, or sitting | Clinical examination, Tinel’s sign, diagnostic nerve block |
| Peripheral Neuropathy | Gradual onset, symmetric distal sensory loss, stocking-glove pattern, motor weakness, and autonomic dysfunction | Nerve conduction study (NCS), blood tests for underlying causes (e.g., diabetes, vitamin deficiencies) |
| Iliotibial Band Syndrome | Outer knee pain, tenderness, and tightness in the iliotibial band; typically associated with repetitive knee flexion and extension | Clinical examination, imaging (ultrasound or MRI) if needed |
| Hip Bursitis | Pain and tenderness over the greater trochanter, aggravated by lying on the affected side, walking, or stair climbing | Clinical examination, imaging (X-ray, ultrasound, or MRI) if needed |
| Sacroiliac Joint Dysfunction | Low back, buttock, and posterior thigh pain; pain may radiate to the groin or lateral thigh | Clinical examination, imaging (X-ray, CT, or MRI), diagnostic sacroiliac joint block |
How do you treat Paresthetic Meralgia?
Therapeutics for Paresthetic Meralgia is commonly treated by releasing pressure on the lateral femoral cutaneous nerve.
The first line of treatment focuses on alleviating nerve compression. This includes weight management, clothing adjustments, and cold pack applications.
Your physician may suggest:
- Avoid wearing constricting clothing or belts that exert pressure on the outer thigh.
- Losing weight to relieve nerve pressure
- Physical therapy for muscle strengthening and posture improvement
- Medications for managing discomfort
- Injections of steroids to reduce inflammation
- Surgical decompression of the nerve in extreme cases
Meralgia paresthetica is generally a benign condition that does not cause serious complications. However, in rare cases, chronic or severe cases of meralgia paresthetica may lead to permanent nerve damage or disability.
Non-pharmacological treatments
- Physical Therapy: Exercises and stretches to help strengthen and release tension in the affected area.
- Cold Compresses: Applying a cold compress to the area can help reduce inflammation.
- Heat Therapy: Using heat to relax the muscles and reduce pain.
- Massage: Applying pressure to the affected area can help to reduce tension and improve circulation.
- Topical Creams: Using topical creams that contain ingredients such as capsaicin and menthol can help to reduce pain.
- Acupuncture: This ancient form of Chinese medicine can help to reduce pain and inflammation.
- Lifestyle Changes: Making changes to your lifestyle such as increasing physical activity, eating a balanced diet, and managing stress levels can help to reduce pain.
How Physical Therapy can Help
Physical therapy can be beneficial in the treatment of meralgia paresthetica, a condition characterized by numbness, tingling, and pain in the outer thigh due to compression of the lateral femoral cutaneous nerve. Here’s how physical therapy helps:
- Manual Therapy and Exercises: Physical therapy techniques, including manual therapy and core stabilization exercises, have been found effective in improving pelvic girdle pain and functional mobility in patients with meralgia paresthetica. These therapies can particularly benefit postpartum patients, leading to the complete resolution of low back pain and lower extremity symptoms (Renard & Abraham-Justice, 2012; Skaggs et al., 2006)(Renard & Abraham-Justice, 2012)(Skaggs et al., 2006).
- Diagnostic and Management Tool: Physical therapy serves as a useful adjunctive tool for diagnosing and managing meralgia paresthetica. It helps identify the condition and provides therapeutic options to alleviate symptoms (Harney & Patijn, 2007)(Harney & Patijn, 2007).
- Kinesio Taping: Techniques like Kinesio taping have been shown to significantly improve symptoms of meralgia paresthetica, including pain, burning sensation, and paresthesia, after 4 weeks of treatment (Kalichman et al., 2010)(Kalichman et al., 2010).
- Mirror Therapy: For patients who have not responded to various conservative therapies, mirror therapy with brushing of the thigh can provide effective pain relief (Dabgotra et al., 2016)(Dabgotra et al., 2016).
- General Physical Therapy: Physical therapy is considered an initial management option for meralgia paresthetica, often used in conjunction with behavioral modification and pharmacotherapy (Chiravuri, 2018)(Chiravuri, 2018).
Advanced Medical Interventions
When Conservative Measures Fail
If symptoms persist, medical interventions like nerve blocks or anti-inflammatory medication are considered. In refractory cases, pulsed radiofrequency neuromodulation is an option.
Surgical Options
Decompression and Neurectomy
Surgery, involving either decompression or neurectomy, is reserved for severe cases unresponsive to other treatments. Neurectomy, though more invasive, often yields higher pain relief.
Frequently Asked Questions
What is parethetic meralgia?
Parethetic meralgia is a condition characterized by burning or tingling sensations in the outer thigh due to irritation or compression of the lateral femoral cutaneous nerve.
What are the causes of parethetic meralgia?
The most common cause of parethetic meralgia is compression of the lateral femoral cutaneous nerve, usually due to tight clothing, obesity, pregnancy, or a direct trauma to the area. Other causes may include diabetes, alcoholism, hernias, and certain medications.
What are the symptoms of parethetic meralgia?
Symptoms of parethetic meralgia may include burning or tingling sensations in the outer thigh, pain when pressure is applied to the area, and/or an increase in pain when standing or walking.
What are the risk factors for developing parethetic meralgia?
Risk factors for developing parethetic meralgia include obesity, pregnancy, and wearing tight clothing or belts. Other risk factors may include diabetes, hernias, alcoholism, and certain medications.
How is parethetic meralgia diagnosed?
Parethetic meralgia is usually diagnosed based on a patient’s symptoms and a physical examination. Additional tests such as an MRI or nerve conduction study may be performed to confirm the diagnosis.
How is parethetic meralgia treated?
Treatment of parethetic meralgia may include lifestyle changes such as weight loss, avoiding tight clothing, and regular stretching exercises. Other treatments may include medications such as non-steroidal anti-inflammatories, corticosteroids, and/or numbing medications.
Are there any complications associated with parethetic meralgia?
Complications associated with parethetic meralgia may include chronic pain, difficulty walking, and decreased mobility in the affected area.
Is surgery an option for treating parethetic meralgia?
Surgery may be an option in cases where lifestyle changes, medications, or other treatments have not been successful. Surgery may involve releasing or decompressing the lateral femoral cutaneous nerve.
Are there any home remedies for treating parethetic meralgia?
Home remedies that may help to reduce symptoms of parethetic meralgia include avoiding tight clothing, weight loss, regular stretching, and applying ice or heat to the affected area.
Are there any long-term effects of parethetic meralgia?
Long-term effects of parethetic meralgia may include chronic pain, decreased mobility in the affected area, and difficulties with activities such as walking, running, and climbing stairs.
Conclusion
Paresthetic Meralgia is a lateral femoral cutaneous nerve disorder that causes tingling, burning, or numbness in the outer thigh. This condition can be caused by obesity, injury, or diabetes.
Typical treatment involves relieving pressure on the nerve through lifestyle modifications.
References
- Renard, J., & Abraham-Justice, K. (2012). Manual Therapy and Core Stabilization Exercises With Postpartum Pelvic Girdle Pain and Meralgia Paresthetica: A Case Report. Journal of Women’s Health Physical Therapy, 36, 35–43.
- Skaggs, C., Winchester, B., Vianin, M., & Prather, H. (2006). A manual therapy and exercise approach to meralgia paresthetica in pregnancy: a case report. Journal of chiropractic medicine, 5(3), 92-6.
- Harney, D., & Patijn, J. (2007). Meralgia paresthetica: diagnosis and management strategies. Pain medicine, 8(8), 669-77.
- Kalichman, L., Vered, E., & Volchek, L. (2010). Relieving symptoms of meralgia paresthetica using Kinesio taping: a pilot study. Archives of physical medicine and rehabilitation, 91(7), 1137-9.
- Dabgotra, M., Das, G., Malik, S., & Bhattarai, R. (2016). Mirror Visual Feedback Treatment for Meralgia Paresthetica.
- Chiravuri, S. (2018). Lateral Femoral Cutaneous Neuropathy—Meralgia Paresthetica. Oxford Medicine Online.
- Cheatham, S. W., Kolber, M., & Salamh, P. (2013). Meralgia paresthetica: a review of the literature. International journal of sports physical therapy, 8(6), 883-93.
MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.