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Meralgia Paresthetica

What is Meralgia Paresthetica?

Meralgia Paresthetica is a painful compressive neuropathy of the lateral femoral cutaneous nerve (LFCN), which causes a “burning” pain and altered sensation in the thigh (1-3).

meralgia paresthetica

Who is most likely to get Meralgia paresthetica?

Meralgia paresthetica can happen at any age, but is most common in middle-aged adults (5,6).  Diabetics have a 6X risk of developing the condition (7-9).  The condition affects men up to three times more frequently than women (8,10-12), which is thought to be due to increased belt use-carpentry, police belts, etc. 

Can Meralgia paresthetica happen on both legs? 

It can happen in either the dominant or non-dominant leg (10). The condition is presenting both legs in 20-25% of cases. (5,10-12).  

What causes Meralgia paresthetica?

Excessive compression stretch of the LFCN is a primary cause of meralgia paresethetica (1,3). Other known sources of compression include excessively tight clothing (especially jeans or belts), pregnancy, and obesity (10,16-21). Recent weight gain often precedes the condition. In fact, 8 percent of new cases report recent weight gains over 15 pounds (10,22). Seat belt compression has also been found to be a contributing factor (23-25).  Excess periods of laying on one's stomach can also contribute (26).  Athletes who are in gymnastics, baseball, soccer, bodybuilding, or strenuous exercise may be predisposed (27-31). 

What are the symptoms of meralgia paresthetica?

The typical symptoms of meralgia paresthetica are isolated pain or paresthesia on the outside of their thigh (1,3).  The pain is variable and patients may feel dull, aching, itching, buzzing or burning and may range from mildly uncomfortable to disabling (3,34-40).  Symptoms may prevent proper function and sleep (3,41).  Complaints are often provoked by walking and alleviated when sitting- as sitting can decrease tension on the inguinal ligament (11,12,41,42). 

Do I need X-rays or imaging for meralgia paresthetica?

The clinical syndrome of meralgia parasthetica is well defined, and diagnostic studies may be unnecessary (1,42). 

What are the best treatment options for meralgia paresthetica?

Conservative management is the frontline treatment for meralgia paresthetica and is successful in up to 91% of cases (16,52,53). 

The goal of treatment is to remove any cause of excessive compression (16,52).  In some cases, simply wearing looser clothing may alleviate the complaint. Other considerations include selective rest from an aggravating activity, weight loss, or carrying a toolbox instead of wearing a tool belt. Wearing high heels should be avoided as this causes excessive anterior pelvic tilt, which may be linked to the problem (32).

Myofascial release and stretching may be appropriate for tightness in the muscles around the hip. (52-57) 

Stabilization exercises are recommended for the core and pelvis (53-57). 

One small study demonstrated significant improvement in meralgia paresthetica symptoms following the application of therapeutic exercise tape. (60,61).

What other treatment options are there?

Patients may consider ice, over-the-counter analgesic creams, and NSAIDs for symptomatic relief (62).  

Severe  cases may benefit from anesthetic block or local steroid injection (63-65). 

Surgery should be reserved for those who fail all other forms of conservative treatments (62).

At Creekside Chiropractic & Performance Center, we are highly trained to treat each of these conditions.  We are the only inter-disciplinary  clinic providing services to Sheboygan, Sheboygan Falls, Plymouth, and Oostburg including chiropractic, manual therapy, myofascial release, ART (Active Release Technique), massage therapy, acupuncture, physiotherapy, rehabilitative exercise, nutritional counseling, personal training, and golf performance training under one roof. Utilizing these different services, we can help patients and clients reach the best outcomes and the best versions of themselves. Voted Best Chiropractor in Sheboygan by the Sheboygan Press.

Evidence Based-Patient Centered-Outcome Focused

Sources:

1. Patijn J, Mekhail N, Hayek S, Lataster A, van Kleef M, Van Zundert J. Meralgia Paresthetica. Pain Pract. May-Jun 2011;11(3):302-8. 

2. Bradley WG, Daroff RB, Fenichel GM, and Marsden CD: Neurology in Clinical Practice: The Neurological Disorders. Butterworth-Heinemann, Boston, 1991. 

3. Grossman MG, Ducey SA, Nadler SS., et al. Meralgia paresthetica: diagnosis and treatment. J Am Acad Orthop Surg. 2001;9(5):336-344 

4. Carai A, Fenu G, Sechi E, Crotti FM, Montella A. Anatomical variability of the lateral femoral cutaneous nerve: findings from a surgical series. Clin Anat. Apr 2009;22(3):365-70. 

5. Harney D., Patijn J. Meralgia paresthetica: diagnosis and management strategies. Pain Med. 2007;8(8):669–677. 

6. Martinez-Salio A, Moreno-Ramos T, Diaz-Sanchez M., et al. Meralgia paraesthetica: a report on a series of 140 cases. Rev Neurol. 2009;49(8):405-408 

7. Parisi TJ, Mandrekar J, Dyck PJ., et al. Meralgia paresthetica: relation to obesity, advanced age, and diabetes mellitus. Neurology. 2011;77(16):1538-1542 

8. van Slobbe AM, Bohnen AM, Bernsen RM., et al. Incidence rates and determinants in meralgia paresthetica in general practice. J Neurol. 2004;251(3):294-297 

9. Harney D, Patijn J. Meralgia Paresthetica: Diagnosis and Management Strategies. Pain Med. 2007;8(8):669-677 

10. Ratliff JK et al. Meralgia Paresthetica Following Iliac Crest Bone Graft for Anterior Cervical Discectomy: A Case Report and Review of the Literature. Department of Neurosurgery; Louisiana State University Medical Center; New Orleans, Louisiana. Accessed 9/18/14 www.medschool.lsuhsc.edu 

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14. Fargo MV, Konitzer LN. Meralgia paresthetica due to body armor wear in U.S. soldiers serving in Iraq: a case report and review of the literature. Mil Med. Jun 2007;172(6):663-5. 

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17. Mondelli M, Rossi S, Romano C. Body mass index in meralgia paresthetica: a case-control study. Acta Neurol Scand. Aug 2007;116(2):118-23. 

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19. Moucharafieh R, Wehbe J, Maalouf G. Meralgia paresthetica: a result of tight new trendy low cut trousers ('taille basse'). Int J Surg. Apr 2008;6(2):164-8. 

20. Park JW, Kim DH, Hwang M., et al. Meralgia paresthetica caused by hip-huggers in a patient with aberrant course of the lateral femoral cutaneous nerve. Muscle Nerve. 2007;35(5):678-680 

21. Sax TW, Rosenbaum RB. Neuromuscular disorders in pregnancy. Muscle Nerve. 2006;34(5):559-571 

22. Ecker A.D., Woltman H.W. Meralgia paresthetica: a report of one hundred and fifty cases.JAMA 110:1650, 1938. 

23. Beresford HR. Meralgia paresthetica after seat-belt trauma. J Trauma. 1971;11(7):629-630 

24. Blake SM, Treble NJ. Meralgia paraesthetica--an addition to ‘seatbelt syndrome’. Ann R Coll Surg Engl. 2004;86(6):W6-7. 

25. Moscona AR, Sekel R. Post-traumatic meralgia paresthetica--an unusual presentation. J Trauma. 1978;18(4):288. 

26. Cho KT, Lee HJ. Prone position-related meralgia paresthetica after lumbar spinal surgery : a case report and review of the literature. J Korean Neurosurg Soc. Dec 2008;44(6):392-5. 

27. Kho KH, Blijham PJ, Zwarts MJ. Meralgia paresthetica after strenuous exercise. Muscle Nerve. 2005;31(6):761-763 

28. Macgregor J, Moncur JA. Meralgia paraesthetica-a sports lesion in girl gymnasts. Br J Sports Med. 1977;11(1):16-19 

29. Szewczyk J, Hoffmann M, Kabelis J. Meralgia paraesthetica in a body-builder. Sportverletz Sportschaden. 1994;8(1):43-45 

30. Ulkar B, Yildiz Y, Kunduracioglu B. Meralgia paresthetica: a long-standing performance-limiting cause of anterior thigh pain in a soccer player. Am J Sports Med. 2003;31(5):787-789 

31. Otoshi K, Itoh Y, Tsujino A., et al. Case report: meralgia paresthetica in a baseball pitcher. Clin Orthop Relat Res. 2008;466(9):2268-2270 

32. Ahmed A. Meralgia paresthetica and femoral acetabular impingement: a possible association. J Clin Med Res. 2010;2(6):274-276 

33. Goel A. Meralgia paresthetica secondary to limb length discrepancy: case report. Arch Phys Med Rehabil. 1999;80(3):348-349 3

4. Ivins GK. Meralgia paresthetica, the elusive diagnosis: clinical experience with 14 adult patients. Ann Surg. 2000;232(2):281-286 

35. Mumenthaler M: Neurology. Thieme-Stratton, Inc., New York, 1983. 

36. Sunderland S: Nerves and Nerve Injuries, ed 2. Churchill-Livingstone, New York, 1978. 

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39. Kramer J: Intervertebral Disc Disease: Causes, Diagnosis, Treatment, and Prophylaxis. Year Book Medical Publishers, Chicago, 1981. 

40. Bradley WG, Daroff RB, Fenichel GM, and Marsden CD: Neurology in Clinical Practice: The Neurological Disorders. Butterworth-Heinemann, Boston, 1991. 

41. Nouraei S.A.R., Anand B., Spink G., O'Neill K.S. A novel approach to the diagnosis and management of meralgia paresthetica. Neurosurgery. 2007;60(4):696–700. 

42. Elizabeth A Sekul Meralgia Paresthetica Clinical Presentation. Medscape. Accessed 9/3/2014. http://emedicine.medscape.com/article/1141848- clinical 

43. Ruige J.B., et al, Performance of an NIDDM Screening Questionnaire Based on Symptoms and Risk Factors. Diabetes Care, 1997, Volume 20, page 491-496. 

44. Mumenthaler M: Neurology. Thieme-Stratton, Inc., New York, 1983. 

45. Nouraei SA, Anand B, Spink G, O’Neill KS. A novel approach to the diagnosis and management of meralgia paresthetica. Neurosurgery. Apr 2007;60(4):696-700; discussion 700.

46. Butler DS, Matheson JE, Boyaci A. The Sensitive Nervous System. Adelaide: NOI Publications; 2000 

47. Butler D. The neurodynamic techniques: a definitive guide from the Noigroup team. Adelaide: NOI Publications; 2005 

49. Nouraei SA, Anand B, Spink G., et al. A novel approach to the diagnosis and management of meralgia paresthetica. Neurosurgery. 2007;60(4):696-700 

50. el Tantawi GA. Reliability of sensory nerve-conduction and somatosensory evoked potentials for diagnosis of meralgia paraesthetica. Clin Neurophysiol. 2009;120(7):1346-1351 

51. Kramer J: Intervertebral Disc Disease: Causes, Diagnosis, Treatment, and Prophylaxis. Year Book Medical Publishers, Chicago, 1981. 

52. Kornbluth, Ira, and Pillip J. Marone. "Meralgia Paresthetica." eMedicine. Eds. Miguel A. Schmitz, et al. 9 Mar. 2009. Medscape. 9 Dec. 2009 

53. Kadel RE, Godbey WD, Davis BP. Conservative and chiropractic treatment of meralgia paresthetica: review and case report. J Manipulative Physiol Ther. 1982;5(2):73-78 

56. Skaggs CD, Winchester BA, Vianin M., et al. A manual therapy and exercise approach to meralgia paresthetica in pregnancy: a case report. J Chiropr Med. 2006;5(3):92-96 

57. Houle S. Chiropractic management of chronic idiopathic meralgia paresthetica: a case study. J Chiropr Med. 2012;11(1):36-41 

60. Kalichman L, Vered E, Volchek L. Relieving symptoms of meralgia paresthetica using Kinesio taping: a pilot study. Arch Phys Med Rehabil. 2010;91(7):1137-1139 

61. Kase K WJ, Kase T. Clinical Therapeutic Applications of the Kinesio Taping Method. 2nd ed. Tokyo, Japan: Ken Ikai Co; 2003 62. Khalil N., Nicotra A., Rakowicz W. Treatment for meralgia paraesthetica. Cochrane Database Syst Rev. 2008;(3):CD004159. 

63. Harney D., Patijn J. Meralgia paresthetica: diagnosis and management strategies. Pain Med. 2007;8(8):669–677. 

64. Hurdle MF, Weingarten TN, Crisostomo RA, Psimos C, Smith J. Ultrasound-guided blockade of the lateral femoral cutaneous nerve: technical description and review of 10 cases. Arch Phys Med Rehabil. Cctober 2007;77 (3):1362-4. 

65. Tumber PS, Bhatia A, Chan VW. Ultrasound-guided lateral femoral cutaneous nerve block for meralgia paresthetica. Anesth Analg. Mar 2008;106(3):1021-2. 

66. Fowler IM, Tucker AA, Mendez RJ. Treatment of Meralgia Paresthetica with Ultrasound-Guided Pulsed Radiofrequency Ablation of the Lateral Femoral Cutaneous Nerve. Pain Pract. Dec 7 2011

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