Meralgia Paresthetica

THE CLINICAL SYNDROME

Meralgia paresthetica is caused by compression of the lateral femoral cutaneous nerve by the inguinal ligament. This entrapment neuropathy presents as pain, numbness, and dysesthesias in the distribution of the lateral femoral cutaneous nerve. These symptoms often begin as a burning pain in the lateral thigh with associated cutaneous sensitivity. Patients suffering from meralgia paresthetica note that sitting, squatting, or wearing wide belts that compress that lateral femoral cutaneous nerve will cause the symptoms of meralgia paresthetica to worsen. Although traumatic lesion to the lateral femoral cutaneous nerve have been implicated in the onset of meralgia paresthetica, in most patients, no obvious antecedent trauma can be identified.

Obesity and wearing of wide belts may cause compression of the lateral femoral cutaneous nerve and cause meralgia paresthetica.

SIGNS AND SYMPTOMS

Physical findings include tenderness over the lateral femoral cutaneous nerve at the origin of the inguinal ligament at the anterior superior iliac spine. A positive Tinel’s sign over the lateral femoral cutaneous nerve as it passes beneath the inguinal ligament may be present. Careful sensory examination of the lateral thigh will reveal a sensory deficit in the distribution of the lateral femoral cutaneous nerve. No motor deficit should be present. Sitting or the wearing of tight waistbands or wide belts that compress the lateral femoral cutaneous nerve may exacerbate the symptoms of meralgia paresthetica.

TREATMENT

The patient suffering from meralgia paresthetica should be instructed in avoidance techniques to help reduce the unpleasant symptoms and pain associated with this entrapment neuropathy. A short course of nonsteroidal anti-inflammatory drugs, or cyclooxygenase-2 inhibitors is a reasonable first step in the treatment of patients suffering from meralgia paresthetica. If the patient does not experience rapid improvement, the following injection technique is a reasonable next step.

To treat the pain of meralgia paresthetica, the patient is placed in the supine position with a pillow under the knees if lying with the legs extended increases the patient’s pain due to traction on the nerve.

Meralgia paresthetica is a common pain complaint encountered in clinical practice. It is often misdiagnosed as lumbar radiculopathy. The described nerve block is a simple technique that can produce dramatic relief for patients suffering form meralgia paresthetica.

If a patient presents with pain suggestive of lateral femoral cutaneous neuralgia and does not respond to lateral femoral cutaneous neuralgia and does not respond to lateral femoral cutaneous neuralgia and does not respond to lateral femoral cutaneous nerve blocks, a diagnosis of lesions more proximal in the lumbar plexus or an L2-3 radiculopathy should be considered. Such patients will often respond to epidural steroid blocks.

Correct needle placement for injection of the femoral cutaneous nerve to treat meralgia paresthetica.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.