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de Ruiter GCW, Oosterhuis JWA, Vissers TFH, Kloet A. Unusual causes for meralgia paresthetica: systematic review of the literature and single center experience. Neurosurg Rev 2023; 46:107. [PMID: 37148363 PMCID: PMC10162905 DOI: 10.1007/s10143-023-02023-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/06/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
Meralgia paresthetica is often idiopathic, but sometimes symptoms may be caused by traumatic injury to the lateral femoral cutaneous nerve (LFCN) or compression of this nerve by a mass lesion. In this article the literature is reviewed on unusual causes for meralgia paresthetica, including different types of traumatic injury and compression of the LFCN by mass lesions. In addition, the experience from our center with the surgical treatment of unusual causes of meralgia paresthetica is presented. A PubMed search was performed on unusual causes for meralgia paresthetica. Specific attention was paid to factors that may have predisposed to LFCN injury and clues that may have pointed at a mass lesion. Moreover, our own database on all surgically treated cases of meralgia paresthetica between April 2014 and September 2022 was reviewed to identify unusual causes for meralgia paresthetica. A total of 66 articles was identified that reported results on unusual causes for meralgia paresthetica: 37 on traumatic injuries of the LFCN and 29 on compression of the LFCN by mass lesions. Most frequent cause of traumatic injury in the literature was iatrogenic, including different procedures around the anterior superior iliac spine, intra-abdominal procedures and positioning for surgery. In our own surgical database of 187 cases, there were 14 cases of traumatic LFCN injury and 4 cases in which symptoms were related to a mass lesion. It is important to consider traumatic causes or compression by a mass lesion in patients that present with meralgia paresthetica.
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Affiliation(s)
- G C W de Ruiter
- Department of Neurosurgery, Haaglanden Medical Center, Lijnbaan 32, 2501, CK, The Hague, The Netherlands.
| | - J W A Oosterhuis
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Th F H Vissers
- Medical Library, Haaglanden Medical Center, The Hague, The Netherlands
| | - A Kloet
- Department of Neurosurgery, Haaglanden Medical Center, Lijnbaan 32, 2501, CK, The Hague, The Netherlands
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Solomons JNT, Sagir A, Yazdi C. Meralgia Paresthetica. Curr Pain Headache Rep 2022; 26:525-531. [PMID: 35622311 DOI: 10.1007/s11916-022-01053-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW This review article summaries the epidemiology, etiology, clinical presentations, and latest treatment modalities of meralgia paresthetica, including the latest data about peripheral and spinal cord stimulation therapy. Meralgia paresthetica (MP) causes burning, stinging, or numbness in the anterolateral part of the thigh, usually due to compression of the lateral femoral cutaneous nerve (LFCN). RECENT FINDINGS There are emerging data regarding the benefit of interventional pain procedures, including steroid injection and radiofrequency ablation, and other interventions including spinal cord and peripheral nerve stimulation reserved for refractory cases. The strength of evidence for treatment choices in meralgia paraesthetica is weak. Some observational studies are comparing local injection of corticosteroid versus surgical interventions. However, more extensive studies are needed regarding the long-term benefit of peripheral and spinal cord stimulation therapy.
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Affiliation(s)
| | - Afrin Sagir
- Beth Israel Deaconess Medical Center, Brookline, MA, USA
| | - Cyrus Yazdi
- Beth Israel Deaconess Medical Center, Brookline, MA, USA.
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Moy WL. A cook with 'burning in the thigh' and a 'hotspot' in the groin! Oxf Med Case Reports 2021; 2021:omab112. [PMID: 34858626 PMCID: PMC8633630 DOI: 10.1093/omcr/omab112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/19/2021] [Accepted: 10/14/2021] [Indexed: 11/12/2022] Open
Abstract
Meralgia paresthetica (MP) is a condition characterised by abnormal sensations on the anterolateral aspect of the thigh due to the dysfunction of the lateral femoral cutaneous nerve. Here, I present a case of a 64-year-old female cook who attended the General Medicine clinic with 2 months of persistent numbness and 'burning' sensation over the right anterolateral thigh. Subsequent physical examination revealed the diagnosis of meralgia paresthetica. The significance of good history taking and thorough physical examination in reaching the diagnosis of meralgia paresthetica cannot be overemphasized. In most typical presentations, advanced imaging and neurodiagnostic testing do not add value to confirm the diagnosis. If the clinical diagnosis is doubtful, nerve conduction study and magnetic resonance imaging may still be performed to exclude other mimicking pathologies. Increasing awareness of MP among doctors unfamiliar with this condition will prevent the ordering of excessive investigations.
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Affiliation(s)
- Wai Lun Moy
- Department of General Medicine, Sengkang General Hospital, Singapore
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Ng E, Ekladious A, Gahlot P. Horses or zebras: a delayed diagnosis of meralgia paraesthetica. BMJ Case Rep 2018; 2018:bcr-2018-226905. [DOI: 10.1136/bcr-2018-226905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kang KN, Rhyu CJ, Chon SW, Choi YS, Yoo JI, Lim YS, Bang YS, Kim YU. Concurrent meralgia paresthetica and radiculopathy of the left leg -A case report-. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.1.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Korea
| | - Chang Joon Rhyu
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Korea
| | - Sung Won Chon
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Korea
| | - Young-Soon Choi
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University of Korea, Incheon, Korea
| | - Jee In Yoo
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University of Korea, Incheon, Korea
| | - Young Su Lim
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University of Korea, Incheon, Korea
| | - Yun-Sic Bang
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University of Korea, Incheon, Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University of Korea, Incheon, Korea
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Son BC, Kim DR, Kim IS, Hong JT, Sung JH, Lee SW. Neurolysis for meralgia paresthetica. J Korean Neurosurg Soc 2012; 51:363-6. [PMID: 22949966 PMCID: PMC3424177 DOI: 10.3340/jkns.2012.51.6.363] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 04/09/2012] [Accepted: 06/13/2012] [Indexed: 11/30/2022] Open
Abstract
Objective Meralgia paresthetica (MP) is a syndrome of pain and/or dysesthesia in the anterolateral thigh that is caused by an entrapment of the lateral femoral cutaneous nerve (LFCN) at its pelvic exit. Despite early accounts of MP, there is still no consensus concerning the effectiveness of neurolysis or transaction treatments in the long-term relief for medically refractory patients with MP. We retrospectively analyzed available long-term results of LFCN neurolysis for medically refractory MP in an effort to clarify this issue. Methods During the last 7 years, 11 patients who had neurolysis for MP were enrolled in this study. Nerve entrapment was confirmed preoperatively by electrophysiological studies or a positive response to local anesthetic injection. Decompression of the LFCN was performed at the level of the iliac fascia, inguinal ligament, and fascia of the thigh distally. The outcome of surgery was assessed 8 weeks after the procedure followed at regular intervals if symptoms persisted. Results Twelve decompression procedures were performed in 11 patients over a 7-year period. The average duration of symptoms was 8.5 months (range, 4-15 months). The average follow-up period was 33 months (range, 12-60 months). Complete and partial symptom improvement were noted in nine (81.8%) and two (18.2%) cases, respectively. No recurrence was reported. Conclusion Neurolysis of the LFCN can provide adequate pain relief with minimal complications for medically refractory MP. To achieve a good outcome in neurolysis for MP, an accurate diagnosis with careful examination and repeated blocks of the LFCN, along with electrodiagnosis seems to be essential. Possible variation in the course of the LFCN and thorough decompression along the course of the LFCN should be kept in mind in planning decompression surgery for MP.
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Affiliation(s)
- Byung-Chul Son
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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Harney D, Patijn J. Meralgia Paresthetica: Diagnosis and Management Strategies. PAIN MEDICINE 2007; 8:669-77. [DOI: 10.1111/j.1526-4637.2006.00227.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Moucharafieh R, Wehbe J, Maalouf G. Meralgia paresthetica: a result of tight new trendy low cut trousers ('taille basse'). Int J Surg 2007; 6:164-8. [PMID: 17521975 DOI: 10.1016/j.ijsu.2007.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Revised: 04/02/2007] [Accepted: 04/09/2007] [Indexed: 11/26/2022]
Abstract
Meralgia paresthetica is an entrapment neuropathy involving the lateral femoral cutaneous nerve of the thigh. Patients complain of a persistent burning sensation, tingling and aching pain, and hypersensitivity or hyposensitivity in the anterolateral aspect of the thigh. Numerous direct and indirect causes for the disease have been suggested in the literature. We present 12 cases that were diagnosed to have meralgia paresthetica due to tight new fashion low cut trousers ('taille basse'). The diagnosis was confirmed by injecting a small amount of a short acting local anesthetic around the lateral femoral cutaneous nerve which alleviated the symptoms for several hours. Electrophysiologic studies were sensitive in 83.3% of the cases. All cases were treated successfully using conservative methods, namely avoiding tight trousers, local steroid infiltration and weight reduction.
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Affiliation(s)
- Ramzi Moucharafieh
- Hand and Microvascular Surgery, Saint George University Hospital, Beirut, Lebanon.
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Atamaz F, Hepgüler S, Karasu Z, Kilic M. Meralgia paresthetica after liver transplantation: a case report. Transplant Proc 2006; 37:4424-5. [PMID: 16387136 DOI: 10.1016/j.transproceed.2005.11.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The focal neuropathies after orthotropic liver transplantation (OLTx) have been well documented to date. Most injuries to the peripheral nervous system involve the peroneal nerve and brachial plexus. We report the first case of lateral femoral cutaneous nerve (LFCN) injury after OLTx. The patient presented with pain and numbness on the lateral aspect of the right thigh that had progressively worsened since operation. Electrodiagnostic studies were indicative for right meralgia paresthetica (MP). The symptoms of MP improved progressively after physical therapy applications during the first 3 months. The etiology of MP in this case is unclear. However, it may be considered that ascites, surgical mechanisms, and immunosuppressive therapy were possible causative factors.
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Affiliation(s)
- F Atamaz
- Department of Physical Therapy and Rehabilitation, Ege University Medical School, Izmir, Turkey.
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Ulkar B, Yildiz Y, Kunduracioğlu B. Meralgia paresthetica: a long-standing performance-limiting cause of anterior thigh pain in a soccer player. Am J Sports Med 2003; 31:787-9. [PMID: 12975204 DOI: 10.1177/03635465030310052601] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Bülent Ulkar
- Department of Sports Medicine, Ankara University Medical School, Ankara, Turkey
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Abstract
OBJECTIVE Meralgia paresthetica is a syndrome of pain or dysesthesia or both in the anterolateral thigh, caused by entrapment of the lateral femoral cutaneous nerve at the anterior superior iliac spine. The aim of this report is to emphasize that meralgia paresthetica can be confused with low-back pain. PATIENT A 21-year-old man was admitted to hospital because of low-back and thigh pain. He had a history of low-back pain. Physical examination and radiologic studies for low-back pain and radiculopathy showed no pathologic findings. It was suspected that the most likely cause was lateral femoral cutaneous neuropathy, caused by the wide military belt he continuously wore tightly around his waist. INTERVENTIONS The nerve was blocked with 10 ml of bupivacaine 0.25%, which provided immediate pain relief. A nonsteroidal anti-inflammatory drug was administered orally. RESULTS After 15 days of bed rest and 45 days without the belt, he was completely symptom-free. CONCLUSIONS It is important to be rigorous in investigating the etiology of low-back pain. Meralgia paresthetica can mimic low-back pain because of the similarity of the symptoms. It can be treated by conservative or ablative therapeutic interventions; however, conservative methods should be considered primarily.
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Affiliation(s)
- Hakan Erbay
- Medical Faculty, Anesthesiology and Reanimation Department, Pamukkale University, Denizli, Turkey.
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Cherny NI. Cancer Pain Syndromes in Colorectal and Anal Cancers. COLORECTAL CANCER 2002. [DOI: 10.1007/978-1-59259-160-2_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Yamamoto T, Nagira K, Kurosaka M. Meralgia paresthetica occurring 40 years after iliac bone graft harvesting: case report. Neurosurgery 2001; 49:1455-7. [PMID: 11846947 DOI: 10.1097/00006123-200112000-00028] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2001] [Accepted: 07/09/2001] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Meralgia paresthetica is an entrapment neuropathy involving the lateral femoral cutaneous nerve. We describe an unusual case in which meralgia paresthetica occurred many years after iliac bone graft harvesting. CLINICAL PRESENTATION An 81-year-old man presented with a 1-year history of pain, dysesthesia, and hypesthesia in the anterolateral aspect of the right thigh. This patient had undergone iliac bone grafting when he sustained a calcaneal fracture 40 years previously. Radiographs and computed tomographic scans of the pelvis revealed a bony excrescence in the anterosuperior iliac spine. INTERVENTION The patient underwent neurolysis of the lateral femoral cutaneous nerve and excision of the bony excrescence. At surgery, the nerve was densely adherent to the bony excrescence. CONCLUSION The etiology of meralgia paresthetica in this patient is considered to be heterotopic ossification on the anterosuperior iliac spine and pubic symphysis degeneration. A significant relationship between pubic symphysis degeneration with increasing age and meralgia paresthetica has been reported. One should be aware of meralgia paresthetica as a late complication of iliac bone graft harvesting.
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Affiliation(s)
- T Yamamoto
- Department of Orthopaedic Surgery, Kobe University School of Medicine, Kobe, Japan.
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Abstract
Meralgia paresthetica is a symptom complex that includes numbness, paresthesias, and pain in the anterolateral thigh, which may result from either an entrapment neuropathy or a neuroma of the lateral femoral cutaneous nerve (LFCN). The condition can be differentiated from other neurologic disorders by the typical exacerbating factors and the characteristic distribution of symptoms. The disease process can be either spontaneous or iatrogenic. The spontaneous form is usually mechanical in origin. The LFCN is subject to compression throughout its entire course. Injuries most commonly occur as the nerve exits the pelvis. The regional anatomy of the LFCN is highly varied and may account for its susceptibility to local trauma. Relief of pain and paresthesias after injection of a local anesthetic agent is helpful in establishing the diagnosis. If no improvement is found, proximal LFCN irritation should be sought. Idiopathic meralgia paresthetica usually improves with nonoperative modalities, such as removal of compressive agents, nonsteroidal anti-inflammatory drugs, and, if necessary, local corticosteroid injections. If intractable pain persists despite such measures, surgery can be considered, although whether neurolysis or transection is the procedure of choice is still controversial. Iatrogenic meralgia paresthetica has been found to occur after a number of orthopaedic procedures, such as anterior iliac-crest bone-graft harvesting and anterior pelvic procedures. Prone positioning for spine surgery has also been implicated. Variations in the anatomy of the LFCN about the anterior superior iliac spine may place the nerve at higher risk for damage. Although nonoperative management usually results in satisfactory results, efforts should be made to avoid injury at the time of surgery.
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Affiliation(s)
- M G Grossman
- Kerlan-Jobe Orthopedic Institute, Suite 125, 6801 Park Terrace, Los Angeles, CA 90045, USA
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Ghavanini MR, Ghavanini AA. Meralgia paresthetica as the presenting feature of chronic appendicitis. Am J Phys Med Rehabil 2001; 80:703-5. [PMID: 11523973 DOI: 10.1097/00002060-200109000-00012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Meralgia paresthetica is an entrapment syndrome of the lateral cutaneous nerve of the thigh manifesting as paresthesia, pain, numbness, or sensory loss in the distribution of the nerve. A variety of causes have been described; however, the etiology often remains unknown. On the basis of our investigations with a patient with meralgia paresthetica, we determined that an inflammatory rather than mechanical effect on the lateral cutaneous nerve of the thigh may account for the pathogenesis; however, a certain conclusion about this issue can not be made.
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Affiliation(s)
- M R Ghavanini
- Department of Physical Medicine and Rehabilitation and the Center for Research Consultation, School of Medicine, Shiraz University of Medical Sciences, Iran
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Affiliation(s)
- R Kanner
- Albert Einstein College of Medicine and Department of Neurology, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
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Abstract
The authors present a 15-year-boy with meralgia paresthetica caused by the recurrence of a diffuse congenital hemangiomatosis in the pelvic region. Relief of the patient's symptoms was achieved by neurolysis of the lateral femoral cutaneous nerve in the thigh and partial excision of the tumor. To our knowledge, hemangiomatosis has never been suggested as a cause of meralgia paresthetica.
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Affiliation(s)
- T Yamamoto
- Department of Orthopaedic Surgery, Kobe University, Kobe, Japan
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Abstract
This article addresses the proximal sensory neuropathies of the leg, concentrating on those nerves that are purely sensory or have a predominately sensory onset. These include the lateral femoral cutaneous nerve, the ilioinguinal nerve, the genitofemoral nerve, and the posterior femoral cutaneous nerve. The obturator and femoral nerves are also summarily mentioned with respect to their sensory symptoms.
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Affiliation(s)
- V Reid
- Department of Neurology, Clinical Neurophysiology Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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