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Chakravorty A, Jaeger M. Surgical anatomy of the lateral femoral cutaneous nerve for meralgia paraesthetica: A simple technical guide for surgeons and trainees alike. J Clin Neurosci 2022; 101:52-56. [PMID: 35533612 DOI: 10.1016/j.jocn.2022.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/20/2022] [Accepted: 04/28/2022] [Indexed: 11/19/2022]
Abstract
Meralgia paraesthetica is an entrapment neuropathy of the lateral femoral cutaneous nerve, usually due to compression at the inguinal ligament as the nerve passes from the pelvis into the thigh. Surgical decompression of the lateral femoral cutaneous nerve is a simple and effective treatment option, but the surgical anatomy of the area is not always familiar to neurosurgeons and neurosurgical trainees alike. This paper is a simple review of the relevant surgical anatomy and the surgical steps of lateral femoral cutaneous nerve decompression, with the aim of providing the busy surgeon and trainee a quick and easy reference guide to the procedure.
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Affiliation(s)
- Ananya Chakravorty
- Department of Neurosurgery, Wollongong Hospital, Wollongong, NSW, Australia; Department of Medicine, University of New South Wales, Sydney, Australia.
| | - Matthias Jaeger
- Department of Neurosurgery, Wollongong Hospital, Wollongong, NSW, Australia; Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia; Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia
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Schwaiger K, Pumberger P, Wimbauer J, Russe E, Schaffler G, Wechselberger G. [Decompression of the lateral femoral cutaneous nerve of the thigh : Treatment of meralgia paresthetica]. Oper Orthop Traumatol 2021. [PMID: 34739548 DOI: 10.1007/s00064-021-00747-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/18/2020] [Accepted: 04/27/2020] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Treatment of non-responding pain to conservative treatment located at the anterolateral thigh with surgical decompression of the lateral femoral cutaneous nerve of the thigh (LFCN). INDICATIONS Compression syndrome of the LFCN; patients suffering from the following symptoms: pain (dysesthesia), numbness (paresthesia), hypersensibility to temperature (or temperature changes) along the course of the LFCN located at the anterolateral thigh. CONTRAINDICATIONS A new or recrudescent hernia with additional pain or recent laparoscopic hernia repair as a supposed iatrogenically induced compression of the LFCN. SURGICAL TECHNIQUE Dissection and release of the LFCN of connective tissue, scar tissue, bone rims, and retraction located along the passage underneath the inguinal ligament and distally. POSTOPERATIVE MANAGEMENT Suture removal after 10-14 days, no sports for 2 weeks. Physiotherapy if necessary. Neurography 4 months after surgery (obligatory if symptoms are persistent). The patient should be followed up for about 24 months. RESULTS Of the patients, 69% had a history of trauma or surgery, which were designated as the onset of pain. Of these patients, 78% had hip prostheses and 22% had previous falls. Postoperatively, a significant reduction of pain of 6.6 points on the numeric rating scale was observed. All other evaluated parameters also improved postoperatively. Patient satisfaction was high, with 86% reporting complete satisfaction, and 14% reporting partial satisfaction.
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Marinelli L, Mori L, Avanti C, Cotellessa F, Fabbri S, Schenone C, Trompetto C. Meralgia Paraesthetica after Prone Position Ventilation in a Patient with COVID-19. Eur J Case Rep Intern Med 2020; 7:002039. [PMID: 33313017 PMCID: PMC7727637 DOI: 10.12890/2020_002039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 10/07/2020] [Indexed: 11/05/2022] Open
Abstract
Background and objectives One of the most feared complications of COVID-19 is respiratory failure caused by acute respiratory distress syndrome. In order to improve oxygenation and survival, patients admitted to intensive care units and intubated may undergo prone position mechanical ventilation. Prolonged prone positioning may cause meralgia paraesthetica due to lateral femoral cutaneous nerve entrapment between the inguinal ligament and the anterior superior iliac spine. Reports of the first two cases have been recently published. Case presentation We describe the case of a 52-year-old man with respiratory failure during COVID-19 infection, who underwent prone position ventilation for 16 hours a day over 19 days and developed persistent burning pain and dysaesthesia on the lateral surface of the thigh bilaterally, diagnosed as meralgia paraesthetica. Conclusion This is the second report describing meralgia paraesthetica following prone position ventilation in COVID-19. Given the ongoing pandemic and the inevitability of more patients with severe respiratory distress requiring prone position ventilation, this disabling entrapment condition should be considered and possibly prevented. LEARNING POINTS
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Affiliation(s)
- Lucio Marinelli
- Division of Clinical Neurophysiology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Neuroscience (DINOGMI), University of Genoa, Genova, Italy
| | - Laura Mori
- Department of Neuroscience (DINOGMI), University of Genoa, Genova, Italy.,Division of Neurorehabilitation, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Avanti
- Department of Neuroscience (DINOGMI), University of Genoa, Genova, Italy.,Division of Neurorehabilitation, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Filippo Cotellessa
- Department of Neuroscience (DINOGMI), University of Genoa, Genova, Italy.,Division of Neurorehabilitation, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Sabrina Fabbri
- Neurology Unit, P.A. Micone Hospital, ASL3 Genovese, Genova, Italy
| | - Cristina Schenone
- Department of Neuroscience (DINOGMI), University of Genoa, Genova, Italy.,Division of Neurorehabilitation, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Carlo Trompetto
- Department of Neuroscience (DINOGMI), University of Genoa, Genova, Italy.,Division of Neurorehabilitation, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Puentes Gutiérrez AB, García Bascones M, Puentes Gutiérrez R, Díaz Jiménez M. [Subcutaneous botulinum toxin in the treatment of peripheral neuropathic pain]. Rehabilitacion (Madr) 2019; 53:131-135. [PMID: 31186096 DOI: 10.1016/j.rh.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 09/24/2018] [Accepted: 12/27/2018] [Indexed: 06/09/2023]
Abstract
Neuropathic pain impairs quality of life in affected individuals and poses a challenge to clinicians due to the complexity of its treatment and frequent therapeutic failures. We present 4clinical cases of chronic neuropathic pain (LANSS ≥ 19), refractory to conservative treatment (meralgia paraesthetica, post-surgical pain and 2surgical scars). Subcutaneous botulinum toxin type A was infiltrated periodically over the painful area. All patients experienced subjective improvement in pain and improvement measured by the visual analogic scale. Pain relief started at 5-21 days and continued up to 1.5-3 months, and up to 9 months in one patient. Pain that reappeared was of lower intensity in 3patients and was reduced in area in 2patients.
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Affiliation(s)
| | - M García Bascones
- Servicio de Rehabilitación, Hospital Virgen de la Salud, Toledo, España
| | | | - M Díaz Jiménez
- Servicio de Rehabilitación, Hospital Virgen de la Salud, Toledo, España
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Zeliha Karaahmet O, Gurcay E, Ozturk D, Guzel S, Cakci A. A rare presentation of meralgia paraesthetica in limb girdle muscular dystrophy. Scott Med J 2017; 63:25-27. [PMID: 28480792 DOI: 10.1177/0036933017707162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 44-year-old female with paraesthesia and pain on the left anterolateral thigh who had been diagnosed with limb-girdle muscular dystrophy by electromyography and muscle biopsy is presented. Neurological examination revealed atrophy of the proximal muscles of both shoulders, plus pseudo hypertrophy of both calves. Electromyography exhibited a myopathic pattern. Musculoskeletal ultrasound imaging demonstrated a fusiform nerve swelling below the inguinal ligament suggesting lateral femoral cutaneous nerve compression, consistent with meralgia paraesthetica. Treatment with a perineural injection of betamethasone dipropionate and betamethasone sodium phosphate combination, and prilocaine-HCl, under ultrasound guidance, was performed. Symptoms resolved within 6 h. At 3-week follow-up, the patient was asymptomatic, and there was no paraesthesia or pain on examination. In this case, ultrasound-guided perineural injection of the lateral femoral cutaneous nerve with local anaesthetics and steroid served both diagnostic and therapeutic functions.
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Affiliation(s)
- Ozgur Zeliha Karaahmet
- Medical Doctor (MD), Department of Physical Medicine and Rehabilitation, Diskapi Yildirim Beyazit Education and Research Hospital, Turkey
| | - Eda Gurcay
- Medical Doctor (MD), Department of Physical Medicine and Rehabilitation, Diskapi Yildirim Beyazit Education and Research Hospital, Turkey
| | - Duygu Ozturk
- Medical Doctor (MD), Department of Physical Medicine and Rehabilitation, Diskapi Yildirim Beyazit Education and Research Hospital, Turkey
| | - Sukran Guzel
- Medical Doctor (MD), Department of Physical Medicine and Rehabilitation, Diskapi Yildirim Beyazit Education and Research Hospital, Turkey
| | - Aytul Cakci
- Medical Doctor (MD), Department of Physical Medicine and Rehabilitation, Diskapi Yildirim Beyazit Education and Research Hospital, Turkey
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Klauser AS, Abd Ellah MMH, Halpern EJ, Sporer I, Martinoli C, Tagliafico A, Sojer M, Taljanovic MS, Jaschke WR. Meralgia paraesthetica: Ultrasound-guided injection at multiple levels with 12-month follow-up. Eur Radiol 2015; 26:764-70. [PMID: 26093463 DOI: 10.1007/s00330-015-3874-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/02/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the efficacy of ultrasound (US)-guided injections around the lateral femoral cutaneous nerve (LFCN) at different levels in meralgia paraesthetica (MP) patients. METHODS The study was approved by the university ethics committee and informed oral and written consent were obtained from all patients. Between June 2008 and August 2013, 20 patients with symptoms of MP, including nine men (mean age, 61.33 years) and 11 women (mean age 61.18 years), were treated with US-guided injection of steroids along the LFCN at three different levels in a mean of 2.25 sessions. A visual analogue scale (VAS) was used to measure symptoms before, immediately after and 12 months after treatment. RESULTS Complete resolution of symptoms was documented in 15/20 patients (mean VAS decreased from 82 to 0), and partial resolution in the remaining five (mean VAS decreased from 92 to 42), which was confirmed at 12-month follow-up. By using the different levels of injection approach overall significantly better symptom relief was obtained (p < 0.05). CONCLUSION The outcome of US-guided injection along the LFCN can be further improved by injections at different levels (p < 0.05), which was confirmed at 12-month long-term follow-up. KEY POINTS Meralgia paraesthetica is an entrapment neuropathy of the lateral femoral cutaneous nerve. Ultrasound proved effective in diagnosis and in guiding injection therapy. Injection at the anterior superior iliac spine has been used previously. Multiple injections along the nerve course were used in this study. Long-term follow-up (12 months) confirmed the results.
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Affiliation(s)
- Andrea S Klauser
- Diagnostic Radiology Department, Medical University Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Mohamed M H Abd Ellah
- Diagnostic Radiology Department, Medical University Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria.
- Diagnostic Radiology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
| | - Ethan J Halpern
- Departments of Radiology and Urology, Jefferson Prostate Diagnostic Center and Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Isabella Sporer
- Diagnostic Radiology Department, Medical University Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Carlo Martinoli
- Cattedra "R" di Radiologia-DIMI, Università di Genova, Largo Rosanna Benzi 8, 16132, Genoa, Italy
| | - Alberto Tagliafico
- Dipartimento di Medicina Sperimentale (DIMES), Università degli Studi di Genova, Genoa, Italy
| | - Martin Sojer
- Neurology Department, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Mihra S Taljanovic
- Department of Radiology, The University of Arizona Health Network, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA
| | - Werner R Jaschke
- Diagnostic Radiology Department, Medical University Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
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