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Gross PW, Chipman DE, Nagra K, Tracey OC, Jones RH, Blanco JS, Sink EL, Scher DM, Dodwell ER, Doyle SM. Incidence of Nerve Palsies During Pavlik Harness Treatment for Developmental Dysplasia of the Hip: A Retrospective Cohort Study. J Bone Joint Surg Am 2024; 106:525-530. [PMID: 38506721 DOI: 10.2106/jbjs.23.00948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND The Pavlik harness has been used for approximately a century to treat developmental dysplasia of the hip (DDH). Femoral nerve palsy is a documented complication of Pavlik harness use, with an incidence ranging from 2.5% to 11.2%. Rare reports of brachial plexus palsy have also been documented. The primary purpose of the current study was to evaluate the incidence of various nerve palsies in patients undergoing Pavlik harness treatment for DDH. Secondary aims were to identify patient demographic or hip characteristics associated with nerve palsy. METHODS We performed a retrospective review of patients diagnosed with DDH and treated with a Pavlik harness from February 1, 2016, to April 1, 2023, at a single tertiary care orthopaedic hospital. Hip laterality, use of a subsequent rigid abduction orthosis, birth order, breech positioning, weight, and family history were collected. The median (and interquartile range [IQR]) or mean (and standard deviation [SD]) were reported for all continuous variables. Independent 2-sample t tests and Mann-Whitney U tests were conducted to identify associations between the variables collected at the initiation of Pavlik harness treatment and the occurrence of nerve palsy. RESULTS Three hundred and fifty-one patients (547 hips) were included. Twenty-two cases of femoral nerve palsy (4% of all treated hips), 1 case of inferior gluteal nerve palsy (0.18%), and 2 cases of brachial plexus palsy (0.37%) were diagnosed. Patients with nerve palsy had more severe DDH as measured by the Graf classification (p < 0.001) and more severe DDH as measured on physical examination via the Barlow and Ortolani maneuvers (p = 0.003). CONCLUSIONS Nerve palsies were associated with more severe DDH at the initiation of Pavlik harness use. Upper and lower-extremity neurological status should be scrutinized at initiation and throughout treatment to assess for nerve palsies. The potential for femoral, gluteal, and brachial plexus palsies should be included in the discussion of risks at the beginning of treatment. Families may be reassured that nerve palsies associated with Pavlik harness can be expected to resolve with a short break from treatment. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Moita Gonçalves E, Lanzaro C, Silva LC, Correia P, Gonçalves JV, Azevedo M, Carrapatoso I, Silva JP, Carvalho C, Cruz A. Enhancing functional recovery following postpartum femoral neuropathy: early neurorehabilitation and multidisciplinary obstetric care. Int J Gynaecol Obstet 2024; 164:830-834. [PMID: 37537869 DOI: 10.1002/ijgo.15025] [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: 02/22/2023] [Revised: 05/26/2023] [Accepted: 07/11/2023] [Indexed: 08/05/2023]
Abstract
Postpartum femoral neuropathy has a reported incidence of less than 1% and its total recovery time extends up to 6 months to a year. A multidisciplinary approach is vital to rule out permanent disability and to assure a correct diagnosis and earlier rehabilitation. We report a case of a 37-year-old puerperal woman with a history of intrapartum epidural analgesia, who presented post-labor unilateral lower-limb motor weakness and sensory loss, with functional compromise on independent gait. A multidisciplinary team consisting of an anesthesiologist, a physiatrist, a neurologist, and an obstetrician was then established. In the initial physiatry and neurology assessment, the patient reported pain (numerical rating scale 7/10) over the inguinal ligament, lower limb hypoesthesia, and muscle weakness. Femoral neuropathy was suspected. Magnetic resonance imaging ruled out potential complications related to the anesthetic procedure. The patient was then enrolled in a supervised rehabilitation program and, 3 weeks later, electrodiagnostic studies confirmed the initial suspicion. Two months later, the patient had regained lower-limb active range of motion and no pain nor paresthesia was reported. Our case report describes how an early multimodal rehabilitation program within a multidisciplinary framework allows for sooner neuromotor function improvement and activities of daily living independence.
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Affiliation(s)
- Eugénio Moita Gonçalves
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Vila Nova de Gaia-Espinho, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Egas Moniz Health Alliance Clinical Academic Center, Aveiro, Portugal
| | - Camile Lanzaro
- Anesthesiology Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - Luísa Cunha Silva
- Gynecology and Obstetrics Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - Pedro Correia
- Neurology Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - José Vítor Gonçalves
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Vila Nova de Gaia-Espinho, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marta Azevedo
- Physical Medicine and Rehabilitation Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - Inês Carrapatoso
- Anesthesiology Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - João Pedro Silva
- Gynecology and Obstetrics Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - Carolina Carvalho
- Physical Medicine and Rehabilitation Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - André Cruz
- Physical Medicine and Rehabilitation Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
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Pearson L, Schmelzer V, Maye J, Zhang SJ. Lateral Femoral Cutaneous Nerve Cryoneurolysis for Meralgia Paresthetica: A Case Report. AANA J 2024; 92:35-39. [PMID: 38289685] [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] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Meralgia paresthetica (MP) is a disorder of lateral femoral cutaneous nerve mononeuropathy caused by entrapment or compression of the nerve. It is characterized by numbing, tingling, and burning pain in the lateral aspect of the thigh. The current treatments for MP include conventional medical management, peripheral nerve blocks, and surgical interventions. Some patients who suffer from MP can experience intractable pain and medical management of MP is often inadequate to provide satisfactory pain control. Although regional anesthesia provides excellent pain relief, the analgesic effects of peripheral nerve block are short-lived. Emerging evidence suggests that cryoneurolysis has a low-risk safety profile and can provide prolonged pain relief of superficial nerves when administered appropriately. We present a successful case of a patient with intractable neuropathic pain resulting from MP treated with cryoneurolysis therapy. The patient demonstrated immediate pain relief by 100% after the procedure followed by 80% and 60% pain reduction at 1-month and 3-months follow-up, respectively. Cryoneurolysis may be an alternative modality for patients who fail at conventional medical treatments of neuropathic pain.
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Affiliation(s)
- Lisa Pearson
- is the President of Metamorphosis Pain Management, Colorado Springs, Colorado; adjunct faculty in the Advanced Pain Management Fellowship at the University of South Florida, Tampa, Florida and Texas Christian University, Fort Worth, Texas. E-mail:
| | - Victoria Schmelzer
- is the Chief Clinical Officer at Elevation Anesthesia and Director of Anesthesia at Southern Coos Hospital and Health Center, Bandon, Oregon.
| | - John Maye
- is a Professor and Program Director for the Advanced Pain Management Fellowship Program, University of South Florida, Tampa, Florida.
| | - Sarah Jingying Zhang
- is an Associate Professor at the Nurse Anesthesiology Program, College of Nursing, University of South Florida, Tampa, Florida; Adjunct Associate Professor at Samuel Merritt University, Oakland, California; and Adjunct Assistant Professor at University of California, San Francisco, San Francisco, California. E-mail:
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Chalk C, Zaloum A. Femoral and obturator neuropathies. Handb Clin Neurol 2024; 201:183-194. [PMID: 38697739 DOI: 10.1016/b978-0-323-90108-6.00007-7] [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] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
The femoral and obturator nerves both arise from the L2, L3, and L4 spinal nerve roots and descend into the pelvis before emerging in the lower limbs. The femoral nerve's primary function is knee extension and hip flexion, along with some sensory innervation to the leg. The obturator nerve's primary function is thigh adduction and sensory innervation to a small area of the medial thigh. Each may be injured by a variety of potential causes, many of them iatrogenic. Here, we review the anatomy of the femoral and obturator nerves and the clinical features and potential etiologies of femoral and obturator neuropathies. Their necessary investigations, including electrodiagnostic studies and imaging, their prognosis, and potential treatments, are discussed in this chapter.
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Affiliation(s)
- Colin Chalk
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Austin Zaloum
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.
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Aggarwal A. Comments on the Role of Ultrasound-Guided Injection in the Management of Meralgia Paresthetica. Pain Physician 2020; 23:E731-E732. [PMID: 33185392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Aakanksha Aggarwal
- Department of Anaesthesiology, Sanjay Gan¬dhi Post Graduate Institute of Medical Sciences, Lucknow,India
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Schwaiger K, Panzenbeck P, Purschke M, Russe E, Kaplan R, Heinrich K, Mandal P, Wechselberger G. Surgical decompression of the lateral femoral cutaneous nerve (LFCN) for Meralgia paresthetica treatment: Experimental or state of the art? A single-center outcome analysis. Medicine (Baltimore) 2018; 97:e11914. [PMID: 30113491 PMCID: PMC6113044 DOI: 10.1097/md.0000000000011914] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Meralgia paresthetica (MP) is a rare lateral femoral cutaneous nerve-(LFCN)-mononeuropathy. Treatment for this disorder includes conservative and operative approaches; the latter is considered if conservative therapy fails. The most commonly used surgical approaches are decompression/neurolysis and avulsion/neurectomy. However, there are no definitive guidelines on the optimal surgical approach to be used. The purpose of this study was to evaluate the outcome of surgical decompression of the LFCN for the treatment of persistent MP with preservation of sensation along the distribution of the LFCN.We evaluated the outcomes of LFCN procedures performed between 2015 and 2016. A total of 16 surgical decompressions could be identified. Retrospective analysis of prospectively collected patient data was performed, as well as systematic evaluation of the postoperative course, with regular follow-up examinations based on a standardized protocol. Pain was analyzed using an NRS (numeric rating scale). Several postsurgical parameters, including temperature hypersensitivity and numbness in the LFCN region, were compared with the presurgical data.Sixty-nine percent of patients had histories of trauma or surgery, which were designated as the onset of pain. Of these patients, 78% had hip prostheses, 2 had previous falls. Postoperatively, a significant reduction of 6.6 points in the mean NRS pain value was observed. All other evaluated parameters also improved postoperatively. Patient satisfaction was high, with 86% reporting complete satisfaction, and 14% reporting partial satisfaction.Previous studies favor either avulsion/neurectomy as the preferred procedure for MP treatment, or provide no recommendation. Our findings instead confirm the decompression/neurolysis approach as the primary surgical procedure of choice for the treatment of MP, if conservative treatment fails.
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Affiliation(s)
- Karl Schwaiger
- Hospital of St. John of God (Barmherzige Brüder) Salzburg, Department of Plastic, Aesthetic and Reconstructive Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Paul Panzenbeck
- Hospital of St. John of God (Barmherzige Brüder) Salzburg, Department of Plastic, Aesthetic and Reconstructive Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Martin Purschke
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Elisabeth Russe
- Hospital of St. John of God (Barmherzige Brüder) Salzburg, Department of Plastic, Aesthetic and Reconstructive Surgery, Paracelsus Medical University, Salzburg, Austria
| | | | | | | | - Gottfried Wechselberger
- Hospital of St. John of God (Barmherzige Brüder) Salzburg, Department of Plastic, Aesthetic and Reconstructive Surgery, Paracelsus Medical University, Salzburg, Austria
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Affiliation(s)
- Alexander Schuh
- Muskuloskelettales Zentrum Klinikum Neumarkt, Akademisches Lehrkrankenhaus der Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberger Str. 12, D-92318, Neumarkt i. d. OPf., Deutschland.
| | - René Handschu
- Neurologische Klinik, Kliniken des Landkreises Neumarkt i. d. OPf., Neumarkt i. d. OPf., Deutschland
| | - Thomas Eibl
- Neurologische Klinik, Kliniken des Landkreises Neumarkt i. d. OPf., Neumarkt i. d. OPf., Deutschland
| | - Michael Janka
- Muskuloskelettales Zentrum, Klinikum Neumarkt i. d. OPf., Neumarkt i. d. OPf., Deutschland
| | - Wolfgang Hönle
- Muskuloskelettales Zentrum, Klinikum Neumarkt i. d. OPf., Neumarkt i. d. OPf., Deutschland
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Jones CD, Guiot L, Portelli M, Bullen T, Skaife P. Two Interesting Cases of Meralgia Paraesthetica. Pain Physician 2017; 20:E987-E989. [PMID: 28934803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Meralgia paraesthetica (MP) is a condition originally described by Bernhardt in 1878 and was eventually named by Roth in 1895. It is caused by compression of the lateral femoral cutaneous nerve (LFCN) resulting in varying types of discomfort. Severity of the symptoms can range from mildly uncomfortable to painfully disabling. In this article we discuss 2 patients with a LFCN injury occurring as a result of laparoscopic ventral rectopexy (LVR). The first patient is a 46-year-old female who reported pain and dysesthesia in the left groin and the anterolateral thigh, 2 days post LCR. A conservative approach was taken and at the 6-month follow-up the symptoms had resolved. The second patient is a 51-year-old female who reported increased sensitivity to bed sheets over the anterolateral aspect of her left thigh, in the immediate post-operative period following LVR. She was similarly managed conservatively but her symptoms persisted. The LFCN arises from the dorsal branches of the second and third lumbar roots. It crosses the iliacus muscle deep to the fascia. Injury or entrapment to surrounding neural structures including the LFCN, commonly results following common laparoscopic procedures. In some cases, additional surgical intervention is required for successful management of the symptoms. In our patients, the MP syndrome was clearly related to the operation because symptoms appeared in the immediate post-operative period and were not present beforehand. LVR is a relatively new and evolving procedure with few reports of associated peri-operative complications.Key words: Meralgia paraesthetica, laparoscopy, rectopexy, lateral femoral cutaneous nerve.
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Affiliation(s)
| | - Luke Guiot
- Department of General Surgery, University Hospital Ayr, Ayr, Scotland
| | - Mark Portelli
- Department of General Surgery, University Hospital Ayr, Ayr, Scotland
| | - Timothy Bullen
- Department of General Surgery, Aintree University Hospital, Liverpool, England
| | - Paul Skaife
- Department of General Surgery, Aintree University Hospital, Liverpool, England
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9
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Knapik JJ, Reynolds KL, Orr R, Pope R. Load Carriage-Related Paresthesias (Part 2): Meralgia Paresthetica. J Spec Oper Med 2017; 17:94-100. [PMID: 28285487 DOI: 10.55460/6krp-71df] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 06/06/2023]
Abstract
This is the second of a two-part series addressing symptoms, evaluation, and treatment of load carriage- related paresthesias. Part 1 addressed rucksack palsy and digitalgia paresthetica; here, meralgia paresthetica (MP) is discussed. MP is a mononeuropathy involving the lateral femoral cutaneous nerve (LFCN). MP has been reported in load carriage situations where the LFCN was compressed by rucksack hipbelts, pistol belts, parachute harnesses, and body armor. In the US military, the rate of MP is 6.2 cases/10,000 personyears. Military Servicewomen have higher rates than Servicemen, and rates increase with age, longer loadcarriage distance or duration, and higher body mass index. Patients typically present with pain, itching, and paresthesia on the anterolateral aspect of the thigh. There are no motor impairments or muscle weakness, because the LFCN is entirely sensory. Symptoms may be present on standing and/or walking, and may be relieved by adopting other postures. Clinical tests to evaluate MP include the pelvic compression test, the femoral nerve neurodynamic test, and nerve blocks using lidocaine or procaine. In cases where these clinical tests do not confirm the diagnosis, specialized tests might be considered, including somatosensory evoked potentials, sensory nerve conduction studies, high-resolution ultrasound, and magnetic resonance imaging. Treatment should initially be conservative. Options include identifying and removing the compression if it is external, nonsteroidal inflammatory medication, manual therapy, and/or topical treatment with capsaicin cream. Treatments for intractable cases include injection of corticosteroids or local anesthetics, pulsed radiofrequency, electroacupuncture, and surgery. Military medical care providers may see cases of MP, especially if they are involved with units that perform regular operations involving load carriage.
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Taşdemir S, Ulaş ÜH, Yücel M, Çetiz A. Meralgia paresthetica after the fragmentation of renal stone using extracorporeal shock wave lithotripsy: a case report. Acta Neurol Belg 2016; 116:423-4. [PMID: 26661478 DOI: 10.1007/s13760-015-0574-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/21/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Serdar Taşdemir
- Department of Neurology, Gulhane Military Academy, GATA Nöroloj Etlik, Ankara, Turkey
| | - Ümit Hıdır Ulaş
- Department of Neurology, Gulhane Military Academy, GATA Nöroloj Etlik, Ankara, Turkey
| | - Mehmet Yücel
- Department of Neurology, Gulhane Military Academy, GATA Nöroloj Etlik, Ankara, Turkey.
| | - Ahmet Çetiz
- Department of Neurology, Gulhane Military Academy, GATA Nöroloj Etlik, Ankara, Turkey
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Affiliation(s)
- Samuel Arends
- Department of Neurology, Haga Hospital, The Hague, the Netherlands
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12
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Grönhagen CM, Tey HL. Sequential Localised Neuropathic Itch Following Drastic Weight Gain and Loss. Ann Acad Med Singap 2016; 45:259-260. [PMID: 27412060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Onat SS, Ata AM, Ozcakar L. Ultrasound-Guided Diagnosis and Treatment of Meralgia Paresthetica. Pain Physician 2016; 19:E667-E669. [PMID: 27228536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Meralgia paresthetica refers to the entrapment of the lateral femoral cutaneous nerve at the level of the inguinal ligament. The lateral femoral cutaneous nerve - a purely sensory nerve - arises from the L2 and L3 spinal nerve roots, travels downward lateral to the psoas muscle, and then crosses the iliacus muscle. Close to the anterior superior iliac spine, the nerve courses in contact with the lateral aspect of the inguinal ligament and eventually innervates the lateral thigh. The entrapment syndrome is usually idiopathic but can also ensue due to trauma/overuse, pelvic and retroperitoneal tumors, stretching of the nerve due to prolonged leg/trunk hyperextension, leg length discrepancies, prolonged standing, external compression by belts, weight gain, and tight clothing. The diagnosis of Meralgia paresthetica is usually clinical, i.e., based on the following symptoms: paresthesia, numbness, burning sensation, dysesthesia, and pain over the anterolateral aspects of the thigh. These complaints may be worsened by walking or prolonged standing and typically disappear after weight loss, abdominal muscle strengthening, or elimination of the underlying cause. Although there are several reports on the confirmatory role of electrodiagnostic studies in the diagnosis of Meralgia paresthetica, electromyographers would usually prefer/suggest not to perform nerve conduction studies in daily clinical practice. Herewith, due to its several advantages, ultrasound imaging has been proposed as an alternative diagnostic method in the recent literature. It not only confirms the entrapment morphologically, but also uncovers a likely underlying cause and provides immediate interventional guidance. The pertinent sonographic findings would be hypoechoic and swollen lateral femoral cutaneous nerve.
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Affiliation(s)
- Sule Sahin Onat
- Physical and Rehabilitation Medicine, Training and Research Center, Ankara, Turkey
| | - Ayse Merve Ata
- Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine
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Magaña-Reyes J, Domínguez-Gasca LG, García-Luna A, Domínguez-Carrillo LG. [Iliacus muscle injury caused by inadequate exercise]. Acta Ortop Mex 2016; 30:154-157. [PMID: 27984691] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Traumatic iliacus muscle injury is rare; it is usually caused by trauma or intense exercise involving the pelvic girdle; it can produce a hematoma with femoral nerve neuropathy. Spontaneous muscle hematomas occur in patients with coagulation disorders. CLINICAL CASE A 45-year-old male with 18 days of evolution, with an intense pain in the right buttock, groin and iliac fossa, with an inability for hip flexion and ambulation caused by inadequate exercise (supine double leg lifts). On the physical examination: intense pain with bending and/or internal rotation of the right hip, positive Thomas maneuver, quadriceps rated 3/5; area of paresthesia in the right femoral nerve territory. Pelvic magnetic resonance imaging showed: right iliacus muscle tear with blood between its fibers. Initial treatment was rest and analgesics for eight days and gradual extension of the hip, axillary crutches with partial weight bearing and diathermy on the right abdominal lower quadrant, active hip exercises, bicycle and right quadriceps strengthening. The evolution was satisfactory, with full recovery in six weeks.
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Affiliation(s)
- J Magaña-Reyes
- Departamento de Imagenología, Hospital Ángeles León, Av. Cerro Gordo Núm. 311, Jardines del Moral, León, Guanajuato, México
| | - L G Domínguez-Gasca
- Hospital General de León, Calle 20 de Enero 927, Obregón, 37320, León, Guanajuato, México
| | - A García-Luna
- Unidad de Cuidados Intensivos, Hospital Ángeles León, Av. Cerro Gordo Núm. 311, Jardines del Moral, León, Guanajuato, México
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Tomaszewski KA, Popieluszko P, Henry BM, Roy J, Sanna B, Kijek MR, Walocha JA. The surgical anatomy of the lateral femoral cutaneous nerve in the inguinal region: a meta-analysis. Hernia 2016; 20:649-57. [PMID: 27115766 PMCID: PMC5023748 DOI: 10.1007/s10029-016-1493-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/13/2016] [Indexed: 02/06/2023]
Abstract
Purpose Several variations in the anatomy and injury of the lateral femoral cutaneous nerve (LFCN) have been studied since 1885. The aim of our study was to analyze the available data on the LFCN and find a true prevalence to help in the planning and execution of surgical procedures in the area of the pelvis, namely inguinal hernia repair. Methods A search of the major medical databases was performed for LFCN anatomy. The anatomical data were collected and analyzed. Results Twenty-four studies (n = 1,720) were included. The most common pattern of the LFCN exiting the pelvis was medial to the Sartorius as a single branch. When it exited in this pattern, it did so on average 1.90 cm medial to the anterior superior iliac spine (ASIS). Conclusions The LFCN and its variations are important to consider especially during inguinal hernia repair, abdominoplasty, and iliac bone grafting. We suggest maintaining a distance of 3 cm or more from the ASIS when operating to prevent injury to the LFCN. Electronic supplementary material The online version of this article (doi:10.1007/s10029-016-1493-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K A Tomaszewski
- International Evidence-Based Anatomy Working Group, Krakow, Poland.
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland.
| | - P Popieluszko
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
| | - B M Henry
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
| | - J Roy
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
| | - B Sanna
- Faculty of Medicine and Surgery, University of Cagliari, Sardinia, Italy
| | - M R Kijek
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
| | - J A Walocha
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
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Lee JJ, Sohn JH, Choi HJ, Yang JS, Lee KH, Do HJ, Lee SH, Cho YJ. Clinical Efficacy of Pulsed Radiofrequency Neuromodulation for Intractable Meralgia Paresthetica. Pain Physician 2016; 19:173-179. [PMID: 27008291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Meralgia paresthetica (MP) is a neurologic disorder of the lateral femoral cutaneous nerve (LFCN), which is characterized by a localized area of paresthesia and numbness on the anterolateral aspect of the thigh. In most patients with MP, symptoms can be successfully managed with conservative treatment. However, in a small group of MP patients who are refractory to medical treatment, more aggressive low-risk treatment should be considered. OBJECTIVE The objective of this study was to evaluate clinical outcomes of pulsed radiofrequency (PRF) neuromodulation of the LFCN in MP patients refractory to conservative treatment. STUDY DESIGN Retrospective evaluation. METHODS We retrospectively reviewed the clinical data of 11 patients with medically intractable MP who underwent PRF neuromodulation of the LFCN. These patients with MP underwent a diagnostic LFCN block using 2.0% lidocaine. Temporary pain relief > 50% was considered to be a positive response to the diagnostic nerve block. Following a positive response to the diagnostic nerve block, patients underwent PRF neuromodulation at 42 degrees for 2 minutes. Patient pain was evaluated using a 10-cm visual analog scale (VAS). In MP patients who received PRF, we statistically evaluated VAS scores and the presence of any complications for 6 or more months after the procedure. RESULTS The mean initial patient VAS score was 6.4 ± 0.97 cm. This score was decreased to 0.91 ± 0.70 cm, 0.82 ± 0.75 cm, and 0.63 ± 0.90 cm at the one-, 3-, and 6- month follow-ups, respectively (P < 0.001). Sixty-three point six percent of patients achieved complete pain relief (pain-free) in the last follow-up, whereas 27.3% of patients achieved successful pain relief (= 50% reduction in pain as determined by the VAS score). Furthermore, we did not observe any complications after the procedure. CONCLUSION PRF neuromodulation of the LFCN provides immediate and long-lasting pain relief without complications. Therefore, PRF of the LCFN can be used as an alternative treatment in patients with MP who are refractory to conservative medical treatment.
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Affiliation(s)
- Jae Jun Lee
- Department of Anesthesiology and Pain medicine Wonju Severance Christian Hospital, Yonsei University, Wonju, Korea
| | - Jong Hee Sohn
- Department of Neurology, College of Medicine, Hallym University, Chuncheon, Korea
| | - Hyuk Jai Choi
- Department of Neurosurgery, College of Medicine, Hallym University, Chuncheon, Korea
| | - Jin Seo Yang
- Department of Neurosurgery, College of Medicine, Hallym University, Chuncheon, Korea
| | - Kwang Ho Lee
- Department of Anesthesiology and Pain medicine, Wonju Severance Christian Hospital, Yonsei University, Wonju, Korea
| | - Hye Jin Do
- Department of Anesthesiology and Pain medicine, Wonju Severance Christian Hospital, Yonsei University, Wonju, Korea
| | - Sung Ho Lee
- Department of Anesthesiology and Pain medicine, Wonju Severance Christian Hospital, Yonsei University, Wonju, Korea
| | - Yong Jun Cho
- Department of Neurosurgery, Kyung Hee Medical Center, Kyung Hee University, Seoul, Korea
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Matthews LJ, McConda DB, Lalli TAJ, Daffner SD. Orthostetrics: Management of Orthopedic Conditions in the Pregnant Patient. Orthopedics 2015; 38:e874-80. [PMID: 26488781 DOI: 10.3928/01477447-20151002-53] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 02/04/2015] [Indexed: 02/03/2023]
Abstract
Managing orthopedic conditions in pregnant patients leads to challenges that must be carefully considered so that the safety of both the mother and the fetus is maintained. Both perioperative and intraoperative considerations must be made based on physiologic changes during pregnancy, risks of radiation, and recommendations for monitoring. Operative timing, imaging, and medication selection are also factors that may vary based on trimester and clinical scenario. Pregnancy introduces unique parameters that can result in undesirable outcomes for both mother and fetus if not handled appropriately. Ultimately, pregnant patients offer a distinct challenge to the orthopedic surgeon in that the well-being of 2 patients must be considered in all aspects of care. In addition, not only does pregnancy affect the management of orthopedic conditions but the pregnant state also causes physiologic changes that may actually induce various pathologies. These pregnancy-related orthopedic conditions can interfere with an otherwise healthy pregnancy and should be recognized as possible complications. Although the management of orthopedic conditions in pregnancy is often conservative, pregnancy does not necessarily preclude safely treating pathologies operatively. When surgery is considered, regional anesthesia provides less overall drug exposure to the fetus and less variability in fetal heart rate. Intraoperative fluoroscopy can be used when appropriate, with 360° fetal shielding if possible. Lateral decubitus positioning is ideal to prevent hypotension associated with compression of the inferior vena cava.
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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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Abstract
Background Meralgia paraesthetica is a fairly common condition resulting from entrapment of the lateral femoral cutaneous nerve. I have found that acupuncture produces a rapid improvement, sometimes effecting a cure, after only one or two treatments. I therefore invited referrals in order to collect a case series. Methods A series of 10 patients, which included two who had refused surgery, but excluded those with significant lumbar spine problems, were treated. Visual Analogue Scale pain scores and analgesic intake were recorded weekly, starting before treatment. Four patients were receiving high doses of analgesics and the average period of symptoms was 3–4 years. Acupuncture points used were BL25, GB30, GB34, GB31, GB32, Huatuojiaji and ah shi points of the buttock and thigh, up to a depth of 7.5 cm. Electroacupuncture was normally given from the second treatment. Results Without exception, patients were specifically tender over GB31 before they started treatment. Most were also tender over the upper lumbar spine. An average of four to five sessions of acupuncture was given. The pain scores for all 10 patients improved by at least 50%, including that of a patient with a 20-year history. At follow-up (varying from 3 to 36 months), improvement was nearly 100%. Most patients were able to stop their analgesics. Conclusions Meralgia paraesthetica appears to respond rapidly to electroacupuncture. A significant trigger point at GB31 was universally present, which may aid diagnosis, although the reason for this is unclear. Further controlled studies are justified.
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Moritz T, Prosch H, Berzaczy D, Happak W, Lieba-Samal D, Bernathova M, Auff E, Bodner G. Common anatomical variation in patients with idiopathic meralgia paresthetica: a high resolution ultrasound case-control study. Pain Physician 2013; 16:E287-E293. [PMID: 23703427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Meralgia paresthetica (MP) is a mononeuropathy of the lateral femoral cutaneous nerve (LFCN) characterized by pain, numbness or paresthesia on the anterolateral aspect of the thigh. Though several contributing factors have been identified, the cause of its idiopathic form still remains unclear. Anatomic and clinical studies have demonstrated a variable course for the LFCN and have suggested a contribution to the pathogenesis of MP. OBJECTIVE It was the aim of the present case-control study to assess the anatomical course and compression site of the LFCN using high resolution ultrasound (HRUS) in patients suffering from idiopathic MP, and compare the anatomical course in these patients to an asymptomatic control group. STUDY DESIGN Case-control study. SETTING Nerve imaging center at a large university hospital in Austria. METHODS Twenty-eight patients with a diagnosis of MP were included in this study (20 men, 8 women; mean age 54 years). The diagnosis was established by clinical history, physical examination, and diagnostic anesthetic block. Fifteen age- and gender-matched healthy volunteers served as the control group. Standardized HRUS examinations were performed by one experienced radiologist from June 2004 through April 2012. Two experienced radiologists reviewed the patients' standardized HRUS examinations and performed examinations in the control group to measure the minimal distance between the LFCN and the anterior superior iliac spine (ASIS). OUTCOMES The minimal distance between the ASIS and the LFCN was measured using HRUS. RESULTS The LFCN could be seen in all patients and volunteers. In MP patients, the mean distance between the LFCN and the ASIS was 0.52 cm (SD 0.46 cm), compared to a mean distance of 1.79 cm (SD 1.48 cm) in the control group (P < 0.001). LIMITATIONS Limited sample size, retrospective design. CONCLUSIONS The results of this study demonstrate a significantly different course of the LFCN, closer to the ASIS in patients with idiopathic MP.
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Affiliation(s)
- Thomas Moritz
- Department of Radiology, Medical University of Vienna A-1090 Vienna, Austria.
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Abstract
Botulinum toxin has been used for a variety of neuropathic conditions in diabetes mellitus. Meralgia paresthetica is a mononeuropathy of femoral nerve seen in diabetes and obesity with an unclear etiopathogenesis. We studied the role of botulinum toxin in resistant cases of meralgia paresthetica in type 2 diabetes.
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Affiliation(s)
- Pawan Dhull
- Department of Neurology, Command Hospital, Bangalore, India
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de Ruiter GCW, Wurzer JAL, Kloet A. Decision making in the surgical treatment of meralgia paresthetica: neurolysis versus neurectomy. Acta Neurochir (Wien) 2012; 154:1765-72. [PMID: 22766927 DOI: 10.1007/s00701-012-1431-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 06/20/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgical treatment options for meralgia paresthetica include neurolysis and neurectomy procedures. Reported success rates for pain relief are generally higher after neurectomy, but an obvious disadvantage compared with neurolysis is the loss of sensation in the anterolateral part of the thigh. In this study we analyzed our results on pain relief after both procedures, and we determined the impact of loss of sensation with a questionnaire. METHODS Between 1999 and 2009, all patients with persistent symptoms of meralgia paresthetica who presented to our clinic after failure of conservative treatment were offered a neurectomy procedure. After this period, the surgical strategy was changed to first neurolysis followed by neurectomy in case of failure. We retrospectively analyzed our results for both strategies with a questionnaire that was focused on pain relief, numbness and the impact of numbness. RESULTS Ten patients underwent a neurolysis with a 60 % pain relief rate compared to 87.5 % of the eight patients that primarily underwent a neurectomy. Most neurectomy patients (62.5 %) were not hindered by the numbness, 25 % sometimes and only one patient was frequently bothered, but was still satisfied with the outcome. The failures of neurolysis were secondarily treated by neurectomy, which resulted in pain relief in three out of four patients. CONCLUSIONS This series confirms previous reports in the literature that have shown higher success rates for the neurectomy procedure. In addition, it shows that most patients are not bothered by the numbness following this procedure. These observations can be used in the surgical decision making for meralgia paresthetica.
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Affiliation(s)
- Godard C W de Ruiter
- Department of Neurosurgery, Medical Center Haaglanden (MCH), The Hague, The Netherlands
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Postop nurse told pt. an 'incident' occurred during procedure. Case on point: Smith v. Hines, 2011 OK 51, 107198 P.3d (6/8/2011)-OK. Nurs Law Regan Rep 2011; 52:2. [PMID: 23088007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Tagliafico A, Serafini G, Lacelli F, Perrone N, Valsania V, Martinoli C. Ultrasound-guided treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy): technical description and results of treatment in 20 consecutive patients. J Ultrasound Med 2011; 30:1341-1346. [PMID: 21968484 DOI: 10.7863/jum.2011.30.10.1341] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The purposes of this study were to describe a technique for treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy) using ultrasound guidance and to report the results of treatment. METHODS Twenty consecutive patients (7 male and 13 female; age range, 23-66 years; mean, 39 years) with meralgia paresthetica confirmed by electromyography were treated with perineural injection of 1 mL of methylprednisolone acetate (40 mg/mL) and 8 mL of mepivacaine, 2%, under direct ultrasound guidance. Main outcome measures included the technical success of the procedure, visual analog scale score for the lateral femoral cutaneous nerve (pain, burning sensation, and paresthesia), and visual analog scale global quality of life score. RESULTS Technical success (successful nerve block at the distribution of the lateral femoral cutaneous nerve) was achieved in all patients. Five patients felt slight sharp pain during needle insertion. The symptoms in 16 patients (80%) diminished progressively after the first week. The 4 remaining patients (20%) required a further perineural injection. The symptoms disappeared in all patients 2 months after injection (mean visual analog scale score ± SD for lateral femoral cutaneous neuropathy at baseline, 8.1 ± 2.1; at 2 months, 2.1 ± 0.5; t = 6.2; P < .001). The mean visual analog scale quality of life scored decreased from 6.9 ± 3.2 to 2.3 ± 2.5 (t = 5.3; P < .002). CONCLUSIONS Treatment of meralgia paresthetica with ultrasound-guided perineural injections resulted in substantial symptom relief in most patients 2 months after injection. Randomized placebo-controlled trials of this treatment should be considered in the future.
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Affiliation(s)
- Alberto Tagliafico
- Department of Radiology, National Institute for Cancer Research, Genoa, Italy.
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Dharmasaroja P, Dharmasaroja P. Meralgia paresthetica-like syndrome may be caused by transient lumbar nerve root injury without definite compression: a case report. J Med Assoc Thai 2010; 93 Suppl 7:S307-S310. [PMID: 21294431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Meralgia paresthetica is a well-known sensory syndrome describing paresthesia and/or anesthesia in the anterolateral aspect of the thigh that is supplied by the lateral femoral cutaneous nerve. Compression of the nerve usually occurs at the point where it passes between the anterior superior iliac spine and the inguinal ligament. Proximal lesions such as lumbar radiculopathy, lumbar disc herniation, and spinal stenosis have been reported to cause meralgia paresthetica-like syndrome. These proximal lesions directly injure L2 and L3 spinal nerve roots and cause a constant compression of the nerve roots. The presented paper introduces a hypothesis that this syndrome can be caused by transient injury to the L2 and L3 nerve roots by the upper adjacent disc bulge without definite compression. This hypothesis is supported by lumbar spine magnetic resonance imaging of a patient presenting with a meralgia paresthetica-like symptom during bending forward and twisting of the body, showing no L2/L3 herniated disc but mildly posterior bulging of T12/L1 disc. This hypothesis emphasizes an importance of appropriate postures in patients with meralgia paresthetica-like symptoms in order to prevent long-term morbidity.
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Affiliation(s)
- Pornpatr Dharmasaroja
- Division of Neurology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
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Caramelli R, Del Corso F, Schiavone V, Fossi S, Cassardo A, Pinto F, de Scisciolo G. Proposal of a New Criterion for Electrodiagnosis of Meralgia Paresthetica by Evoked Potentials. J Clin Neurophysiol 2006; 23:482-5. [PMID: 17016161 DOI: 10.1097/01.wnp.0000214401.00968.29] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We examined 19 subjects with meralgia paresthetica (bilateral in three cases), recording bilateral somatosensory-evoked potentials (SSEPs) after stimulation of the tibial posterior nerve (TPN) and cutaneous stimulation in the region of the lateral femoral cutaneous nerve (LFCN). We calculated the difference between TPN SSEPs and LFCN SSEPs cortical potentials, identifying a temporal parameter that we termed D(SEP). We defined D(SEP) normal values in a control group. D(SEP) evaluation showed good sensitivity and specificity (85.7% and 82.4%, respectively; accuracy, 83.3%) in discriminating affected limbs from unaffected. The main advantage of this method is to disengage from the necessity of contralateral comparison of LFCN recordings, joined with a reduction of interindividual variability of LFCN SSEPs amplitude and latency that often causes a lower sensitivity of other methods. As an interesting consideration, D(SEP) evaluation appears to mark out a possible subclinical involvement of LFCN in the asymptomatic side of patients with meralgia paresthetica.
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Affiliation(s)
- Riccardo Caramelli
- Neurophysiology Unit, Department of Neurology and Psychiatry, Azienda Ospedaliera Careggi, Florence, Italy.
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Paolaggi JB. [Natural history of non specific neuralgias of the limbs. Exponential kinetics of the root pain recovery in sciatica and femoral neuralgia; uncertain kinetics for brachial neuralgia]. Bull Acad Natl Med 2003; 187:1631-45; discussion 1646-7. [PMID: 15369234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Very few studies are dedicated to the natural history of sciatica, and none to femoral neuralgia or brachial neuralgia natural course. Hence, the results of a collection of five studies on these topics appear worth being published. A rheumatology department. The first study was a retrospective comparison of sciatica (145 patients) and femoral neuralgia (63 patients). The second study was a retrospective study concerning 107 patients with sciatica observed in a second different period. A third and a fourth retrospective studies were carried out on 38 femoral neuralgia and 69 brachial neuralgia patients. The fifth study was a prospective cohort study on patients with sciatica. As there are no diagnosis criteria for non specific neuralgias, the diagnosis was based on seniors' opinion. Neuralgia due to specific causes were carefully excluded. As there are no relevant outcomes measures specially dedicated to idiopathic acute root pain, the full recovery of root pain was used as endpoint. The kinetics of sciatica and of femoral neuralgia recoveries are related Plotted as neuralgia survival sciatica as well as femoral neuralgia exhibited a decreasing, exponential kinetics curve. Half sciatica disappear each 6 to 7 weeks. Half femoral neuralgia disappear each 5 to 6 weeks. The brachial neuralgia survival exhibited a more complex kinetics. These pilot studies, do not allow definitive conclusions. Nevertheless, given the scarcity of available data, they may be used as a factual basis for perfectly designed prospective inception cohort studies.
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SHERIDAN JF, MAYFIELD FH. MERALGIA PARESTHETICA: REPORT OF A CASE SUCCESSFULLY TREATED BY SURGERY. Ohio State Med J 1964; 60:561-2. [PMID: 14134751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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RISTIC M. [MERALGIA PARAESTHETICA]. Med Glas 1964; 18:130-1. [PMID: 14257777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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DUPONT C, DORAY J, CLOUTIER GE. [COMPRESSION NEURITIS OF THE FEMORO-CUTANEOUS NERVE OR MERALGIA PARESTHETICA]. Union Med Can 1964; 93:426-8. [PMID: 14143584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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REGLI F, HAYNAL A. [FEMORAL NERVE LESIONS]. Schweiz Med Wochenschr 1964; 94:147-55. [PMID: 14153117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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CASTLE J. MERALGIA PARAESTHETICA. Med J Aust 1963; 2:311-2. [PMID: 14044355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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KNOX EW. Meralgia paraesthetica and thrombophlebitis. Ulster Med J 1963; 32:78-81. [PMID: 14033855 PMCID: PMC2384878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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SERRATRICE G, OLMER M. [Meralgia paraesthetica]. Prog Med (Paris) 1963; 91:205-6. [PMID: 13988129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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LABRAM C. [Notes from neurological semeiology. XV. The peripheral nerves. b) Spinal nerves. The crural and obturator nerves]. Concours Med 1962; 84:3872-5. [PMID: 14461307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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MORITZ P. [Contributions to the pathogenesis of meralgia paraesthetica]. Zentralbl Neurochir 1962; 22:295-302. [PMID: 14476135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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GHENT WR. Further studies on meralgia paresthetica. Can Med Assoc J 1961; 85:871-5. [PMID: 13898185 PMCID: PMC1848422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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BUCHBENDER E, WEISS R. [3 cases of femoral paralysis after a gynecological abdominal operation]. Nervenarzt 1961; 32:413-5. [PMID: 13874243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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LIEVRE JA. [Neuralgia of the femorocutaneous nerve]. Rev Prat 1960; 10:2939-41. [PMID: 13762085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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GHENT WR. Meralgia paraesthetica. Can Med Assoc J 1959; 81:631-3. [PMID: 13827727 PMCID: PMC1831302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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JONQUIERES ED. The histamine reaction in meralgia paresthetica. Int J Lepr 1959; 27:163-5. [PMID: 14407825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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MORITZ P. [Data on the pathogenesis of meralgia paraesthetica]. Orv Hetil 1959; 100:387-91. [PMID: 13645013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
|
47
|
KHAZANOV MA, KORENEVSKAIA AA. [Femoral nerve neuritis of radioactive genesis]. Sov Med 1958; 22:116-8. [PMID: 13615536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
|
48
|
|
49
|
JOHNSON DA, MONTGOMERY RR. Femoral neuropathy in abdominopelvic surgery. Med Ann Dist Columbia 1958; 27:513-4 passim. [PMID: 13589249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
|
50
|
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