Meralgia paresthetica
Background
- Entrapment of the lateral femoral cutaneous nerve usually in the inguinal canal
Etiology
- Intrapelvic (pregnancy, enlarging mass, aneurysm)
- Extrapelvic (trauma, tight garment or belt, obesity)
- Systemic (DM)
Clinical Features
- Numbness and pain of anterolateral thigh
- Usually unilateral with subacute onset
- Pelvic compression test
- Turn patient on side
- Compress pelvis
- If symptoms are relieved after 30s of lateral compression diagnosis is confirmed
Differential Diagnosis
Hip pain
Acute Trauma
- Femur fracture
- Proximal
- Intracapsular
- Extracapsular
- Shaft
- Mid-shaft femur fracture (all subtrochanteric)
- Proximal
- Hip dislocation
- Pelvic fractures
Chronic/Atraumatic
- Hip bursitis
- Psoas abscess
- Piriformis syndrome
- Meralgia paresthetica
- Septic arthritis
- Obturator nerve entrapment
- Avascular necrosis of hip
Thigh Numbness
- L3/L4 radiculopathy
- Lumbosacral plexopathy
- Femoral neuropathy
Evaluation
- History - tight fitting clothes/ belts, recent weight gain, worse with valsalva or prolonged walking
- Neurologic exam - diminished sensation in the distribution of the lateral femoral cutaneous nerve
- Rule out weakness or reflex changes that would suggest an alternative diagnosis
- Imaging - generally not necessary, unless atypical symptoms or concern for radiculopathy/ plexopathy
- Nerve conduction studies (NCS)/ Electromyography (EMG) - generally not necessary, unless atypical symptoms or concern for radiculopathy/ plexopathy
Management
- Usually self-limited with frequent spontaneous remission
- Reduce pressure over the nerve in the groin area
- NSAIDs
- Weight loss
- Corticosteroid injection