Meralgia paresthetica


Meralgia paresthetica

Description, Causes and Risk Factors:

Meralgia paraesthetica is a neurological condition that causes pain in the outer thigh. It is caused by compression of a nerve called the lateral cutaneous nerve of the thigh. This nerve supplies sensation (feeling) to the outer thigh. In many cases, the cause is not known. Usually the condition improves with conservative (nonsurgical) treatment - such as anti-inflammatories, painkillers or steroid injections.

The original term "meralgia paresthetica," is derived from Latin. Translated today, the description simply means: "pain and numbness of the thigh."

The cause of the pain is due to squeezing of the sensory (feeling) nerve as it passes under the gristle near the bony prominence (the anterior superior iliac spine) between the groin and the hip joint. The more descriptive term is entrapment of the lateral cutaneous nerve of the thigh.

The cause of meralgia paresthetica is occasionally identifiable. However, most cases are idiopathic. Reported antecedents of the syndrome include local trauma, pregnancy, intrapelvic disease, seat belts, braces, local tumors, disc lesions and prolonged hip extension. In a recent anatomical study, Edelson and Nathan found that in 51 percent of unselected adult autopsy cases there was a significant enlargement at the ligamentous stress point. The authors postulate that this pseudoganglion results from mechanical irritation and may play a role in otherwise idiopathic cases of meralgia paresthetica.

meralgia paresthetica

Anyone can get meralgia paraesthetica and it affects men and women in equal numbers. Generally it occurs between the ages of 20 and 60, though it is at its most common in middle age, and is much rarer in children.

Risk factors include obesity, pregnancy and ascites (a tense swelling of the abdomen due to fluid).

It is estimated that about 4 in 10,000 people per year develop meralgia paraesthetica. This makes it seem quite an uncommon condition. However, this reflects the number of new cases; there are always a greater number of people with the existing condition. GPs are used to seeing people with meralgia paraesthetica.

Symptoms:

The onset is usually gradual rather than dramatic or sudden. There is often a vague sense of discomfort and sensitivity of the skin ina rather variable ovoid shape on the outer and top part of the thigh. This can be quite extensive, from the groin to above the knee insome patients, whereas in other patients the patch of sensitivity and numbness can be relatively small. In most all cases, the patchof sensory abnormality can be quite easily mapped out by the patient, using a black felt marking pen.

Often it is not strictly a numbness but rather an irritating hypersensitivity; people describe a sensation of ants crawling on the skin oras though their leg hairs are standing on end. They find it uncomfortable when clothing rubs against the skin of the thigh. It iscommonly bothersome when they have been standing for some length of time; often they will shift from one leg to another ifstanding in a line. Sometimes it can be more obvious after sitting or crouching, again after a long period of time.

Usually meralgia paresthetica will begin in one leg and then after a few months may gradually appear in the other; it can be just inone leg or in both. Sometimes at night in bed the warmth of the blankets will make things worse and the skin becomes hot andburning; people often describe this sensation as being similar to a sunburn.

Because the nerve is pinched in the groin region, it rarely if ever should be associated with back pain, and indeed if there is backpain, it makes the diagnosis of meralgia paresthetica unlikely. Moreover, because it is a pure sensory nerve, any perception ofweakness of the hip or thigh or loss of muscle bulk in the thigh muscles should also indicate that it is not meralgia paresthetica.

Diagnosis:

Diagnosis is typically made based on the symptoms and physical exam findings. Occasionally imaging studies (X-rays, CT, MRI) of the back, pelvis or hip may be ordered. X-rays will help identify any bone abnormalities that might be putting pressure on the nerve. If your physician suspects that a growth such as a tumor is the source of the pressure, you may need to get an MRI or CT (computed tomography) scan. In rare cases, a nerve conduction study may be advised.

Treatment:

There are several categories of treatment for meralgia paresthetica. Depending on what is causing the problem and how severe your symptoms are, your doctors will work with you to design a program most appropriate to your circumstances. Treatments can be grouped into conservative treatments (which are nonsurgical), and surgical treatment (operations). In most cases, only conservative treatments are needed.

Examples of conservative treatments include:

    Rest - Meralgia paresthetica is aggravated by standing and walking. Reduction in physical activity, and sometimes even bed rest, may be advised in severe cases.

  • Weight loss - if obesity is thought to be the cause.

  • Analgesics (painkillers) - such as paracetamol or codeine.

  • Non-steroidal anti-inflammatory drugs (NSAIDs) - such as ibuprofen, naproxen and diclofenac.

  • Corticosteroid injections - commonly referred to as steroid injections. A steroid and, usually some local anesthetic, can be injected around the lateral cutaneous nerve to numb it and reduce inflammation.

  • Other medicines - sometimes medications are used that act as nerve painkillers. Some types of antidepressant medications (tricyclic antidepressants) such as amitriptyline or anticonvulsant drugs can be useful for nerve-related pain (also called neuralgia or neuropathic pain). Examples of these drugs include gabapentin (brand name Neurontin®), pregabalin (brand name Lyrica®) and carbamazepine (brand name Tegretol®).

Surgical treatment involves taking the pressure off the nerve (surgical decompression) and releasing any entrapment.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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