MERALGIA PARESTHETICA: Lateral Femoral Cutaneous Nerve Neuropathy

Meralgia paresthetica is a rarely encountered sensory problem(mononeuropathy) characterized by paresthesis, pain or sensory impairment along the distribution of the lateral femoral cutaneous nerve caused by entrapment or compression of the nerve as it crosses the anterior superior iliac spine and runs beneth the inguinal ligament. The condition also named as Bernhardt-Rooth syndrome.

In simpler terms Meralgia paresthetica means abnormal sensation or pain in the thigh. Meralgia paresthetica generally occurs unilaterally, in case of bilateral involvement, it rarely have equal effect on both sides.

Symptoms of Meralgia paresthetica:

• Numbness
• Pain
• Burning
• Tingling(prickling)
• Hypersenstivity 
• Aching
• Vague discomfort
• Stinging or "pins & needles".

Causes of Meralgia paresthetica:

Meralgia paresthetica is typically caused by compression or irritation of  lateral femoral cutaneous nerve. Weight gain, weight loss, tight fitting pants, belts, carpenters belt, pregnancy, or lap belt trauma after motor vehicle accident can cause the compression or irritation of this nerve.

there are four predisposing variants which have been implicated in the pathogenesis of  meralgia paresthetica:-

1. Passage of the lateral femoral cutaneous nerve through rather than deep to the inguinal ligament.
2. "Bowing" of the nerve as it crosses the iliacus fascia.
3. Passage of the nerve through the sartorious muscle.
4. Passage of the nerve lateral and posterior to the ASIS.

Any process increasing intra-abdominal or intra-pelvic pressure can cause meralgia paresthetica as well as discrete tumerous enlargement of organs. eg. Ascites, pregnancy.

Systemic disease known to cause neuropathies may occasionally produce an isolated neuropathy of the Lateral femoral cutaneous nerve. Meralgia paresthetica has been reported as the sole complaint in alcoholics, in patients with diabetes mellitus and in led poisoning.  

You may found some other medical conditions associated with meralgia paresthetica such as surgery in the area of the front of the hip/waist, enlarged lymph nodes, braces and hernia support trusses.

Management: 

Management of meralgia paresthetica depends upon what is the cause and how worse your symptoms are. your doctor will work with you to make a most appropriate treatment program as per your need.
Most patients with meralgia paresthetica achieve satisfactory pain relief from conservative treatment such as life style changes, weight loss, reduction or elimination of offending mechanical factors, eg., corset, belt or obesity. If the pain persists, mild analgesics and anti-inflammatory drugs give partial relief in most cases.
You may require single or multiple therapeutic local anesthetic nerve blocks.
In some cases more aggressive interventions may be required, as per the symptoms, such as surgical decompression (neurolysis) or transection of  lateral femoral cutaneous nerve. Unfortunately there is no reliable way of predicting the long term benefit from a surgical decompression.

Physical Therapy Management: 

The modalities and techniques used in physiotherapy may relieve your symptoms without having medications and/or surgical procedures depending upon the progress of your condition.
A gentle electrical stimulation of the skin around  the painful area blocks the pain signals hence relieving the symptoms.
A gentle stretch to the quadriceps and iliopsoas muscle may relieve the compression over lateral femoral cutaneous nerve. another technique named Neurodynamics may help to decrease your symptoms as applied for lateral femoral nerve for few sittings.