Meralgia Paresthetica: Symptoms, Causes, Diagnosis, Treatment

Meralgia Paresthetica: Symptoms, Causes, Diagnosis, Treatment

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What Is Meralgia Paresthetica?

Meralgia paresthetica is a situation characterized by the aid of using tingling, numbness, and burning ache in your outer thigh. The motive of meralgia paresthetica is compression of the nerve that substances sensation to the pores and skin floor of your thigh.

Tight clothing, weight problems or weight gain, and being pregnant are not unusual places reasons for meralgia paresthetica. However, meralgia paresthetica also can be because of nearby trauma or disease, including diabetes.

In maximum cases, you may relieve meralgia paresthetica with conservative measures, including sporting looser clothing. In excessive cases, the remedy might also additionally encompass medicines to alleviate soreness or, rarely, surgery.

SIGNS AND SYMPTOMS

Meralgia paresthetica is characterized with the aid of using ache, numbness, and tingling (paresthesia), and faded sensation (hypesthesia) over the higher outer thigh.

Symptoms are normally unilateral and generally, the onset of ache is subacute. Patients symbolize their signs and symptoms as:

  • Tingling or “pins and needles” sensation withinside the outer (lateral) part of the thigh
  • Numbness withinside the outer (lateral) part of the thigh
  • Burning withinside the outer (lateral) a part of the thigh
  • Itching withinside the outer (lateral) a part of the thigh
  • Hyperpathia, wherein mild contact (from garb or a hand) outcomes in unsightly sensations withinside the outer (lateral) part of the thigh
  • Pain every now and then has a tendency to be unchanged with positional adjustments or sports which include strolling or status has been mentioned in a few studies. or,
  • Pain in a few cases may be irritated with the aid of using extended status, strolling, thigh extension and relieved with the aid of using sitting
  • Valsalva maneuvers or different sports which include cough, that will increase intra-belly strain might also worsen the soreness in a few cases

Clinical exam indicates a lack of mild contact and/or pinprick sensation in a discrete location of the higher lateral thigh, regularly in a greater constrained location than the area of paresthesias.

Symptoms can be reproduced with the aid of using tapping over the lateral component of the inguinal ligament (Tinel’s sign).

Meralgia Paresthetica Causes and Risk Factors

Nerves journey during your body, wearing messages to and from your mind. A sure set of nerves, known as the sensory nerves, collect and ship indicators on your mind approximately your skin, muscles, and different tissues.

If you’ve got meralgia paresthetica, a massive sensory nerve on your outer thigh doesn’t have sufficient room to skip via your hip bone or joints. This can be because of swelling, trauma, or elevated strain on this area.

A lot of factors can squeeze or harm the nerve, which includes:

  • Weight gain and obesity
  • Tight clothing, which includes pants, stockings, a belt, or girdle
  • Pregnancy
  • Injury, which includes trauma from a seatbelt at some point of a vehicle crash
  • Something heavy worn around your waist, like a device or gun belt
  • A sickness that may harm the nerves, like diabetes
  • Repetitive motions that would worsen the nerve, which include sure leg movements
  • Standing or strolling for a protracted time

Your chance of having the circumstance is better if you:

  • Are overweight
  • Are pregnant
  • Have sure scientific conditions, which include diabetes, hypothyroidism, and alcoholism
  • Are among a long time 30 and 60
  • Have been uncovered to lead-primarily based totally paint
  • Have legs which can be one of a kind lengths

EVALUATION

Detailed records need to be obtained, mainly approximately current weight gain, use of tight-becoming garments or belts, workout habits, and different capacity chance elements for compression on the inguinal ligament. [See ‘Causes and risk factors’ above].

Inquiring records approximately nerve-racking elements mainly with Valsalva or extended taking walks is beneficial in suggesting inguinal compression.

If the ache is present, it has to be restricted to the anterolateral part of the thigh. Backache, which includes radicular ache or “sciatica,” has to improve suspicion for lumbosacral backbone or plexus pathology in preference to meralgia paresthetica.

Neurologic exam: A targeted neurologic exam of the decreased extremities need to be done with a purpose to locate dwindled sensation withinside the distribution of the LFCN and additionally to rule out a weak point or reflex modifications suggesting an opportunity diagnosis.

  • Sensory exam: Pinprick and mild contact have to be examined withinside the affected thigh.
    • Hypesthesia is usually blanketed about 10 inches via way of means of 5-inch oval-fashioned place at the anterolateral thigh.
    • Sensory abnormalities will also be visible at the anterior thigh for the reason that the distribution of the LFCN isn’t always strictly lateral.
    • The sensory exam is in any other case normal.
    • NOTE: even though sufferers with diabetes might also additionally have a sensory loss in a distal symmetric distribution, suggestive of a distal symmetric polyneuropathy.
  • Motor exam: The motor exam has to encompass bilateral muscle electricity checking out of all predominant muscle businesses of the decrease extremities and direct leg improvement.
    • Direct leg improvement has to be negative.
    • Proximal and distal motor electricity have to be preserved.
  • Deep tendon reflexes (DTRs)
    • DTRs have to be symmetric in each leg.
    • Loss of the patellar or Achilles reflex at the aspect of the sensory abnormality shows an opportunity diagnosis, for example, femoral neuropathy or L3/L4 radiculopathy [See below for ‘differential diagnosis’]

Meralgia Paresthetica Diagnosis

Your medical doctor will provide you with a bodily examination and ask approximately your signs and your scientific history — specifically approximately any current accidents or surgeries. The medical doctor will contact your leg to discover the affected location. They will take a look at any neurological abnormalities of the decreased leg.
You may also get positive scientific tests:

  • Imaging tests. Your medical doctor may also order pics of the inner of your hip and pelvic location to search for different issues that might be inflicting your signs. You may also get x-rays, a CT scan, or an MRI.
  • Electromyography. This measures the electric pastime on your muscle groups thru a skinny needle electrode. If you’ve got got a meralgia paresthetica, the effects can be normal. But it is able to monitor every other reason for your ache.
  • Nerve conduction test. Electrode patches carried out in your pores and skin positioned out a small electrical impulse to look how nicely your nerve sends messages to the muscle groups.
  • Nerve blockade. Anesthesia is injected into your thigh on the factor in which your LFCN is probably to be compressed. If you’ve got meralgia paresthetica, the ache will briefly move away.
  • Blood tests. Your medical doctor may also take a look at symptoms and symptoms of diabetes, hormone or nutrition imbalances, anemia, or lead exposure.

It may be tough to inform the distinction between meralgia paresthetica and different back, hip, or groin conditions. Be an affected person as you figure together along with your medical doctor to discover the proper diagnosis.

Meralgia Paresthetica: Symptoms, Causes, Diagnosis, Treatment

Differential Diagnosis

The differential analysis of meralgia paresthetica includes different peripheral apprehensive device lesions that deliver overlapping sensory territory withinside the anterior and lateral thigh.

L3/L4 radiculopathy 

The L3 and L4 dermatomes generally correspond to the anterolateral thigh.

  • Muscular innervation of the anterior thigh is overlapping, and involvement of both degrees may also produce weak spots of hip flexion, knee extension, and hip adduction.
  • Radiculopathies secondary to nerve root compression generally contain lower backache with radiation into the thigh and every so often beneath neath the knee down the medial thing of the leg.
  • Pain can be reproduced on immediately leg enhance trying out and exacerbated with the aid of using lower back movement, coughing, sneezing, or straining.
  • The maximum not unusual place reasons for L3/L4 radiculopathy are nerve root compression because of disc herniation and spondylosis.

Lumbosacral plexopathy

The lumbar plexus is derived from the anterior rami of the L1 via L4 nerve roots and runs alongside the psoas principal muscle withinside the pelvis.

  • Lumbar plexus lesions generally tend to reason weak spot of hip flexion and adduction and/or knee extension. Sensory disturbances generally contain the anterior and medial thigh.
  • The maximum not unusual place reasons are diabetic amyotrophy, idiopathic lumbosacral radiculoplexus neuropathy, retroperitoneal or pelvic tumors, and retroperitoneal hematomas.

Femoral neuropathy 

The femoral nerve is the biggest nerve rising from the lumbar plexus. It passes beneath neath the inguinal ligament medial to the lateral femoral cutaneous nerve of the thigh. The femoral nerve innervates the anteromedial pores and skin of the thigh (thru the medial femoral cutaneous branch) in addition to the medial decrease leg thru the saphenous nerve.

  • Weakness generally includes the quadriceps muscle group (knee flexion) with sparing of adduction and variable involvement of hip flexion.
  • The knee jerk reflex is generally lost.
  • Common reasons consist of iatrogenic surgical injury, hip or pelvic fractures, and hundreds or hematomas withinside the iliacus muscle.

Treatment For Meralgia Paresthetica

For maximum human beings, the signs of meralgia paresthetica ease in some months. The treatment makes a specialty of relieving nerve compression.

Conservative measures

Conservative measures encompass:

  • Wearing looser clothing
  • Losing extra weight
  • Taking OTC ache relievers consisting of acetaminophen (Tylenol, others), ibuprofen (Advil,
  • Motrin IB, others), or aspirin

Medications

If signs persist for greater than months or your ache is intense, the remedy may encompass:

  • Corticosteroid injections. Injections can lessen infection and quickly relieve ache. Possible aspect outcomes encompass joint infection, nerve damage, ache, and whitening of pores and skin across the injection site.
  • Tricyclic antidepressants. These medicinal drugs may relieve your ache. Side outcomes encompass drowsiness, dry mouth, constipation, and impaired sexual functioning.
  • Gabapentin (Gralise, Neurontin), phenytoin (Dilantin), or pregabalin (Lyrica). These anti-seizure medicinal drugs may assist reduce your painful signs. Side outcomes encompass constipation, nausea, dizziness, drowsiness, and lightheadedness.

Surgery

Rarely, surgical treatment to decompress the nerve is considered. This alternative is simplest for human beings with intense and long-lasting signs.

Physiotherapy

You can work with a physical therapist on stretching and strengthening exercises for your leg muscles or abdominal muscles. They can also try phonophoresis, which uses ultrasound to help your body absorb medication from your skin, or transcutaneous electrical nerve stimulation (TENS), which provides electrical impulses through pads applied to your skin to prevent pain.

INITIAL THERAPY

Meralgia paresthetica is a self-limited, benign disorder in maximum sufferers and maximum sufferers have spontaneous remission.

Although recurrent signs and symptoms are not unusual places about greater than 90% of sufferers reply to conservative measures alone.

The acute remedy of meralgia paresthetica includes:

  • Educating and reassuring. This is a benign circumstance and it’ll remedy spontaneously.
  • Reducing stress over the nerve withinside the groin place with the aid of using fending off tight apparel and belts.
  • Weight loss if appropriate.
  • The use of oral non-opioid analgesics inclusive of acetaminophen, NSAIDs, and salicylates, can be powerful for a few sufferers.

The physical remedy does now no longer play a sizeable position withinside the control of this disorder.

PERSISTENT SYMPTOMS

In sufferers with chronic signs and symptoms for greater than 1 to two months, regardless of the above measures, reexamining the place to verify the neighborhood nature of the hassle is important.

Anticonvulsants inclusive of carbamazepine, phenytoin, or gabapentin can be useful in decreasing neuropathic ache signs and symptoms however have now no longer been systematically studied in meralgia paresthetica.

Tricyclic antidepressants inclusive of amitriptyline might also add a useful resource in relieving ache.

Consultation with an anesthesiologist for a neighborhood nerve block also can be taken into consideration for chronic signs and symptoms. Injection of a neighborhood anesthetic agent, glucocorticoid, or each may be beneficial to quickly deal with this neuropathy.

Rarely, a surgical operation is important in sufferers with extreme persistent signs and symptoms which are refractory to greater conservative measures.

  • Surgical release: decompression of the nerve might also additionally offer a long-lasting remedy in a few sufferers.
    • This system has the gain of maintaining sensory function. However, it isn’t always uniformly successful.
  • Nerve transection: sectioning of the lateral femoral cutaneous nerve because it exits the pelvis is the maximum definitive system, however, has the drawback of everlasting anesthesia.
    • From a realistic factor of view, handiest sufferers with intractable dysesthetic ache are inclined to go through a system that effects everlasting anesthesia.

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