Dr. Ebraheim’s educational animated video describes Meralgia Paresthetica.
Meralgia paresthetica is a pain or burning sensation felt over the anterolateral aspect of the thigh usually caused by compression of the lateral femoral cutaneous nerve (LFCN). Wearing super-tight jeans may cause this compression of the LFCN. Usually the patient complains of tingling, numbness, and pain as well as sensitivity to the touch in the area of the skin innervated by that nerve (the outer part of the thigh). There will be hypersensitivity over the anterolateral aspect of the thigh and the patient will sometimes notice this sensitivity while placing their hands of car keys inside the pocket.
Causes of Meralgia Paresthetica are tight pants, belt, corset braces, obesity and weight gain, pregnancy, local trauma and diabetes. Injury is usually caused by compression as the nerve passes under the inguinal ligament.
Anatomy of the LFCN
The lateral femoral cutaneous nerve of the thigh arises from the branches of L2 and L3. The variations in the course of the LFCN in the area of the ASIS can cause entrapment of the nerve near the iliac crest causing Meralgia Paresthetica.
The LFCN can become injured during harvesting anterior iliac crest bone graft, illioinguinal approach for acetabulum fixation, application of external fixator of the pelvis, total hip replacement by anterior approach or Smith Peterson approach. The LFCN usually passes under the inguinal ligament approximately 2 cm medial to the ASIS. Once outside the pelvis, the nerve splits and pierces the fascia, running over the lateral aspect of the thigh in the subcutaneous region and lies superficial to the Sartorius muscle. The course of the LFCM in the area of the ASIS is variable: under ligament, over ligament, over & under ligament and over iliac crest. These variations can cause entrapments of the nerve near the iliac crest causinf meralgia paresthetica. Recognizing the variability and the relationship of this nerve and its branches is important to avoid injury to the nerve. It is difficult to establish a safe zone for the nerve during surgical approaches to the acetabulum or the proximal femur.
Disc herniation that affects the L2-L3 nerve roots can also cause Meralgia Paresthetica. Consider spine pathology when dealing with Meralgia Paresthetica.
Signs of Meralgia Paresthetica include burning, tingling sensation, hypersensitivity to heat where warm water feels like it is burning the skin. The condition is usually diagnosed by the patient describing the symptoms in the area of the thigh. Some people say it is an elusive or obscure diagnosis for many physicians and can be missed or overlooked. It can lead to a significant disability if missed. The condition could be mistaken for other disorders. Physicians may think it is a hip, groin, abdominal or iliotibial band problem. This can cause misdiagnosis and may lead to other unnecessary treatment given to the patient.
•strengthening the abdominal muscles
•avoid wearing tight clothing and tight bands around the pelvis.
•Steroid injection: Ultrasound guidance for steroid injection is better than blind injection. Injection can be diagnostic and therapeutic aiding in the diagnosis.
•Surgery is done only in severe cases. Surgery is a last resort in order to decompress the nerve.
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Background music provided as a free download from YouTube Audio Library.
Song Title: Every Step