Meralgia paraesthetica
Encyclopedia
Meralgia paraesthetica or meralgia paresthetica (US spelling) (me-ral'-gee-a par-es-thet'-i-ka) — also called Bernhardt
-Roth
syndrome — is numbness or pain in the outer thigh not caused by injury to the thigh, but by injury to a nerve
that extends from the thigh
to the spinal column.
This chronic
neurological disorder
involves a single peripheral nerve, namely the lateral cutaneous nerve of thigh
(also called the Lateral femoral cutaneous nerve). The term meralgia paraesthetica comprises four Greek
roots, which together denote "thigh pain with anomalous perception".
) and the inguinal ligament
near the attachment at the anterior superior iliac spine
(the upper point of the hip bone). Less commonly, the nerve may be entrapped by other anatomical or abnormal structures, or damaged by diabetic
or other neuropathy or trauma such as from seat belt
injury in an accident.
The nerve may become painful over a period of time as weight gain makes underwear, belting or the waistband of pants gradually exert higher levels of pressure. The pain may be acute and radiate into the rib cage, into the groin and thigh.
Or, weight loss or aging may remove protective fat layers under the skin compressing the nerve against underwear, outer clothing but more commonly by belting. Pressure may also be caused by long periods of standing or leg exercise which increase tension on the inguinal ligament.
may be required to exclude any problems in those areas.
Electromyography
(EMG) nerve conduction studies may be required. X-rays may be needed to exclude bone abnormalities that might put pressure on the nerve; likewise CT or MRI scans to exclude soft tissue causes such as a tumor.
Whatever the cause, recovery typically requires several weeks to months, depending on the severity of nerve damage, and is facilitated by using looser clothing and suspenders rather than belting.
Non-steroidal anti-inflammatory drug
s (NSAIDs) will reduce inflammatory pain, plus narcotic pain killers may be required as the level of pain can become disabling and prevent sleep. Reduction of physical activity is mandatory, in relationship to the pain level. Absolute bed rest is required for acute pain levels.
The lateral cutaneous nerve of the thigh can occasionally be damaged during laparoscopic
hernia repair, or scarring from the operation can lead to meralgia paraesthetica.
For lower pain levels, treatment may involve:
It may take significant time (weeks) for the pain to stop and, in some cases, numbness will persist despite treatment. In severe cases a local nerve block can be done at the inguinal ligament using a combination of local anaesthetic (lidocaine
) and corticosteroid
s to give relief that may last several weeks. Pain modifier drugs for neuralgic pain
(such as amitriptyline
, carbamazepine
or gabapentin
) may be tried, but are often not as helpful in the majority of patients.
In persistent and severe cases, surgery may be needed to decompress the nerve or as a last resort to resect the nerve. The latter treatment results in permanent numbness in the area.
Martin Bernhardt
Martin Bernhardt was a noted German neuropathologist.Bernhardt was a native of Potsdam. In 1867 he received his medical doctorate at the University of Berlin, where he was a student of Rudolf Virchow and Ludwig Traube...
-Roth
Vladimir Karlovich Roth
Vladimir Karlovich Roth — sometimes Vladimir Karlovich Rot — was a Russian neuropathologist.Roth was native of Orel. He studied medicine at the University of Moscow, where he graduated in 1871. From 1877 to 1879 he travelled abroad, and worked in clinics at Vienna, Berlin and Paris...
syndrome — is numbness or pain in the outer thigh not caused by injury to the thigh, but by injury to a nerve
Nerve
A peripheral nerve, or simply nerve, is an enclosed, cable-like bundle of peripheral axons . A nerve provides a common pathway for the electrochemical nerve impulses that are transmitted along each of the axons. Nerves are found only in the peripheral nervous system...
that extends from the thigh
Thigh
In humans the thigh is the area between the pelvis and the knee. Anatomically, it is part of the lower limb.The single bone in the thigh is called the femur...
to the spinal column.
This chronic
Chronic (medicine)
A chronic disease is a disease or other human health condition that is persistent or long-lasting in nature. The term chronic is usually applied when the course of the disease lasts for more than three months. Common chronic diseases include asthma, cancer, diabetes and HIV/AIDS.In medicine, the...
neurological disorder
Neurological disorder
A neurological disorder is a disorder of the body's nervous system. Structural, biochemical or electrical abnormalities in the brain, spinal cord, or in the nerves leading to or from them, can result in symptoms such as paralysis, muscle weakness, poor coordination, loss of sensation, seizures,...
involves a single peripheral nerve, namely the lateral cutaneous nerve of thigh
Lateral cutaneous nerve of thigh
The lateral cutaneous nerve of the thigh is a cutaneous nerve that innervates the skin on the lateral part of the thigh.-Structure:...
(also called the Lateral femoral cutaneous nerve). The term meralgia paraesthetica comprises four Greek
Greek language
Greek is an independent branch of the Indo-European family of languages. Native to the southern Balkans, it has the longest documented history of any Indo-European language, spanning 34 centuries of written records. Its writing system has been the Greek alphabet for the majority of its history;...
roots, which together denote "thigh pain with anomalous perception".
Aetiology
The lateral cutaneous nerve of thigh most often becomes injured by entrapment or compression where it passes between the upper front hip bone (iliumIlium (bone)
The ilium is the uppermost and largest bone of the pelvis, and appears in most vertebrates including mammals and birds, but not bony fish. All reptiles have an ilium except snakes, although some snake species have a tiny bone which is considered to be an ilium.The name comes from the Latin ,...
) and the inguinal ligament
Inguinal ligament
The inguinal ligament is a band running from the pubic tubercle to the anterior superior iliac spine. Its anatomy is very important for operating on hernia patients.-Anatomy:...
near the attachment at the anterior superior iliac spine
Anterior superior iliac spine
The anterior superior iliac spine is an important landmark of surface anatomy. It refers to the anterior extremity of the iliac crest of the pelvis, which provides attachment for the inguinal ligament, and the sartorius muscle...
(the upper point of the hip bone). Less commonly, the nerve may be entrapped by other anatomical or abnormal structures, or damaged by diabetic
Diabetic neuropathy
Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. These conditions are thought to result from diabetic microvascular injury involving small blood vessels that supply nerves in addition to macrovascular conditions that can culminate in diabetic neuropathy...
or other neuropathy or trauma such as from seat belt
Seat belt
A seat belt or seatbelt, sometimes called a safety belt, is a safety harness designed to secure the occupant of a vehicle against harmful movement that may result from a collision or a sudden stop...
injury in an accident.
The nerve may become painful over a period of time as weight gain makes underwear, belting or the waistband of pants gradually exert higher levels of pressure. The pain may be acute and radiate into the rib cage, into the groin and thigh.
Or, weight loss or aging may remove protective fat layers under the skin compressing the nerve against underwear, outer clothing but more commonly by belting. Pressure may also be caused by long periods of standing or leg exercise which increase tension on the inguinal ligament.
Signs and symptoms
- PainPainPain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
on the outer side of the thigh, occasionally extending to the outer side of the knee, usually constant. - A burning sensation, tingling, or numbness in the same area
- Multiple bee-sting like pains in the affected area
- Occasionally, aching in the groin area or pain spreading across the buttocksButtocksThe buttocks are two rounded portions of the anatomy, located on the posterior of the pelvic region of apes and humans, and many other bipeds or quadrupeds, and comprise a layer of fat superimposed on the gluteus maximus and gluteus medius muscles. Physiologically, the buttocks enable weight to...
- Usually more sensitive to light touch than to firm pressure
- Hyper sensitivity to heat (warm water from shower feels like it is burning the area)
Diagnosis
Diagnosis is largely made on the description given by the patient and relevant details about recent surgeries, injury to the hip, or repetitive activities that could irritate the nerve. An examination will check for any sensory differences between the affected leg and the other leg. An abdominal and pelvic examinationPelvic examination
A pelvic examination, also pelvic exam, is a physical examination of the female pelvic organs.Broadly, it can be divided into the external examination and internal examination.It is also called "Bimanual Exam" & "Manual Uterine Palpation"....
may be required to exclude any problems in those areas.
Electromyography
Electromyography
Electromyography is a technique for evaluating and recording the electrical activity produced by skeletal muscles. EMG is performed using an instrument called an electromyograph, to produce a record called an electromyogram. An electromyograph detects the electrical potential generated by muscle...
(EMG) nerve conduction studies may be required. X-rays may be needed to exclude bone abnormalities that might put pressure on the nerve; likewise CT or MRI scans to exclude soft tissue causes such as a tumor.
Treatment
Treatments will vary. In most cases, the best treatment is to remove the cause of the compression by modifying patient behavior, in combination with medical treatment to relieve inflammation and pain. The following treatments are examples.Whatever the cause, recovery typically requires several weeks to months, depending on the severity of nerve damage, and is facilitated by using looser clothing and suspenders rather than belting.
Non-steroidal anti-inflammatory drug
Non-steroidal anti-inflammatory drug
Nonsteroidal anti-inflammatory drugs, usually abbreviated to NSAIDs or NAIDs, but also referred to as nonsteroidal anti-inflammatory agents/analgesics or nonsteroidal Anti-inflammatory medicines , are drugs with analgesic and antipyretic effects and which have, in higher doses, anti-inflammatory...
s (NSAIDs) will reduce inflammatory pain, plus narcotic pain killers may be required as the level of pain can become disabling and prevent sleep. Reduction of physical activity is mandatory, in relationship to the pain level. Absolute bed rest is required for acute pain levels.
The lateral cutaneous nerve of the thigh can occasionally be damaged during laparoscopic
Laparoscopy
Laparoscopy is an operation performed in the abdomen or pelvis through small incisions with the aid of a camera...
hernia repair, or scarring from the operation can lead to meralgia paraesthetica.
For lower pain levels, treatment may involve:
- Rest periods to interrupt long periods of standing, walking, cycling, or other aggravating activity
- Weight loss in overweight individuals and exercise to strengthen abdominal muscles
- Wearing clothing that is loose at the upper front hip area
- Heat, ice, or electrical stimulation
- Nonsteroidal anti-inflammatory medications for 7–10 days
It may take significant time (weeks) for the pain to stop and, in some cases, numbness will persist despite treatment. In severe cases a local nerve block can be done at the inguinal ligament using a combination of local anaesthetic (lidocaine
Lidocaine
Lidocaine , Xylocaine, or lignocaine is a common local anesthetic and antiarrhythmic drug. Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic or as a local anesthetic for minor surgery.- History :Lidocaine, the first amino...
) and corticosteroid
Corticosteroid
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte...
s to give relief that may last several weeks. Pain modifier drugs for neuralgic pain
Neuralgia
Neuralgia is pain in one or more nerves that occurs without stimulation of pain receptor cells. Neuralgia pain is produced by a change in neurological structure or function rather than by the excitation of pain receptors that causes nociceptive pain. Neuralgia falls into two categories: central...
(such as amitriptyline
Amitriptyline
Amitriptyline is a tricyclic antidepressant . It is the most widely used TCA and has at least equal efficacy against depression as the newer class of SSRIs...
, carbamazepine
Carbamazepine
Carbamazepine is an anticonvulsant and mood-stabilizing drug used primarily in the treatment of epilepsy and bipolar disorder, as well as trigeminal neuralgia...
or gabapentin
Gabapentin
Gabapentin is a pharmaceutical drug, specifically a GABA analogue. It was originally developed for the treatment of epilepsy, and currently is also used to relieve neuropathic pain...
) may be tried, but are often not as helpful in the majority of patients.
In persistent and severe cases, surgery may be needed to decompress the nerve or as a last resort to resect the nerve. The latter treatment results in permanent numbness in the area.