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Meralgia Paresthetica is a painful compressive neuropathy of the lateral femoral cutaneous nerve (LFCN), causing burning pain and paresthesia in the anterolateral thigh. (1-3)

Lateral Femoral Cutaneous Nerve

The LFCN splits directly from the lumbar plexus then runs through the pelvis, adjacent to the lateral border of the iliopsoas muscle, before passing beneath the lateral aspect of the inguinal ligament near the ASIS- which is also the most common site of entrapment. (4)

Watch the docs demonstrate the essential treatments, exercises, and nerve glides for meralgia paresthetica:

Meralgia Paresthetica Clinical Pearls

Prevalence & Incidence

  • Most common in middle-aged adults (5,6)
  • Diabetics have a nearly six-fold increased risk of developing the condition (7-9)
  • Present bilaterally in 20-25% of cases (5,10-12)
  • Affects men up to 3x more frequently than women (8,10-12)

Risk factors

Excessive compression or ischemic stretch of the LFCN is a primary etiological factor. (1,3) Obesity or recent weight gain often precedes the condition. (10,16-21) In fact, 8% of new cases report recent weight gains of more than 15 pounds. (10,22) The “COVID 15″ weight gain concept will likely affect the incidence of this condition, as surveys suggest that worldwide, approximately one-third of adults have gained significant weight during the pandemic. (61) Other risk factors include:

  • Pregnancy
  • Carpentry tool belts, police duty belts, and soldier body armor (14,15)
  • Tight-fitting clothing, jeans, belts, or body-shaping undergarments
  • Direct trauma, including seat belt compression (23-25)
  • Extended periods of time lying prone on a hard surface (i.e. surgery) (26)

Presenting Symptoms

  • Complaints include pain, paresthesia, or hypersensitivity on the outside of the thigh described as dull, aching, itching, buzzing, or burning (1,3)
  • Symptoms may impair function and sleep (3,41)
  • Complaints are often provoked by walking and alleviated when sitting, as sitting may decrease tension on the inguinal ligament (11,12,41,42)

The primary site of tenderness is the emergence of the LFCN approximately one to two finger-widths inferior and medial to the ASIS. (44)

Clinical Findings

  • Tenderness over the lateral inguinal ligament in greater than 75% of cases (44)
  • Symptoms provoked by hip or lumbar extension and relieved by flexion (11,12,41,42)
  • Neurologic evaluation may demonstrate numbness or hyperesthesia over the distribution of the LFCN (41) 
  • Pelvic compression test positive (sensitivity of 95% and a specificity of 93.3%)
  • LFCN Neurodynamic Test will likely reproduce symptoms (46,47) 

Management

  • (Judicious) STM of the hip flexors, sartorius, TFL, quadriceps, and thigh adductors(52-57)
  • Nerve mobilization of the LCFN
  • Stabilization exercises for the core and pelvis (53-57)
  • Therapeutic exercise tape (60,61)

ADL Considerations

  • Losing weight
  • In some cases, simply wearing looser clothing may alleviate the complaint
  • Selective rest from aggravating activity (particularly repetitive hip flexion)
  • Carrying a toolbox instead of wearing a tool belt
  • Avoid wearing high heels (32)

Home Exercise

Conservative management is the frontline treatment for meralgia paresthetica and is successful in up to 91% of cases. (16, 52, 53) The central goal of treatment is to remove any cause of excessive compression. (16, 52) 

Review the ChiroUp Meralgia Paresthetica protocol for a complete best-practice synopsis.

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References
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