Meralgia Paresthetica: Relevance, Diagnosis, and Treatment

Christoph Scholz, Marc Hohenhaus, Maria T Pedro, Anne-Kathrin Uerschels, Nora F Dengler, Christoph Scholz, Marc Hohenhaus, Maria T Pedro, Anne-Kathrin Uerschels, Nora F Dengler

Abstract

Background: Pain and sensory disturbance in the distribution of the lateral femoral cutaneous nerve in the ventrolateral portion of the thigh is called meralgia paresthetica (MP). The incidence of MP has risen along with the increasing prevalence of obesity and diabetes mellitus and was recently estimated at 32 new cases per 100 000 persons per year. In this review, we provide an overview of current standards and developments in the diagnosis and treatment of MP.

Methods: This review is based on publications retrieved by a selective literature search, with special attention to meta-analyses, systematic reviews, randomized and controlled trials (RCTs), and prospective observational studies.

Results: The diagnosis is mainly based on typical symptoms combined with a positive response to an infiltration procedure. In atypical cases, electrophysiological testing, neurosonography, and magnetic resonance imaging can be helpful in establishing the diagnosis. The literature search did not reveal any studies of high quality. Four prospective observational studies with small case numbers and partly inconsistent results are available. In a meta-analysis of 149 cases, pain relief was described after infiltration in 85% of cases and after surgery in 80%, with 1-38 months of follow-up. In another meta-analysis of 670 cases, there was pain relief after infiltration in 22% of cases, after surgical decompression in 63%, and after neurectomy in 85%. Hardly any data are available on more recent treatment options, such as radiofrequency therapy, spinal cord stimulation, or peripheral nerve stimulation.

Conclusion: The state of the evidence is limited in both quantity and quality, corresponding to evidence level 2a for surgical and non-surgical methods. Advances in imaging and neurophysiological testing have made the diagnosis easier to establish. When intervention is needed, good success rates have been achieved with surgery (decompression, neurectomy), and variable success rates with infiltration.

Figures

Figure 1
Figure 1
The anatomical course of the right lateral femoral cutaneous nerve and the area typically affected by symptoms of meralgia paresthetica in the left thigh Our heartfelt thanks to Dr. Roberto Ferrarese (Department of Neurosurgery, University Hospital Freiburg) for drawing the illustration
Figure 2
Figure 2
Algorithm for the treatment of patients suspected of having meralgia paresthetica CT, Computed tomography; MRI, magnetic resonance imaging
Figure 3
Figure 3
Intraoperative view of an infrainguinal approach with decompression of the right lateral femoral cutaneous nerve

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