Meralgia Paresthetica

    Meralgia paresthetica is caused by entrapment of the lateral femoral cutaneous nerve.  It is characterized by a constellation of symptoms including unpleasant sensations called dysesthesias in the upper lateral thigh. The pain is often burning in nature and patients suffering from meralgia paresthetica will often avoid any contact of clothing with the affected area.  The pain of meralgia paresthetica is often exacerbate by sitting or squatting for long periods of time.  Wide belts and obesity have also been implicated as inciting factors for development of the syndrome.   Meralgia paresthetica is usually unilateral but can occur bilaterally, especially in the obese patient. 

    The term meralgia paresthetica is derived from the Greek meros meaning thigh and algo meaning pain.   Sigmund Freud was said to suffer from the syndrome and initially ascribed the clinical symptomatology as psychosomatic in origin.  In fact, the basis of the clinical symptomatology associated with meralgia paresthetica is caused by entrapment of the lateral femoral cutaneous nerve.  Diagnosis is made on a clinical basis with confirmation obtained by electromyography.  Electromyography will help distinguish meralgia paresthetica from femoral neuropathy or lumbar radiculopathy involving the second and third lumbar nerve roots.  Rarely, lesions of the lumbar plexus may present clinically as meralgia paresthetica.

    Treatment is aimed at avoidance techniques including removing wide belts or tight garters or girdles that may be compressing the lateral femoral cutaneous nerve.  Weight loss is often beneficial.   Neural blockade of the affected lateral femoral cutaneous nerve with local anesthetic and anti-inflammatory steroid will serve as both a diagnostic and therapeutic maneuver.  Rarely, surgical decompression and/or destruction of the lateral femoral cutaneous nerve is necessary.