In Short: If you have Meralgia Pain Med. No obstante, la meralgia parestésica también puede deberse a un traumatismo local o a una enfermedad, como la diabetes. J Korean Neurosurg Soc. 2020 Nov 8:pnaa326. The 4 remaining patients (20%) required a further injection because the pain had not remitted. Meralgia paresthetica, also called lateral femoral nerve entrapment, is a condition that appears when a major sensory nerve in your leg, the lateral femoral cutaneous nerve (LFCN), is compressed. Twenty consecutive patients (7 male and 13 female; age range, 23–66 years; mean, 39 years) with meralgia paresthetica confirmed by electromyography were treated with perineural injection of 1 mL of methylprednisolone acetate (40 mg/mL) and 8 mL of mepivacaine, 2%, under direct ultrasound guidance. Case report: Pathogenesis, clinical aspects and therapy of compression of the lateral cutaneous nerve of the thigh]. Using this approach, the nerve appeared in cross section as an oval structure on short‐axis images and tubular on longitudinal images (Figure 1). Preliminary data from this article were presented as a scientific communication at the 96th Scientific Assembly and Annual Meeting of the Radiological Society of North America; November 30, 2010; Chicago, Illinois. Ultrasound guidance has been shown to be particularly suitable for injection of tiny and superficial structures such as the lateral femoral cutaneous nerve, overcoming the anatomic variability in most patients.6–10 It has recently been suggested that ultrasound guidance can facilitate blockade of the nerve for diagnostic and therapeutic purposes and may be particularly beneficial in patients with challenging surface anatomic landmarks and when low‐volume injections are desired.10 However, that suggestion arose from a retrospective evaluation of 10 patients treated without a standardized protocol.10 Moreover, in a very preliminary study, it was reported that treatment of lateral femoral cutaneous neuropathy under ultrasound guidance was effective in reducing patient discomfort.11,12 No defined “evidence‐based” treatment exists for this condition. Conclusion: Philip CN, Candido KD, Joseph NJ, Crystal GJ. 1E,F). Near the anterior superior iliac spine, the nerve courses in contact with the lateral aspect of the inguinal ligament and innervates the lateral thigh. Objective: 2011 Aug;50(2):151-3. doi: 10.3340/jkns.2011.50.2.151. This nerve provides sensation to the skin along the outer thigh starting from the inguinal ligament and extending down toward the knee. MP occurs when the nerve that provides feeling to the area is pinched. Complications. Anatomic studies showed that the distance from the lateral femoral cutaneous nerve to the anterior superior iliac spine at the inguinal ligament can range from 3 mm to 7.3 cm.6,8,15 In a study by Hospodar et al,6 the course of the nerve was variable but was most commonly found 10 to 15 mm from the anterior superior iliac spine, although it was found as far medially as 46 mm. 2016 Mar26(3):764-70. doi: 10.1007/s00330-015-3874-1. eCollection 2014. View chapter Purchase book. Spinal cord stimulation for neuropathic pain: current perspectives. Use the link below to share a full-text version of this article with your friends and colleagues. History, physical exam, and diagnostic work-up were consistent with meralgia paresthetica. The transducer was gently moved in a mediocaudal direction while the operator searched for the echo signature of the lateral femoral cutaneous nerve. Meralgia paresthetica can occur if diabetes is untreated not the other way around. Two months after the implantation, she continued to have 100% pain relief, worked full-time, was physically active, and no longer required any pain medication including opioids. History, physical exam, and diagnostic work-up were consistent with meralgia paresthetica. Learn about our remote access options. Randomized placebo‐controlled trials of this treatment should be considered in the future. Treatment of meralgia paresthetica with ultrasound‐guided perineural injections resulted in substantial symptom relief in most patients 2 months after injection. Medications commonly utilized in the treatment of neuropathic pain, such as gabapentin, may be used. Peripheral Nerve Stimulation: A New Treatment for Meralgia Paresthetica. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, By continuing to browse this site, you agree to its use of cookies as described in our, I have read and accept the Wiley Online Library Terms and Conditions of Use, The lateral femoral cutaneous nerve block, Management of meralgia paresthetica: a multimodality regimen, Evaluation of local anaesthetic blockade of the lateral femoral cutaneous nerve, Lateral femoral cutaneous nerve block revisited: a nerve stimulator technique, Anatomic study of the lateral femoral cutaneous nerve with respect to the ilioinguinal surgical dissection, Anatomical variations of the lateral femoral cutaneous nerve and the consequences for surgery, Lateral femoral cutaneous nerve: an anatomic study, Anatomical course of the lateral femoral cutaneous nerve and its susceptibility to compression and injury, Ultrasound-guided blockade of the lateral femoral cutaneous nerve: technical description and review of 10 cases, Peripheral nerves: ultrasound-guided interventional procedures, US-guided treatment of meralgia paresthetica (lateral femoral cutaneous nerve neuropathy): results of treatment in 9 patients, Ultrasound of the lateral femoral cutaneous nerve: normal findings in a cadaver and in volunteers, Relieving symptoms of meralgia paresthetica using Kinesio taping: a pilot study, Operative treatment of meralgia paresthetica: transection versus neurolysis, Ultrasound-guided visco-supplementation of subacromial space in elderly patients with cuff tear arthropathy using a high weight hyaluronic acid: prospective open-label non-randomized trial, https://doi.org/10.7863/jum.2011.30.10.1341. Meralgia paresthetica is a condition caused by compression of the nerve that supplies sensation to the thigh’s skin surface. An alternative to surgery may be administration of local lidocaine with steroids around the course of the lateral femoral cutaneous nerve.15 Ultrasound‐guided injections allow real‐time visualization of relevant anatomy and needle positioning. Moreover, the needle had to be inserted at an angle that normally is not supported by commercially available devices. doi: 10.1093/pm/pnaa326. In this study, sonography identified the nerve in all cases, including 4 obese patients. 1982 Jun;5(2):73-8. Department of Radiology, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy. Corticosteroids are artificial substances that mimic cortisol, a stress hormone created by the adrenal gland. In persistent cases a steroid injection around the nerve may help. Experts can help answer questions about meralgia paresthetica prevention or if meralgia paresthetica … However, after 2 injections, all patients reported improvement of symptoms, and none of them required a third injection. This approach guaranteed successful treatment in every patient. Twenty consecutive patients (7 male and 13 female; age range, 23–66 years; mean, 39 years) with meralgia paresthetica confirmed by electromyography were treated with perineural injection of 1 mL of methylprednisolone acetate (40 mg/mL) and 8 mL of … Ultrasound-guided perineural injection of the lateral femoral cutaneous nerve is quick, safe, simple, economical, and effective in percutaneous treatment of meralgia paresthetica. As the lateral femoral cutaneous nerve passes through the groin to supply feeling to the outer part of the thigh. ... Dispersion of the injection fluid is continuously monitored by means of ultrasound, so that dispersion around the nerve can be observed. The average time for the procedure was 12 minutes (range, 5–14 minutes), mainly depending on the time needed to find the lateral femoral cutaneous nerve. The approach was tailored depending on the position of the lateral femoral cutaneous nerve relative to the anterior superior iliac spine. The injection can include a steroid (to reduce inflammation) and/or lidocaine or marcaine (to reduce pain). I’m going to explain what this diagnosis means, one simple trick to elevate the pain and what likely caused neuralgia parenthetica in the first place. B, The therapeutic solution is injected in the perineural tissues (star) and spaces the nerve out from the adjacent structures. In this study, real‐time visualization of the nerve resolved the problem of anatomic variability and probably increased the effectiveness of the procedure. Epub 2015 Jun 21. | Meralgia paresthetica is a lateral femoral cutaneous nerve entrapment syndrome causing burning, numbness, and paresthesias along the proximolateral aspect of the thigh. Several limitations of the study should be taken into account. Decompression or resection of the nerve by an orthopedic surgeon may be needed in extreme cases; •Surgery is done only in severe cases. Alimran Medical center. Once the nerve was visualized in a transverse plane, the nerve was traced proximally and distally to confirm its appropriate course toward the lateral thigh. Meralgia paresthetica is usually treated by eradicating the cause of nerve compression. J Pain Res. The patients were given detailed information on the procedure, and informed written consent was obtained from all of them. The anterior superior iliac spine was palpated and visualized with the ultrasound probe as a hyperechoic structure with posterior acoustic shadowing. Two parameters were measured before the first treatment and during follow‐up. The most serious complication after the injection is infection. Multiple medications, physical therapy, and chiropractic therapy were not successful for this patient. The symptoms disappeared in all patients 2 months after injection (mean visual analog scale score ± SD for lateral femoral cutaneous neuropathy at baseline, 8.1 ± 2.1; at 2 months, 2.1 ± 0.5; t = 6.2; P < .001). Online ahead of print. Some meralgia paresthetica patients may benefit from corticosteroid injections. Another possible limitation was the relatively low number of patients evaluated; however, to the best of our knowledge, this study included the largest number of patients treated under ultrasound guidance to date. Meralgia paresthetica is chronic pain, numbness, and tingling in the outer part of your upper thigh. In most instances, the injection is performed just inferior to the inguinal ligament and 1 cm medial to the anterior superior iliac spine (ASIS). It is idiopathic most patients but can also be caused by trauma (avulsion fracture of the anterior superior iliac spine), pelvic and retroperitoneal tumors, stretching of the nerve due to prolonged leg and trunk hyperextension, leg length discrepancies, prolonged standing, external compression by belts, weight gain, and tight clothing.16 The initial treatment of meralgia paresthetica is conservative.17 Patients who do not respond to conservative measures may be considered for surgical decompression. Moreover, the results of this study were both clinically and statistically significant. Randomized placebo‐controlled trials of this treatment should be considered in the future. Five patients felt slight sharp pain in the anterolateral thigh during needle insertion; the pain disappeared immediately after needle repositioning. In some cases, perhaps the easiest treatment would be to leave the lateral cutaneous femoral nerve alone, as most cases of meralgia paresthetica resolve on their own. The 4 remaining patients (20%) required a further perineural injection. Prevention and treatment information (HHS). Methods. Conservative and chiropractic treatment of meralgia paresthetica: review and case report. If you do not receive an email within 10 minutes, your email address may not be registered, After injection, no local or general complications were observed. Like cortisol, the steroids reduce inflammation in the nerve and provide temporary pain relief. Please check your email for instructions on resetting your password. Meralgia paresthetica is a rare entrapment neuropathy, and most patients only require medical treatment. Needle insertion was performed by a freehand technique With this method, one hand held the transducer, and the free hand inserted the needle. First, we did not have a control group, and the follow‐up duration was short. The procedure in all cases was performed by 3 sonographers with expertise in interventional musculoskeletal procedures (G.S., F.L., and A.T.) using a commercially available ultrasound scanner equipped with a 7‐ to 17‐MHz transducer. Patients were referred to the sonography unit for treatment with ultrasound‐guided percutaneous perineural injection of methylprednisolone acetate and a local anesthetic. ltrasounduided iagnosis and Treatment of Meralgia aresthetica axis) technique and the latter refers to a blind injection after precise sonographic measurements have been ac-quired. Chopra PJ, Shankaran RK, Murugeshan DC; Meralgia 1992 Feb 18;81(8):215-21. Between June 2009 and January 2011, 20 consecutive patients (7 male and 13 female; age range, 23–66 years; mean, 39 years; body mass index range, 20.14–31.12 kg/m2; mean, 25.22 kg/m2) with a diagnosis of meralgia paresthetica (bilateral in 1 patient) were included in this prospective study. Background: Surgery. Under rigorous aseptic conditions, the transducer was inserted into a sterile bag, and sterile gel was applied to the area of interest. This method showed good validity and excellent reliability.14 A repeated (dependent) measures t test was used to evaluate the differences before and after the treatment. | C, Illustration of the procedure. 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