Meralgia Paresthetica

Meralgia paresthetica is a compression neuropathy of the lateral femoral cutaneous nerve (LFCN).  As the LFCN travels from the spine to the thigh region, the nerve can be pinched between the anterior superior iliac spine, inguinal ligament attaching and overlaying musculature.  Pressure on this nerve causes feelings of burning, pain and numbness along the front and lateral part of the thigh, extending all the way from anterior hip, groin and gluteal area to the knee. The constellation of symptoms is called Meralgia paresthetica.


This condition can be caused by several different mechanisms:

•Abnormal anatomical spacing between the nerve and its tunnel (surrounding tissues), as noted in at least 5% of population

•Blunt trauma or surgery done in nearby areas, changing a previously normal to now abnormal (due to swelling and post-op scarring) spacing between the nerve and its tunnel

•Professional activities: police officers, firefighters and construction workers all wear heavy and loaded belts around their waist, exposing the nerve to excess and repetitive pressure, especially if anatomical nerve path abnormalities already exist.

•Various sports like karate or kickboxing.  Changes in body habitus such as abdominal obesity or pregnancies can contribute to repetitive stress and stretching of the nerve, especially if anatomical nerve path abnormalities already exist.

•Diabetic patients, due to abnormal glucose metabolism, may develop swelling of the nerve, as well as narrowing of the tunnel itself. This alters the normally perfect relationship between the nerve and its tunnel, making it now too narrow for the more swollen nerve, resulting in lateral femoral cutaneous nerve neuropathy. Therefore, diabetic patients are at much higher risk for experiencing symptoms of Meralgia paresthetica than the general population and may benefit from an early evaluation by a peripheral nerve surgeon, and early surgical treatment before the nerve is irreversibly damaged.


You should see Dr. Ducic for meralgia paresthetica if your symptoms persist:

•Despite the medical care prescribed to you by your physician

•Despite supportive medical care, such as activity and work adjustments

•After three months of prescribed medical and conservative care

•Despite good medical diabetic care

•If you had surgery for a different, non-nerve related problem that was followed with an acute lateral femoral cutaneous nerve functional loss (acute numbness, pain). With this presentation, timely evaluation and intervention within 6 or the most 12 weeks after its onset is critical to maximize the likelihood of a positive outcome. Restoration of nerve function may be significantly reduced if decompression is performed after 3 months from neuropathy onset. This is unfortunately often overlooked by many who instead choose a physical therapy and “let’s wait and see” approach.


Peripheral Nerve Surgery for Meralgia Paresthetica

Patients should first have their lower back evaluated by a neurologist to ensure their symptoms do not originate from the lumbar spine. The same MRI evaluation can exclude the presence of a compressing mass in the pelvis. If no masses or lumbar spine pathology  is identified, conservative methods such as supportive medications and lifestyle changes should be initially attempted. If symptoms persist despite these measures beyond three months, evaluation by me for possible peripheral nerve surgery is warranted.  It is my belief and practice that addressing the cause of the problem, rather than focusing on the symptoms, is the only effective way to address any neuropathy, including lateral femoral cutaneous nerve-related meralgia paresthetica. Therefore, I do not find injections, chronic pain medications, radiofrequency ablation (RFA), or spinal cord stimulators appropriate since they all are symptomatic treatments only. The success of the surgery depends on how long the nerve has been compressed, the severity of the compression, the extent of nerve damage due to injury and the possible presence of underlying medical or spine problems.


During peripheral nerve surgery for Meralgia paresthetica:

1.You will receive anesthesia so you won’t feel any pain during the surgery.

2.Applying minimally invasive peripheral nerve surgery principles, I make a small incision next to the anterior hip/groin area. Decompression of the nerve is done using microsurgical instruments and techniques. The skin is then closed in anatomical layers.

3.The surgery is done as an outpatient. Dressings will stay on for about 3-4 days, while the sutures are removed two-three weeks later.


If you are not sure about your eligibility for surgery, and if you are not in the Washington, D.C. area, you can send me your records so I can determine if you are a good candidate for treatment. Visit my patient forms page for a downloadable form.

 

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            Dr. Ducic Plastic & Nerve Surgery