1

Journal of Neurological Sciences and

Research
Genesis-JNSR-4(2)-38
Volume 4 | Issue 2
Open Access
ISSN:3048-5797

Diagnosis and Treatment of Meralgia

Paresthetica (Literature Review)
Dmytro Stelmashchuk*
Neurologist, Kyiv, Ukraine

*Corresponding author: Neurologist, Kyiv, Ukraine.

Copyright©️ 2024 genesis pub by Stelmashchuk D. CC BY-
Citation: Stelmashchuk D. Diagnosis and Treatment of NC-ND 4.0 DEED. This is an open-access article distributed
Meralgia Paresthetica (Literature Review). J Neurol Sci under the terms of the Creative Commons Attribution-Non-
Res. 2(1):1-7. Commercial-No Derivatives 4.0 International License. This
allows others distribute, remix, tweak, and build upon the
Received: October 1, 2024 | Published: October 10,
work, even commercially, as long as they credit the authors
2024
for the original creation.

Abstract
Meralgia paresthetica (MP) is a condition characterized by damage to the lateral femoral cutaneous nerve
(LFCN), leading to sensory disturbances and pain in the anterolateral thigh. Currently, studies on MP
interventions are scarce, with most available data being limited to case reports and small-scale studies. This
article reviews the available diagnostic and therapeutic approaches for MP, highlighting the need for
further research into more effective treatments. The primary aim of this article is to raise awareness of
meralgia paresthetica and assist clinicians in its diagnosis and management.

Keywords
Meralgia paresthetica; Bernhardt-Roth Syndrome; Lateral femoral cutaneous nerve.

Mini-Review | Stelmashchuk D. J Neurol Sci Res. 2024, 4(2)-38

DOI: http://doi.org/10.52793/JNSRR.2024.4(2)-38
 2

Introduction
Meralgia paresthetica (Bernhardt-Roth Syndrome, Lateral femoral cutaneous nerve neuropathy) is a
pathological condition characterized by burning pain, tingling, and other sensory disturbances in the
anterolateral region of the thigh, resulting from compression and injury to the lateral femoral cutaneous nerve
[1]. The lateral femoral cutaneous nerve (LFCN) is purely an afferent sensory nerve, with its terminal receptors
located in the area of the anterolateral part of the skin of the thigh. The nerve typically courses anterior to the
anterior superior iliac spine (ASIS), where it lies beneath or passes through the inguinal ligament. The nerve
continues through the pelvis and then passes through the psoas major muscle, reaching the L2-L3 spinal roots
and the posterior spinal roots [2].

Despite its rarity, meralgia paresthetica (MP) is one of the most common compression-ischemic neuropathies
of the lower limbs. The prevalence of the condition is 32-43 cases per 100,000 people per year [1,3,4]. In
patients with diabetes mellitus, the incidence increases fivefold compared to the general population, reaching
247 cases per 100,000 individuals [5]. Interestingly, the incidence among military personnel is nearly twice that
of the average incidence in the general population, amounting to 62 cases per 100,000 service members [6].

The causes of lateral femoral cutaneous nerve injury are diverse, including metabolic factors (such us diabetes
mellitus, hypothyroidism, alcohol intoxication), internal nerve compression (caused by increased intra-
abdominal pressure due to obesity, pregnancy, or the development of a tumor) and external nerve
compression (resulting from tight straps or seat belts, restrictive clothing) [1, 3]. As well as iatrogenic causes
due to surgical interventions or direct nerve damage during hip replacement surgery, spinal surgeries, or
laparoscopic procedures in the groin area [2,7]. Additionally, meralgia paresthetica may occur as a complication
of postoperative positioning [8], or after prone positioning ventilation [9-10]. The condition can occur at any
age, but the incidence is highest among those aged 40 to 60 years [5].

Diagnosis
For diagnosis, it is important to take a thorough medical history and perform an appropriate physical
examination. Although the diagnosis of meralgia paresthetica is essentially clinical, auxiliary diagnostic
methods such as nerve conduction studies and ultrasound examination are useful complementary tools.

Clinical characteristics of MP:

1. Сausalgia or burning pain, paresthesias, and hypesthesia over the upper lateral thigh
2. Symptoms are typically unilateral.
3. The development of the pathology is usually subacute, occurring over several days or weeks
4. Symptoms may be associated with prolonged hip extension, such as during walking, rising from a
seated position, or prolonged standing.

A diagnostic maneuver that can be used for diagnosis:

1. The Pelvic Compression Test: the patient should be positioned on the unaffected side, and the
examiner applies a downward compressive force on the patient's pelvis for 45 seconds. If the patient
reports relief of symptoms, the test is considered positive. The sensitivity of the test is 95%, and the
specificity is 93.3% [11].

Mini-Review | Stelmashchuk D. J Neurol Sci Res. 2024, 4(2)-38

DOI: http://doi.org/10.52793/JNSRR.2024.4(2)-38
 3

When alarming, non-specific signs for MP (red flags) are detected, it is necessary to thoroughly examine
the patient to conduct a differential diagnosis [12-13]. These (red flags) include: Motor deficits and reflex
changes (which are characteristic of lumbar stenosis, intervertebral disc herniation with nerve root
radiculopathy or damage to a peripheral motor nerve, in this case, the femoral nerve), history of cancer (if
bone metastasis is suspected).

2. Nerve conduction study [14-17]: Sensory nerve conduction studies are useful for confirming the
diagnosis and determining the severity of LFCN damage. Such an examination is especially useful in
cases of unilateral damage, as it allows for the comparison of SNAP changes on both sides.
Electrophysiological examination can also be used to assess the functional capacity of the nerve during
the course of treatment. The normal amplitude (μV) is ≥4 [17].

The examination is useful but has several drawbacks:

In some normal individuals without symptoms, especially those older than age 40, these responses may be
very small, requiring electronic averaging, or may be absent. Thus, a low-amplitude or absent potential
should not necessarily be interpreted as abnormal. Side-to-side comparisons often are very useful in this
regard if one side is symptomatic and the other is not [17].

• Electrophysiological examination of the LFCN is technically challenging, especially in patients with

obesity. Thus, a low-amplitude or absent potential should not necessarily be interpreted as abnormal
unless side-to-side comparisons are done in patients with symptoms limited to one side [18].

Ultrasonography
The advantages of ultrasonography are its general availability and quickness. This method is useful both for
diagnosis (localizing the site of damage, ruling out neoplasms) and for treatment (localizing the nerve during
injection). For compressive neuropathy, an increase in the cross-sectional area (> 5 mm² is considered
pathological) of the LFCN and hypoechogenicity of the nerve bundles are typical [18-19]. Ultrasound is more
sensitive for abnormalities than MRI [20].

MRI
MRI is used to perform differential diagnosis to rule out tumor formations in the pelvic area, as well as to
exclude urogenital or gynecological diseases, and and lumbar disc herniations. MRI can also detect signal
changes and neuroma formation of the LFCN associated with compression or trauma [21].

Treatment
Treatment of MP includes treatment of the underlying cause (if any) and conservative treatment. Surgical
intervention is recommended only when all non-surgical methods of treatment have failed to provide effective
treatment.
MP is a benign condition with possible spontaneous remission. According to the study by Ecker et al [22]
spontaneous improvement occurred in 69% (in 20 out of 29 patients) without medical interventions. Chhuttani
et al [23] reported improvement in 70% (in 42 out of 60 patients).

Mini-Review | Stelmashchuk D. J Neurol Sci Res. 2024, 4(2)-38

DOI: http://doi.org/10.52793/JNSRR.2024.4(2)-38
 4

1. Preventive measures: Since the main causes of the pathology are now known, it is advisable to counsel each
patient on preventive methods, such as avoiding and preventing further nerve compression. This includes
weight reduction, regular exercise, avoiding tight clothing, and managing concomitant metabolic disorders.
2. Injection: Injection therapy with anesthetic and/or glucocorticosteroid under ultrasound guidance is
particularly beneficial for patients with neuropathic pain syndrome [24-26]. Performing the injection under
ultrasound guidance allows for the demonstration of morphological changes and the identification of
anatomical variations in the course of the lateral femoral cutaneous nerve [27-28]. A total of five major nerve
course variations have been described [29]. Ultrasound guidance also helps visualize the spread of the
medication in real-time, reducing the likelihood of complications during the blockade and decreasing the need
for repeat injections.
The main mechanism of analgesic action of corticosteroids is associated with their antiinflammatory and
membrane-stabilizing properties through inhibition of myelinated C fiber transmission and inhibition of ectopic
release [24].

Local injection of anesthetic drugs blocks A-delta and C fibers, inhibits sodium channels of sympathetic nerves,
leading to the release of nitric oxide, which increases vascular microcirculation and reduces inflammation [30-
31].

3. Medications for neuropathic pain relief that can be used include [32]:

• Tricyclic antidepressants
• Anticonvulsants: gabapentin, pregabalin
• Topical therapy with capsaicin [33]
• Topical application of lidocaine [34]

4. Therapeutic exercise and manual techniques [35-38]: Some clinical case reports indicate the benefits of
manual techniques and therapeutic exercises. Treatment may include the following techniques: Active Release
Techniques (ART), mobilization for the pelvis, myofascial therapy for the rectus femoris and illiopsoas,
transverse friction massage of the inguinal ligament, exercises to improve flexibility of the hip and pelvic
muscles, along with stabilization exercises for the pelvis and strengthening of the abdominal core. These
interventions are safe and effective for alleviating symptoms in MP.

5. Transcutaneous electrical nerve stimulation (TENS): 10 sessions, 5 days per week for 2 weeks, with 20
minutes per daily session [24].

6. Kinesiotaping: It may be an additional method in the treatment of MP. Although the exact physiological
mechanism of action is unknown, there is a single study involving a group of 10 patients with a clinical and
electromyographic diagnosis of MP, where kinesiotaping was used, and improvement in patients' condition
was reported over the 4-week study period [39].

7. Acupuncture [40-41]: There are several studies reporting successful treatment of MP with acupuncture;
however, the exact physiological mechanisms are still under investigation. Further research is needed to gain
a broader understanding of the effectiveness of acupuncture in treating MP.

Mini-Review | Stelmashchuk D. J Neurol Sci Res. 2024, 4(2)-38

DOI: http://doi.org/10.52793/JNSRR.2024.4(2)-38
 5

8. Surgical [42-44]: neurolysis (decompression and transposition) or neurectomy. Surgical intervention for MP
is generally reserved for patients who are resistant to conservative treatment.

Discussion /Conclusion
Current studies on interventions for MP are scarce. Available data are mostly limited to single case reports and
studies with small sample sizes. Further multicenter randomized clinical trials are needed to develop a
comprehensive approach to treatment and diagnosis, as well as to unify all previous data. Given the aging
population and the rising prevalence of obesity, metabolic syndrome, and diabetes mellitus, an increase in the
incidence of meralgia paresthetica can be anticipated, making this issue relevant for further research.

References
1. Coffey R, Gupta V. 2024 Meralgia Paresthetica. 2023 May 1. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing, PMID: 32491667.
2. Swezey E, Bordoni B. 2024 Anatomy, Bony Pelvis and Lower Limb, Lateral Femoral Cutaneous Nerve. 2023 Aug
8. In: StatPearls [Internet]. Treasure Island (FL) StatPearls Publishing PMID: 30335334.
3. Parisi TJ, Mandrekar J, Dyck PJB, Klein CJ. 2011. Meralgia paresthetica: relation to obesity, advanced age, and
diabetes mellitus. Neurology. 77:1538–1542.
4. Van Slobbe AM, Bohnen AM, Bernsen RM, Koes BW, Bierma-Zeinstra SM. 2004 Incidence rates and determinants
in meralgia paresthetica in general practice. J Neurol. 251(3):294-7.
5. Weng WC, Wei YC, Huang WY, Chien YY, Peng TI, et al. 2017 Risk factor analysis for meralgia paresthetica: A
hospital-based study in Taiwan. J Clin Neurosci. 43:192-195.
6. Knapik JJ, Reynolds KL, Orr R, Pope R. 2017 Load Carriage-Related Paresthesias (Part 2): Meralgia Paresthetica. J
Spec Oper Med. Spring. 17;(1):94-100.
7. Scholz C, Hohenhaus M, Pedro MT, Uerschels AK, Dengler NF.2023 Meralgia Paresthetica: Relevance, Diagnosis,
and Treatment. Dtsch Arztebl Int. 29;120(39):655-661.
8. Yoshida S, Oya S, Matsui T. 2021 Risk factors of meralgia paresthetica after prone position surgery: Possible
influence of operating position, laminectomy level, and preoperative thoracic kyphosis. J Clin Neurosci. 89:292-
296.
9. Juhl CS, Ballegaard M, Bestle MH, Tfelt-Hansen P. 2016 Meralgia paresthetica after prone positioning ventilation
in the intensive care unit. Case Rep Crit Care. 2016:1–3.
10. Bellinghausen AL, LaBuzetta JN, Chu F, Novelli F, Rodelo AR, et al. 2020 Lessons from an ICU recovery clinic: two
cases of meralgia paresthetica after prone positioning to treat COVID-19-associated ARDS and modification of
unit practices. Crit Care.24:580
11. Nouraei SA, Anand B, Spink G, O'Neill KS. 2007 A novel approach to the diagnosis and management of meralgia
paresthetica. Neurosurgery. 60(4):696‐700.
12. Harney D, Patijn J. 2007 Meralgia paresthetica: diagnosis and management strategies. Pain Med. 8(8):669-77.
13. Cheatham SW, Kolber MJ, Salamh PA. 2013 Meralgia paresthetica: a review of the literature. Int J Sports Phys
Ther. 8(6):883-93.
14. Suh DH, Kim DH, Park JW, Park BK. 2013 Sonographic and electrophysiologic findings in patients with meralgia
paresthetica. Clin Neurophysiol. 124:1460–1464.
15. Tataroglu C, Coban A, Sair A, Kizilay Z. 2019 Inguinal segmental nerve conduction of the lateral femoral cutaneous
nerve in healthy controls and in patients with meralgia paresthetica. J Clin Neurosci. 67:40–45.
16. Seror P, Seror R. 2006 Meralgia paresthetica: Clinical and electrophysiological diagnosis in 120 cases. Muscle
Nerve. 33:650–654.

Mini-Review | Stelmashchuk D. J Neurol Sci Res. 2024, 4(2)-38

DOI: http://doi.org/10.52793/JNSRR.2024.4(2)-38
 6

17. Electromyography and Neuromuscular Disorders: Clinical-Electrophysiologic-Ultrasound Correlations 4th Edition

by David C. Preston, Barbara E. Shapiro.
18. Shin YB, Park JH, Kwon DR, Park BK. 2006 Variability in conduction of the lateral femoral cutaneous nerve. Muscle
Nerve. 33(5):645–649.
19. Becciolini M, Pivec C, Riegler G. 2022 Ultrasound of the lateral femoral cutaneous nerve: a review of the literature
and pictorial essay. J Ultrasound Med. 41:1273–1284.
20. Powell GM, Baffour FI, Erie AJ, Puffer RC, Spinner RJ,et al. 2020 Sonographic evaluation of the lateral femoral
cutaneous nerve in meralgia paresthetica. Skeletal Radiol. 49(7):1135-1140.
21. Powell GM, Baffour FI, Erie AJ, Puffer RC, Spinner RJ,et al. 2020 Sonographic evaluation of the lateral femoral
cutaneous nerve in meralgia paresthetica. Skeletal Radiol. 49(7):1135-1140.
22. Ecker AD, Woltman HW. 1938 Meralgia paraesthetica: a report of one hundred and fifty cases. Journal of the
American Medical Association. 110:1650‐2.
23. Chhuttani PN, Chawla LS, Sharma TD. 1966 Meralgia paraesthetica. Acta Neurologica Scandinavica 42(4):483‐90.
24. Kiliç S, Özkan FÜ, Külcü DG, Öztürk G, Akpinar P, et al. 2020 Conservative Treatment Versus Ultrasound-Guided
Injection in the Management of Meralgia Paresthetica: A Randomized Controlled Trial. Pain Physician. 23(3):253-
262
25. Hurdle MF, Weingarten TN, Crisostomo RA, Psimos C, Smith J. 2007 Ultrasoundguided blockade of the lateral
femoral cutaneous nerve: Technical description and review of 10 cases. Arch Phys Med Rehabil 88:1362-1364
26. Tagliafico A, Serafini G, Lacelli F, Perrone N, Valsania V, et al. 2011 Ultrasound-guided treatment of meralgia
paresthetica (lateral femoral cutaneous neuropathy): Technical description and results of treatment in 20
consecutive patients. J Ultrasound Med 30:1341-1346.
27. Moritz T, Prosch H, Berzaczy D, Happak W, Lieba-Samal D et al.2013 Common anatomical variation in patients
with idiopathic meralgia paresthetica: A high resolution ultrasound case-control study. Pain Physician 16:287-
293.
28. De Ruiter GCW, Wesstein M, Vlak MHM. 2021 Preoperative Ultrasound in Patients with Meralgia Paresthetica to
Detect Anatomical Variations in the Course of the Lateral Femoral Cutaneous Nerve. World Neurosurg. 149:e29-
e35.
29. Aszmann OC, Dellon ES, Dellon AL. 1997 Anatomical course of the lateral femoral cutaneous nerve and its
susceptibility to compression and injury. Plast Reconstr Surg. 100(3):600‐604
30. Dernek B, Aydin T, Koseoglu PK, Kosegolu PK, Kesiktas FN et al. 2017 Comparison of the efficacy of lidocaine and
betamethasone dipropionate in carpal tunnel syndrome injection. J Back Musculoskelet Rehabil. 30:435-440.
31. Newton DJ, McLeod GA, Khan F, Belch JJ. 2007 Mechanisms influencing the vasoactive effects of lidocaine in
human skin. Anaesthesia. 62:146-150.
32. Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, et al. 2015 Pharmacotherapy for neuropathic pain in
adults: a systematic review and meta-analysis. Lancet Neurol. 14(2):162-73.
33. Puig L, Alegre M De, Moragas JM. 1995 Treatment of meralgia paraesthetica with topical capsaicin. Dermatology.
191:73–4.
34. Devers A, Galer BS. 2000 Topical lidocaine patch relieves a variety of neuropathic pain conditions: An open-label
study. Clin J Pain. 16:205–8
35. Kadel RE, Godbey WD, Davis BP. 1982 Conservative and chiropractic treatment of meralgia paresthetica: review
and case report. J Manipulative Physiol Ther. 5(2):73-8.
36. Houle S. 2012 Chiropractic management of chronic idiopathic meralgia paresthetica: a case study. J Chiropr Med.
11(1):36-41.
37. Skaggs CD, Winchester BA, Vianin M, Prather H. 2006 A manual therapy and exercise approach to meralgia
paresthetica in pregnancy: a case report. J Chiropr Med. 5(3):92-6.
38. Roecker CB, Hewawasam SR, Skalski MR. 2023 Chiropractic management of bilateral meralgia paresthetica: a
case report. J Can Chiropr Assoc. 67(2):175-185.
Mini-Review | Stelmashchuk D. J Neurol Sci Res. 2024, 4(2)-38
DOI: http://doi.org/10.52793/JNSRR.2024.4(2)-38
 7

39. Kalichman L, Vered E, Volchek L. 2010 Relieving symptoms of meralgia paresthetica using Kinesio taping: a pilot
study. Arch Phys Med Rehabil. 91(7):1137‐1139.
40. Aigner N, Aigner G, Fialka C, Fritz A. 1997 Möglichkeit der Behandlung der Meralgia paraesthetica mit
Akupunktur. Zwei Fallbeispiele [Therapy of meralgia paresthetica with acupuncture. Two case reports]. Schmerz.
11(2):113-5.
41. Yang XY, Shi GX, Li QQ, Zhang ZH, Xu Q et al. Characterization of deqi sensation and acupuncture effect. Evid
Based Complement Alternat Med. 2013:319734.
42. De Ruiter GC, Kloet A. 2015 Comparison of effectiveness of different surgical treatments for meralgia
paresthetica: Results of a prospective observational study and protocol for a randomized controlled trial. Clin
Neurol Neurosurg. 134:7-11.
43. Lu VM, Burks SS, Heath RN, Wolde T, Spinner RJ, et al. Meralgia paresthetica treated by injection, decompression,
and neurectomy: a systematic review and meta-analysis of pain and operative outcomes. J Neurosurg.
135(3):912-922.
44. Khalil N, Nicotra A, Rakowicz W. 2012 Treatment for meralgia paraesthetica. Cochrane Database Syst Rev.
12(12):CD004159.

Mini-Review | Stelmashchuk D. J Neurol Sci Res. 2024, 4(2)-38

DOI: http://doi.org/10.52793/JNSRR.2024.4(2)-38