MERALGIA PARESTHETICA
Definition
Meralgia paresthetica is a condition characterized by tingling, numbness and burning pain in the outer part
of your thigh. The cause of meralgia paresthetica is compression of the nerve that supplies sensation to the
skin surface of your thigh.
Tight clothing, obesity or weight gain, and pregnancy are common causes of meralgia paresthetica.
However, meralgia paresthetica can also be due to local trauma or a disease, such as diabetes.
In most cases, meralgia paresthetica can be relieved with conservative measures, such as wearing looser
clothing. In severe cases, treatment may include medications to relieve discomfort or, rarely, surgery.
Symptoms
Pressure on the lateral femoral cutaneous nerve, which supplies sensation to your upper thigh, may cause
these symptoms of meralgia paresthetica:
Tingling and numbness in the outer (lateral) part of your thigh
Burning pain in or on the surface of the outer part of your thigh
Less commonly, dull pain in your groin area or across your buttocks
These symptoms commonly occur only on one side of your body and may intensify after walking or standing.
When to see your doctor
See your doctor if you experience any of the symptoms of meralgia paresthetica listed above, including
tingling, numbness or burning pain in the outer part of your thigh.
Causes
Meralgia paresthetica occurs when the lateral femoral cutaneous nerve a nerve that supplies sensation to
the surface of your outer thigh becomes compressed, or "pinched." The lateral femoral cutaneous nerve is
purely a sensory nerve and does not affect your ability to use your leg muscles.
In most people, this nerve passes through the groin to the upper thigh without trouble. But in meralgia
paresthetica, the lateral femoral cutaneous nerve becomes trapped often under the inguinal ligament,
which runs along your groin from your abdomen to your upper thigh.
Common causes of this compression include any condition that increases pressure on the groin, including:
Tight clothing
Obesity
Pregnancy
Scar tissue near the inguinal ligament, due to injury or past surgery
Walking, cycling or standing for long periods of time
Nerve injury, which can be due to diabetes or seat belt injury after a motor vehicle accident, for example,
also can cause meralgia paresthetica.
Risk factors
The following conditions may increase your risk of meralgia paresthetica:
Extra weight.
Being overweight or obese may increase the pressure on your lateral femoral cutaneous nerve.
Pregnancy.
A growing belly puts added pressure on your groin, through which the lateral femoral cutaneous nerve
passes.
Diabetes.
Diabetes-related nerve injury can lead to meralgia paresthetica.
Age.
People between the ages of 40 and 60 are at a higher risk.
Tests and diagnosis
In most cases, your doctor can make a diagnosis of meralgia paresthetica based on your medical history and
a physical examination. He or she may touch the affected leg, ask you to describe the pain, and ask you to
trace out the specific location of the numb or painful area on your leg.
To rule out other conditions, your doctor may recommend:
X-ray imaging. This diagnostic tool uses electromagnetic radiation to make images of your hip and pelvic
area.
Electromyography (EMG). This test measures the electrical discharges produced in muscles to help evaluate
and diagnose muscle and nerve disorders. During the test, a thin needle electrode is placed into the muscle
to record electrical activity. Results of this test are normal in meralgia paresthetica, but the test may be
needed to exclude other disorders when the diagnosis isn't clear.
Nerve conduction study. In this test, patch-style electrodes are placed on your skin to stimulate the nerve
with a mild electrical impulse. The electrical impulse helps diagnose damaged nerves.
Physical examination
Examination reveals numbness of the anterolateral thigh in all or part of the area involved with the
paresthesias.
Occasionally, patients are hyperesthetic in this area.
Tapping over the upper and lateral aspects of the inguinal ligament or extending the thigh posteriorly, which
stretches the nerve, may reproduce or worsen the paresthesias.
Deep palpation just below the anterior superior iliac spine (pelvic compression testing) reproduces the
symptoms. A study in 45 patients found that the pelvic compression test had a sensitivity of 95% and a
specificity of 93.3% for meralgia paresthetica.
Motor strength in the involved leg should be normal.
Treatments and drugs
Removing the cause of compression is the best therapy.
In some patients, this entails weight loss and wearing loose clothing.
Most patients with meralgia paresthetica will have mild symptoms that respond to conservative
management.
Neurogenic pain medications such as carbamazepine or gabapentin typically are not as helpful but may be
beneficial in rare patients. If medication of this type is required, then surgical decompression should be
considered.
Conservative measures
Conservative measures are effective for most people, with pain usually going away within a few months.
They include:
Wearing looser clothing
Losing weight
Medications
If symptoms persist for more than two months or your pain is severe, treatment may include:
Corticosteroid injections.
Tricyclic antidepressants.
Surgery
Rarely, surgery is considered to decompress the nerve. This option is only for people with severe and longlasting symptoms.
Rehabilitation Program
Physical Therapy
Meralgia paresthetica (MP) is treated with conservative therapy, such as physical therapy, weight reduction
to reduce abdominal girth, heat application, and analgesics (see Medication). Patients should avoid wearing
constrictive garments, belts, or braces that impart excessive focal pressure at the IL.
Physical therapy may be recommended as an adjunct to analgesic medications for pain control in patients
with MP. In addition to moist heat, other modalities that may be recommended by the physical therapist
include transcutaneous electrical nerve stimulation, interferential current, or low-intensity phonophoresis.
These modalities are used to help alleviate pain and enable the patient to perform gentle stretching
exercises with greater ease.
Soft-tissue techniques (eg, trigger point therapy) also may be beneficial for pain and tightness in the hip and
thigh muscles. In addition, the physical therapist may instruct the patient in a general fitness program to
assist with weight reduction, as well as proper biomechanics and postural reeducation.
Treatment may comprise:
Spinal and pelvic realignment
Deep tissue massage/myofascial release
Joint mobilisation
Joint manipulation
Ultrasound/electrotherapy
Exercise programs to stretch, self treat and improve proprioception, balance, strength and core stability
Biomechanical Assessment
Neural mobilisation
Education / training advise/ phased return to exercise
Activity modification advice
Orthotic/Insole advice
Ice or heat treatment
Taping
Outer Thigh Meralgia Paresthetica Exercises
Hip Exercises
Reducing hip tightness is one way to alleviate the symptoms of meralgia paresthetica by improving flexibility
and building strength. Bridging consists of lying flat on the floor and lifting your bottom up while tightening
your gluteal muscles. Hip extensions involve lying on your belly and lifting your leg up while tightening the
gluteals. Standing hip abduction requires standing upright while slowly lifting each leg to one side, keeping
the knee straight.
Such exercises should not cause any thigh pain.
Quadriceps Stretches
The quadriceps muscles are located next to the sensory nerve involved in meralgia paresthetica. Stretching
these muscles can improve flexibility and strength in the upper thigh. A traditional quad stretch involves
pulling the heel of your foot back toward your buttocks while standing, stretching the length of the upper
thigh. Again, stretching should cease if pain occurs.
Lunges
Lunges strengthen both the hips and quadriceps muscles to help prevent thigh pain. These start by standing
upright and stepping forward with one foot, lowering the body until the opposite knee touches the ground at
a right angle. The exercise then can either be reversed or proceed forward by stepping with the opposite leg.
Resistance Bands
More advanced outer thigh exercises can incorporate resistance bands to improve flexibility and strength. A
resistance band is looped around the ankle and tied at the other end to a solid, immovable object. A variety
of exercises can then be accomplished, including extending the hip backward, outward and forward. These
should only be conducted when outer thigh pain is completely gone.
Considerations
While exercises are important to recovery, the most immediate response to meralgia paresthetica should be
rest. Athletes might try cross-training as a way to maintain fitness without aggravating the condition. Weight
loss, wearing loosely fitting clothes, and in some cases getting a corticosteroid injection will also help relieve
symptoms.
Lifestyle changes
The following self-care measures can help treat and prevent meralgia paresthetica:
Avoid wearing tight clothing.
Maintain a healthy weight, or lose weight if you're overweight.
Avoid standing or walking for long periods.
