Chiropractic management of chronic idiopathic meralgia paresthetica: a case study

Chiropractic management of bilateral meralgia paresthetica: a case report

Objective

The purpose of this report is to describe the course of chiropractic care for an adult male experiencing persistent anterolateral thigh pain due to bilateral meralgia paresthetica.

Clinical features

A 40-year-old male U.S. Veteran was referred to chiropractic care for a two-year history of bilateral anterolateral thigh pain and paresthesia that worsened with inguinal pressure and hip extension activities.

Intervention and outcomes

A total of six chiropractic visits, including a combination of telehealth and in-person appointments, took place over a period of 10 weeks. Treatments included patient education, soft-tissue therapy, therapeutic exercise prescription, and spinal manipulation directed toward the lumbar spine. The patient's pain was reduced from a 6/10 rating to a 0/10, he was able to reengage in recreational activities without discomfort, and sustained improvement was reported.

Summary

In this case, a trial of chiropractic care was associated with a resolution of the patient's bilateral meralgia paresthetica symptoms.

Chiropractic Management of a Patient With Radial Nerve Entrapment Symptoms: A Case Study

Objective

This report describes the case of a patient with chronic radial nerve entrapment symptoms managed with chiropractic care. We propose a complementary functional neurologic assessment of muscle function in different positions that could reveal muscle dysfunctions absent with standard test position.

Clinical Features

A 45-year-old man presented to a private chiropractic clinic with a throbbing pain 5 cm above the right lateral elbow epicondyle radiating onto the back of the lower arm and increasing after using a mouse when working on a computer. A Mill test and a Cozen test created pain near the lateral epicondylitis. The use of complementary functional neurologic assessment for radial nerve entrapment showed changes in manual muscle testing after tests were done in different positions to increase the compression on the nerve.

Intervention and Outcome

Chiropractic management was performed, including myofascial therapy, spinal and proximal radioulnar joint adjustments, neural mobilization, and the use of a splint. After 7 days (2 treatments), the patient showed no elbow pain even if he worked on his computer using a mouse. After a 2-year follow-up, no recurrence was reported.

Conclusion

In this case of radial nerve entrapment symptoms, the patient benefited from chiropractic management using standard chiropractic, applied kinesiology, and neural mobilization techniques. The complementary functional neurologic assessment of radial nerve entrapment proposed revealed muscles dysfunctions absent with the standard test position. These changes in manual muscle testing were useful to determine the possible sites of entrapment in order to direct the therapeutic efforts to these locations.

Meralgia paresthetica: a review of the literature

BACKGROUND AND PURPOSE

Meralgia Paresthetica (MP) is a nerve entrapment which may cause pain, paresthesias, and sensory loss within the distribution of the lateral cutaneous nerve of the thigh. When the differential diagnosis of lateral or anterolateral thigh pain is inconclusive, MP should be considered as a potential source. MP produces similar signs and symptoms as those associated with more common diagnoses such as lumbar spine pathology. This clinical commentary will review the most relevant literature on MP with an emphasis on recognition and management of this condition.

DESCRIPTION OF TOPIC WITH RELATED EVIDENCE

The authors reviewed the most relevant published literature on MP from 1970 to 2013 located using the databases PubMed, CINAHL, and Proquest.

DISCUSSION/RELATION TO CLINICAL PRACTICE

MP still remains a diagnostic challenge since it can mimic other common diagnoses. Understanding the current literature surrounding the diagnosis and treatment of MP is essential for clinicians practicing in the outpatient environment. The consensus on the most effective non-surgical and surgical interventions is still limited, as is the research on physical therapy interventions for this condition. Perhaps the lack of research and global consensus represents a knowledge deficit that makes MP a challenge to diagnose and successfully treat. Future collaborative studies are needed to improve the clinical diagnostics and understanding of interventions for this pathology.

LEVEL OF EVIDENCE

5.