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Chalk C, Namiranian D. Meralgia paresthetica. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:195-201. [PMID: 38697741 DOI: 10.1016/b978-0-323-90108-6.00013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Meralgia paresthetica is a common but probably underrecognized syndrome caused by dysfunction of the lateral femoral cutaneous nerve. The diagnosis is based on the patient's description of sensory disturbance, often painful, on the anterolateral aspect of the thigh, with normal strength and reflexes. Sensory nerve conduction studies and somatosensory evoked potentials may be used to support the diagnosis, but both have technical limitations, with low specificity and sensitivity. Risk factors for meralgia paresthetica include obesity, tight clothing, and diabetes mellitus. Some cases are complications of hip or lumbar spine surgery. Most cases are self-limited, but a small proportion of patients remain with refractory and disabling symptoms. Treatment options include medications for neuropathic pain, neurolysis, neurectomy, and radioablation, but controlled trials to compare efficacy are lacking.
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Affiliation(s)
- Colin Chalk
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.
| | - Dina Namiranian
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
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El-Din Mahmoud LS, El Meligie MM, Yehia RM. Effectiveness of the muscle energy technique on postpartum meralgia paresthetica: A randomized controlled trial. J Back Musculoskelet Rehabil 2022; 36:677-684. [PMID: 36617775 DOI: 10.3233/bmr-220090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The effectiveness of the muscle energy technique (MET) on postpartum meralgia paresthetica (MP) affecting the lateral femoral cutaneous nerve is unknown. OBJECTIVE To investigate the effectiveness of the MET on postpartum MP affecting the lateral femoral cutaneous nerve. METHODS In this randomized controlled trial, 30 patients with postpartum MP were randomly allocated to study and control groups. The study group received the MET with conventional therapeutic exercises and the control group received the conventional exercises alone for four weeks (thrice a week, for 30-40 minutes duration). Lateral femoral cutaneous nerve distal latency, pain intensity, response to the prone knee bend (PKB) test and pelvic compression test were assessed. RESULTS Patients allocated to the MET group had improvements compared to the controls in pain intensity (MD: -1.66, 95%CI -2.39 to -0.94), distal latency (MD: -0.66, 95%CI -0.94 to -0.36), and knee range of motion in the PKB test (MD: 19.5∘, 95%CI 13 to 26.1) with high treatment effects, Cohen's d -ES = 1.71, 1.86 and 2.24 respectively. However, there was no between-group difference for the pelvic compression test (p= 0.41). CONCLUSION The MET can reduce pain, distal latency, and increasingly prone knee range of motion and increase the prone knee range of motion in women with MP affecting the lateral femoral cutaneous nerve.
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Affiliation(s)
- Lama Saad El-Din Mahmoud
- Department of Neuromuscular Disorders and Its Surgery, Faculty of Physical Therapy, October 6 University, Giza, Egypt
| | - Mohamed Magdy El Meligie
- Department of Physical Therapy for Basic Sciences, Faculty of Physical Therapy, Ahram Canadian University, 6th of October City, Egypt
| | - Radwa Mohammed Yehia
- Department of Physical Therapy For Paediatrics and Women Health, Faculty Of Physical Therapy, Ahram Canadian University, Egypt
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Dengler NF. Treatment of idiopathic meralgia paresthetica – is there reliable evidence yet? Neurol Res 2022; 45:429-434. [PMID: 36520581 DOI: 10.1080/01616412.2022.2151115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Meralgia paresthetica is a common condition that is usually diagnosed by its classical clinical presentation and by exclusion of a spinal origin of pain, sensory loss, and/or paresthesias in the anterolateral thigh. Treatment modalities include conservative management, local injections, and surgical therapy. To date, no level 1 evidence exists about treatment options for idiopathic meralgia paresthetica. This review article aims to give a structured overview of epidemiology, history, anatomy, diagnostics, and treatment. It focuses on the existing literature and current developments in clinical management. METHODS A literature search on PubMed/MEDLINE was performed on 20 December 2021, yielding 1412 results. Abstracts were screened and classified in terms of epidemiology, anatomy, diagnostics, and treatment. RESULTS High-quality observational data that was included in recent meta-analyses showed satisfactory results for conservative management, injections, and surgical decompression or neurectomy, but there is some major methodological criticism. For idiopathic meralgia paresthetica, the results of surgical decompression have never been compared to those of neurectomy in a randomized setup. The only study protocol published so far does not consider any extended decompression techniques (dynamic, circumferent, proximal, and distal to the inguinal ligament). A multicenter, prospective design has never been proposed. DISCUSSION Reliable high-quality evidence on the treatment of idiopathic meralgia paresthetica is lacking at the current state, and challenges in clinical decision-making remain.
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Affiliation(s)
- Nora F. Dengler
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Saba EKA. Efficacy of neural prolotherapy in treatment of meralgia paresthetica: a case series. EGYPTIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1186/s41984-022-00160-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Meralgia paresthetica is an entrapment neuropathy. Neuropathic pain was reported to be improved by using neural prolotherapy. Aim of the research was to assess and evaluate the short-term efficacy of neural prolotherapy on relieving pain, paresthesia and improving function and quality of life of patients with meralgia paresthetica. The study included 19 lower limbs with idiopathic meralgia paresthetica obtained from 15 patients. Subcutaneous perineural injection of dextrose (5%) in sterile water was given once. All patients were evaluated for outcome measures twice, at baseline visit and at follow-up visit four weeks after the injection which included: patient assessment of overall symptoms of meralgia paresthetica, patient assessment of meralgia paresthetica pain, patient assessment of meralgia paresthetica paresthesia and patient assessment of meralgia paresthetica effect on function and quality of life using visual analogue scale.
Results
There was a statistically significant improvement in the visual analogue scale of patient assessment of overall meralgia paresthetica symptoms, patient assessment of meralgia paresthetica pain, patient assessment of meralgia paresthetica paresthesia and patient assessment of meralgia paresthetica effect on function and quality of life when the findings at the postinjection visit were compared to the preinjection assessment among all patients. All the patients tolerated the injection procedure-induced pain. All the patients experienced immediate postinjection relieve of the meralgia paresthetica pain. At the postinjection assessment visit, all patients were satisfied with the procedure. There were 12 lower limbs (63.2%) from 10 patients (66.6%) that showed improvement and recovery. Two patients of them had bilateral meralgia paresthetica. There was no patient withdrawal, and no patients were lost to follow-up. There was one lower limb (5.3%) from one patient (6.7%) who had bruises at the injection sites that resolved within few days after the procedure.
Conclusions
Neural prolotherapy is easy, safe, tolerable, effective and successful in treatment of meralgia paresthetica. It is effective in relieving pain, paresthesia and improving function and quality of life of patients with meralgia paresthetica. Neural prolotherapy injection should be included in the conservative treatment armamentarium of meralgia paresthetica.
Trial registration : NCT04499911. Registered 5 August 2020—retrospectively registered.
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Karaaslan T, Avarisli A, Durdu B, Daskaya H. A case of meralgia paresthetica caused by prone positioning in a COVID-19 patient with acute respiratory distress syndrome. EMERGENCY CARE JOURNAL 2022. [DOI: 10.4081/ecj.2022.10310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
COVID-19 critically ill patients usually require prone positioning for the treatment of respiratory failure caused by Acute Respiratory Distress Syndrome (ARDS). Prone position provides a better ventilation-perfusion compatibility, resulting in a significant improvement in oxygenation and a decrease in mortality, but prolonged prone positioning may cause Meralgia Paresthetica (MP), one of the most common mononeuropathies of the lower limb. The early diagnosis of MP is crucial to avoid a permanent damage with pain and disability, and to start immediately the correct treatment. In this article, we report a rare case of MP in a critically ill COVID-19 patient with ARDS, with the main aim to create awareness for MP among the medical team working.
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Gutiérrez Robles AE, Mousselli R, Gude L, Mohan A, Chang A. Successful application of spinal cord stimulation in a patient with refractory bilateral meralgia paresthetica. Pain Manag 2022; 12:409-416. [DOI: 10.2217/pmt-2021-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We present a 38-year-old morbidly obese male who presented with functionally limiting bilateral anterior thigh pain consistent with meralgia paresthetica. His symptoms had been unresponsive to conservative measures which included physical therapy, oral medications and multiple nerve blocks. Patient underwent a trial of spinal cord stimulation (SCS), experiencing 70% of pain relief. He then underwent permanent SCS implant. At subsequent follow-ups 3 and 6 months later, he continued to report 70% improvement of his pain, as well as improved function and quality of life. To our knowledge, this is only the second reported case of successful treatment of meralgia paresthetica with SCS, and the first in a morbidly obese patient.
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Affiliation(s)
- Andrés E Gutiérrez Robles
- Department of Physical Medicine & Rehabilitation, Resident Physician, Memorial Rehabilitation Institute at Memorial Healthcare System, Memorial Regional Hospital South, 3600 Washington St, Hollywood, FL 33021, USA
| | - Robert Mousselli
- Department of Physical Medicine & Rehabilitation, Resident Physician, Memorial Rehabilitation Institute at Memorial Healthcare System, Memorial Regional Hospital South, 3600 Washington St, Hollywood, FL 33021, USA
| | - Luis Gude
- Department of Physical Medicine & Rehabilitation, Resident Physician, University of Miami Health System/Jackson Health System, Christine E Lynn Rehabilitation Center, 1611 NW 12th Avenue, Miami, FL 33136, USA
| | - Abhinav Mohan
- Department of Physical Medicine & Rehabilitation, Resident Physician, Memorial Rehabilitation Institute at Memorial Healthcare System, Memorial Regional Hospital South, 3600 Washington St, Hollywood, FL 33021, USA
| | - Andrew Chang
- Department of Physical Medicine & Rehabilitation, Resident Physician, Memorial Rehabilitation Institute at Memorial Healthcare System, Memorial Regional Hospital South, 3600 Washington St, Hollywood, FL 33021, USA
- Department of Pain Medicine, Attending Physician, Memorial Rehabilitation Institute at Memorial Healthcare System, 3702 Washington St, Suite 303, Hollywood, FL 33021, USA
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Controversies in treatment strategies in patients with foot drop due to peroneal nerve entrapment: Results of a survey among specialists. BRAIN AND SPINE 2022; 2:100887. [PMID: 36248140 PMCID: PMC9560709 DOI: 10.1016/j.bas.2022.100887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/13/2022] [Accepted: 03/29/2022] [Indexed: 12/26/2022]
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Ostrominski JW, Huang Q, Kamenker-Orlov Y. Beneath the Surface: Massive Retroperitoneal Liposarcoma Masquerading as Meralgia Paresthetica. Fed Pract 2021; 38:S61-S67. [PMID: 34177242 DOI: 10.12788/fp.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In patients presenting with focal neurologic findings involving the lower extremities, a thorough abdominal examination should be considered an integral part of the full neurologic work up.
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Affiliation(s)
- John W Ostrominski
- is a Resident Primary Care Physician; is a Pathologist in the Department of Pathology and Laboratory Medicine; and is a Primary Care Physician and Director of the Resident Primary Care Clinic; all at the West Roxbury Veterans Affairs Medical Center. John Ostrominski is Resident in Internal Medicine, Qin Huang and Yelena Kamenker-Orlov are Assistant Professors, all at Brigham and Women's Hospital and Harvard Medical School in Massachusetts
| | - Qin Huang
- is a Resident Primary Care Physician; is a Pathologist in the Department of Pathology and Laboratory Medicine; and is a Primary Care Physician and Director of the Resident Primary Care Clinic; all at the West Roxbury Veterans Affairs Medical Center. John Ostrominski is Resident in Internal Medicine, Qin Huang and Yelena Kamenker-Orlov are Assistant Professors, all at Brigham and Women's Hospital and Harvard Medical School in Massachusetts
| | - Yelena Kamenker-Orlov
- is a Resident Primary Care Physician; is a Pathologist in the Department of Pathology and Laboratory Medicine; and is a Primary Care Physician and Director of the Resident Primary Care Clinic; all at the West Roxbury Veterans Affairs Medical Center. John Ostrominski is Resident in Internal Medicine, Qin Huang and Yelena Kamenker-Orlov are Assistant Professors, all at Brigham and Women's Hospital and Harvard Medical School in Massachusetts
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Kokubo R, Kim K, Umeoka K, Isu T, Morita A. Meralgia paresthetica attributable to surgery in the park-bench position. J NIPPON MED SCH 2021; 89:355-357. [PMID: 33692308 DOI: 10.1272/jnms.jnms.2022_89-112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Meralgia paresthetica (MP) is an entrapment neuropathy of the lateral femoral cutaneous nerve (LFCN). We report a rare MP complication after microvascular decompression (MVD) surgery in the park-bench position in a patient with hemi-facial spasm. CASE The patient was a 46-year-old female (height: 155 cm, weight: 42 kg). She was neither diabetic nor a regular alcohol user. After the first MVD for right hemifacial spasm, her symptom recurred and she underwent a second MVD procedure in the park-bench position that led to the disappearance of her hemifacial spasm. However, she complained of right antero-lateral thigh pain and dysesthesia without motor weakness. The symptom was limited to the LFCN area; pelvic compression test elicited a positive Tinel-like sign. Our preliminary diagnosis was MP. As conservative therapy was ineffective she underwent LFCN block 9 months after the second MVD procedure. Her symptom improved dramatically and we made a definitive diagnosis of MP. There has been no recurrence in the course of 30 months although she reported persistent mild dysesthesia in the LFCN area. CONCLUSION MP is a rare complication after MVD surgery in the park-bench position. Symptom abatement and a definitive early diagnosis can be obtained by LFCN blocks.
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Affiliation(s)
- Rinko Kokubo
- Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School
| | - Kyongsong Kim
- Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School
| | - Katsuya Umeoka
- Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School
| | - Toyohiko Isu
- Department of Neurosurgery, Kushiro Rosai Hospital
| | - Akio Morita
- Department of Neurosurgery, Nippon Medical School
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Abstract
Meralgia paresthetica (MP) is a painful mononeuropathy that causes paresthesia, tingling, stinging or a burning sensation in the thigh's anterolateral part due to the entrapment of the lateral femoral cutaneous nerve under the inguinal ligament. The treatment options for MP include conservative or interventional management and must follow an algorithm. The objective is to eliminate the underlying cause if known. In the present study, four patients with MP who were successfully treated with either conservative or interventional management are presented. The advantages and disadvantages of neurolysis (decompression and transposition) and neurectomy procedures for surgical treatments are discussed.
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Affiliation(s)
- Hande Gurbuz
- Department of Anesthesiology & Reanimation, University of Health Sciences, Bursa Yuksek Ihtisas Training & Research Hospital, Bursa, Turkey.,Formerly: Department of Anesthesiology & Reanimation, University of Health Sciences, Derince Training & Research Hospital, Kocaeli, Turkey
| | - Alper Gultekin
- Department of Orthopedics & Traumatology, University of Health Sciences, Derince Training & Research Hospital, Kocaeli, Turkey
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Lu VM, Burks SS, Heath RN, Wolde T, Spinner RJ, Levi AD. Meralgia paresthetica treated by injection, decompression, and neurectomy: a systematic review and meta-analysis of pain and operative outcomes. J Neurosurg 2021; 135:912-922. [PMID: 33450741 DOI: 10.3171/2020.7.jns202191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 07/31/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Meralgia paresthetica is caused by entrapment of the lateral femoral cutaneous nerve (LFCN) and often presents with pain. Multiple treatment options targeting the LFCN can be pursued to treat the pain should conservative measures fail, with the most common options being injection, neurolysis, and neurectomy. However, their efficacy in causing pain relief and their clinical outcomes have yet to be directly compared. The aim of this study was to interrogate the contemporary literature and quantitatively define how these options compare. METHODS The electronic databases Ovid Embase, PubMed, SCOPUS, and the Cochrane Library were interrogated from inception to May 2020 following the PRISMA guidelines. Candidate articles were screened against prespecified criteria. Outcome data were abstracted and pooled by random-effects meta-analysis of proportions. RESULTS There were 25 articles that satisfied all criteria, reporting outcomes for a total of 670 meralgia paresthetica patients, with 78 (12%) treated by injection, 496 (74%) by neurolysis, and 96 (14%) by neurectomy. The incidence of complete pain relief was 85% (95% CI 71%-96%) after neurectomy, 63% (95% CI 56%-71%) after neurolysis, and 22% (95% CI 13%-33%) after injection, which were all statistically different (p < 0.01). The incidence of revision procedures was 12% (95% CI 4%-22%) after neurolysis and 0% (95% CI 0%-2%) after neurectomy, which were significantly lower than 81% (95% CI 64%-94%) after injection (p < 0.01). The incidences of treatment complications were statistically comparable across all three treatments, ranging from 0% to 5% (p = 0.34). CONCLUSIONS There are multiple treatment options to target pain in meralgia paresthetica. The incidence of complete pain relief appears to be the greatest among the 3 interventions after neurectomy, accompanied by the lowest incidence of revision procedures. These findings should help inform patient preference and expectations. Greater exploration of the anatomical rationale for incomplete pain relief after surgical intervention will assist in optimizing further surgical treatment for meralgia paresthetica.
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Affiliation(s)
- Victor M Lu
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | - S Shelby Burks
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Rainya N Heath
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Tizeta Wolde
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Robert J Spinner
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Allan D Levi
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and
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Abstract
Importance Carpal tunnel syndrome and meralgia paresthetica are 2 common neuropathies complicating pregnancy. Each of these causes significant discomfort but can be diagnosed and treated safely during pregnancy. Objective This article outlines the existing literature diagnosis, treatment, and prognosis of carpal tunnel syndrome and meralgia paresthetica, specifically looking at the implications during pregnancy. The aim is to provide a reference for physicians diagnosing and treating neuropathies in pregnant patients. Evidence Acquisition Existing literature on neuropathies during pregnancy, clinical presentation, and treatment options for both carpal tunnel syndrome and meralgia paresthetica was reviewed through a MEDLINE and PubMed search. Referenced articles were reviewed and used as primary source materials as appropriate. Results Carpal tunnel syndrome affects individuals of all ages and sexes but is more prevalent in women, particularly during pregnancy. Meralgia paresthetica can occur in various circumstances but is most commonly associated with prolonged second stage in lithotomy position. Multiple clinical signs and neurologic tests are useful to establish the diagnosis of either neuropathy. Effective treatment for carpal tunnel syndrome includes wrist splints, steroid and lidocaine injections, and release surgery. Optimal treatment of meralgia paresthetica remains controversial but includes nerve block injections and active release techniques. Conclusions and Relevance Neuropathies are common in pregnancy and can result in significant impairment. Accurate diagnosis is possible during pregnancy and can usually be accomplished with bedside neurologic tests. Treatment options can be safely considered during pregnancy and can result in symptomatic improvement and reduction in chronic symptoms.
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Kıbıcı K, Erok B, Atca AÖ. Decompression and Neurolysis of the Lateral Femoral Cutaneous Nerve in the Surgical Treatment of Meralgia Paresthetica and the Results. INDIAN JOURNAL OF NEUROSURGERY 2020. [DOI: 10.1055/s-0040-1715785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractMeralgia paresthetica (MP), also known as Bernhardt–Roth syndrome, is a peripheral neuropathy of the primary sensory lateral femoral cutaneous nerve (LFCN). Its diagnosis is challenging, because it can mimic other clinical conditions particularly associated with upper lumbar spine or pelvis. Patients present with pain and paresthesia over the anterolateral thigh. Diagnosis is usually based on clinical examination and is supported by sensory nerve conduction (SNC) studies. The initial treatment is always conservative. In limited number of patients who are refractory to conservative managements, surgical treatment via decompression/neurolysis or neurectomy is concerned. There is still no consensus on which surgical technique is the best and the first choice. We retrospectively analyzed the surgical outcomes of 12 nonobese patients who underwent decompression/neurolysis between the years 2013 and 2018. Bilateral SNC studies were performed in all cases which supported the diagnosis. We applied conservative treatments for 3 months in addition to the treatments previously applied in other centers. Surgery was recommended for the patients who were refractory to these treatments. Preoperative and postoperative pain levels during follow-up visits were evaluated with visual analogue scale (VAS). A retrospective analysis was performed on preoperative and postoperative 6th month VAS scores. The mean preoperative VAS value was 8.75 ± 0.62 and the postoperative VAS value at the sixth month was 1.17 ± 0.72. A significant reduction in the pain was shown (p < 0.05). Our surgical results showed that decompression/neurolysis of the LFCN should be concerned as the primary surgical approach to avoid negative outcomes of resection surgeries.
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Affiliation(s)
- Kenan Kıbıcı
- Department of Neurosurgery, Altınbas University School of Medicine Bahcelievler Medical Park Hospital, İstanbul, Turkey
| | - Berrin Erok
- Department of Radiology, Cihanbeyli State Hospital, Konya, Turkey
| | - Ali Önder Atca
- Department of Radiology, Altınbas University School of Medicine Bahcelievler Medical Park Hospital, İstanbul, Turkey
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Affiliation(s)
- Ardo Sanjaya
- Lecturer at the Department of Anatomy, Faculty of Medicine, Maranatha Christian University, Bandung, Indonesia
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Malessy MJA, Eekhof J, Pondaag W. Dynamic decompression of the lateral femoral cutaneous nerve to treat meralgia paresthetica: technique and results. J Neurosurg 2018; 131:1552-1560. [PMID: 30544337 DOI: 10.3171/2018.9.jns182004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/26/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The results of lateral femoral cutaneous nerve (LFCN) decompression to treat idiopathic meralgia paresthetica (iMP) vary widely. Techniques to decompress the LFCN differ, which may affect outcome, but in MP it is unknown to what extent. The authors present a new technique using dynamic decompression and discuss the outcomes. METHODS A retrospective cohort study was performed in a consecutive series of 19 cases. The goal of decompression was pain relief and recovery of sensation. The plane ventral to the LFCN was decompressed by cutting the fascia lata and the inferior aspect of the inguinal ligament. The plane dorsal to the LFCN was decompressed by cutting the fascia of the sartorius muscle. Subsequently, the thigh was brought in full range of flexion and extension/abduction. The authors identified and additionally cut fibers that tightened and caused compression at various locations of the LFCN during movement in all patients, referring to this technique as dynamic decompression. Postoperatively, an independent neurologist scored pain and sensation on a 4-point scale: completely resolved, improved, not changed, or worsened. Patients scored their remaining pain or sensory deficit as a percentage of the preoperative level. Statistical assessment was done using ANOVA to assess the association between outcome and duration of preoperative symptoms, BMI, and length of follow-up. RESULTS In 17 of the 19 cases (89%), the pain and/or paresthesia completely resolved. Patients in the remaining 2 cases (11%) experienced 70% and 80% reduction in pain. Sensation completely recovered in 13 of the 19 cases (69%). In 5 of the 19 cases (26%) sensation improved, but an area of hypesthesia remained. Four of these 5 patients indicated a sensory improvement of more than 75%, and the remaining patient had 50% improvement. Sensation remained unchanged in 1 case (5%) with persisting hypesthesia and mild hyperesthesia. There was no significant impact of preoperative symptom duration, BMI, and length of follow-up on postoperative outcome. CONCLUSIONS Dynamic decompression of the LFCN is an effective technique for the treatment of iMP. Most patients become completely pain free and sensation recovers considerably.
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Affiliation(s)
- Martijn J A Malessy
- 1Leiden University Medical Center, and
- 2Alrijne Medical Center, Leiden, The Netherlands
| | - Job Eekhof
- 2Alrijne Medical Center, Leiden, The Netherlands
| | - Willem Pondaag
- 1Leiden University Medical Center, and
- 2Alrijne Medical Center, Leiden, The Netherlands
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Ataizi ZS, Ertilav K, Ercan S. Surgical options for meralgia paresthetica: long-term outcomes in 13 cases. Br J Neurosurg 2018; 33:188-191. [DOI: 10.1080/02688697.2018.1538480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Zeki Serdar Ataizi
- Department of Neurosurgery, Yunus Emre State Hospital, Eskisehir, Turkey
| | - Kemal Ertilav
- Department of Neurosurgery, School of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Serdar Ercan
- Department of Neurosurgery, Eskisehir State Hospital, Eskisehir, Turkey
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Morimoto D, Kim K, Kokubo R, Kitamura T, Iwamoto N, Matsumoto J, Sugawara A, Isu T, Morita A. Deep Decompression of the Lateral Femoral Cutaneous Nerve Under Local Anesthesia. World Neurosurg 2018; 118:e659-e665. [DOI: 10.1016/j.wneu.2018.06.252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
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Zagarella S. Nerve entrapment syndromes in dermatology: Review and practical approach to treatment. Australas J Dermatol 2018; 59:286-290. [PMID: 29676437 DOI: 10.1111/ajd.12822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 03/07/2018] [Indexed: 11/28/2022]
Abstract
A good understanding of cutaneous nerve entrapment syndromes is important for physicians to provide early and accurate diagnosis and treatment. These syndromes have traditionally been managed with analgesics, antidepressants or antiepileptic medication but this approach is often inadequate and causes frequent adverse medication effects. With early diagnosis and treatment, many nerve entrapment syndromes can be successfully managed with physical, non-pharmacological approaches including stretches, exercises and physiotherapy.
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Affiliation(s)
- Samuel Zagarella
- Department of Dermatology, Concord Hospital, University of Sydney Medical School, Sydney, New South Wales, Australia
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Abstract
Meralgia paresthetica is a non-life-threatening neurological disorder characterized by numbness, tingling, and burning pain over the anterolateral thigh due to impingement of the lateral femoral cutaneous nerve. This disorder has been seen in patients with diabetes mellitus and obesity, but has also been observed in patients after procedures such as posterior spine surgery, iliac crest bone grafts, lumbar disk surgery, hernia repair, appendectomies, and pelvic osteotomies that ultimately lead to compression or damage to the lateral femoral cutaneous nerve. Overall, permanent sequelae of meralgia paresthetica are rare, however, some cases do require intervention.
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Abstract
The purpose of this clinical commentary is to review the anatomy, etiology, evaluation, and treatment techniques for nerve entrapments of the hip region. Nerve entrapment can occur around musculotendinous, osseous, and ligamentous structures because of the potential for increased strain and compression on the peripheral nerve at those sites. The sequela of localized trauma may also result in nerve entrapment if normal nerve gliding is prevented. Nerve entrapment can be difficult to diagnose because patient complaints may be similar to and coexist with other musculoskeletal conditions in the hip and pelvic region. However, a detailed description of symptom location and findings from a comprehensive physical examination can be used to determine if an entrapment has occurred, and if so where. The sciatic, pudendal, obturator, femoral, and lateral femoral cutaneous are nerves that can be entrapped and serve a source of hip pain in the athletic population. Manual therapy, stretching and strengthening exercises, aerobic conditioning, and cognitive-behavioral education are potential interventions. When conservative treatment is ineffective at relieving symptoms surgical treatment with neurolysis or neurectomy may be considered. Level of Evidence 5.
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Evaluating the evidence: is neurolysis or neurectomy a better treatment for meralgia paresthetica? Acta Neurochir (Wien) 2017; 159:931-936. [PMID: 28283866 DOI: 10.1007/s00701-017-3136-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/22/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Meralgia paresthetica is a mononeuropathy of the lateral femoral cutaneous nerve (LCFN). Surgical treatment involves transection or decompression of the LCFN. There is no clear consensus on the superiority of one technique over the other. We performed a systematic review of the literature to answer this question. METHODS Eligible studies included those that compared neurolysis versus neurectomy for the treatment of meralgia paresthetica after failure of conservative therapy. Our outcome of interest was resolution of symptoms. We performed a computerized search of MEDLINE (PubMed; all years) and of the Cochrane Central Register of Controlled Trials. Eligible studies had to include the words "meralgia paresthetica" and "surgery." All patients regardless of age were included, and there was no language restriction. We then reviewed the articles' titles and abstracts. All studies that compared neurolysis to neurectomy were included in the analysis. RESULTS Of the studies identified, none were randomized controlled trials. There were two German language articles that were translated by a third researcher. Each study was evaluated by two independent researchers who assigned a level of evidence according to American Association of Neurologist algorithm and also performed data extraction (neurolysis vs. neurectomy and resolution of pain symptoms). Each study was found to be level four evidence. CONCLUSION After reviewing the data, there was insufficient evidence to recommended one method of treatment over the other. This highlights the importance of keeping a national registry in order to compare outcomes between the two methods of treatment.
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Kang KN, Rhyu CJ, Chon SW, Choi YS, Yoo JI, Lim YS, Bang YS, Kim YU. Concurrent meralgia paresthetica and radiculopathy of the left leg -A case report-. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.1.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Korea
| | - Chang Joon Rhyu
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Korea
| | - Sung Won Chon
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Korea
| | - Young-Soon Choi
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University of Korea, Incheon, Korea
| | - Jee In Yoo
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University of Korea, Incheon, Korea
| | - Young Su Lim
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University of Korea, Incheon, Korea
| | - Yun-Sic Bang
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University of Korea, Incheon, Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University of Korea, Incheon, Korea
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Ahmed A, Arora D, Kochhar AK. Ultrasound-guided alcohol neurolysis of lateral femoral cutaneous nerve for intractable meralgia paresthetica: a case series. Br J Pain 2016; 10:232-237. [PMID: 27867513 DOI: 10.1177/2049463716668811] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Meralgia paresthetica is a rare sensory entrapment neuropathy which leads to burning, tingling and numbness in the antero-lateral aspect of thigh. Mostly it runs a benign course, and responds to conservative measures. We present a case series of six patients with intractable meralgia paresthetica with severe pain over antero-lateral thigh along the distribution of lateral cutaneous nerve of thigh which was further confirmed by nerve conduction study. These patients did not respond to the oral anti-neuropathic medications. The two successive diagnostic lateral femoral cutaneous nerve block not only had confirmed the diagnosis but also provided pain relief for a few days. Then the ultrasound-guided lateral femoral cutaneous nerve neurolysis was done using 50% alcohol. In all the patients, there were more than 50% decrease in pain intensity and improvement in quality of life after the procedure, and the relief and improvement were maintained for up to 12 weeks. This case series shows ultrasound-guided lateral femoral cutaneous nerve neurolysis is a safe and effective treatment for intractable meralgia paresthetica and also provides prolonged pain relief and is a good option in avoiding the surgery. Summary points The literature on neurolysis is rare, with only few case reports. This is the first case series on this topic, and it will greatly improve the evidence that ultrasound-guided neurolysis can also be used for intractable meralgia paresthetica patients who do not respond to conservative measures before proceeding to surgery.
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Affiliation(s)
- Arif Ahmed
- Department of Anesthesiology and Pain Medicine, Asian Institute of Medical Sciences, Faridabad, India
| | - Divesh Arora
- Department of Anesthesiology and Pain Medicine, Asian Institute of Medical Sciences, Faridabad, India
| | - Amit Kumar Kochhar
- Department of Anesthesiology and Pain Medicine, Asian Institute of Medical Sciences, Faridabad, India
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Shumway NK, Cole E, Fernandez KH. Neurocutaneous disease. J Am Acad Dermatol 2016; 74:215-28; quiz 229-30. [DOI: 10.1016/j.jaad.2015.04.059] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/06/2015] [Accepted: 04/22/2015] [Indexed: 02/01/2023]
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Ng AM, Fike FB, Schneider SJ, Hong AR, Dolgin SE. Meralgia paresthetica after “all-in-one” appendectomy. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Abstract
BACKGROUND Meralgia paraesthetica is a clinical syndrome for which a number of treatments are in common use, including conservative measures, injection of corticosteroid with local anaesthetic and surgery. We aimed to examine the evidence for the relative efficacy of these interventions. This review was first published in 2008. Searches were updated in 2010 and 2012. OBJECTIVES To assess the relative efficacy of commonly used treatments for meralgia paraesthetica. SEARCH METHODS We searched the Cochrane Neuromuscular Disease Group Specialized Register (1 October 2012), CENTRAL (2012, issue 9 in The Cochrane Library), MEDLINE (January 1966 to October 2012), EMBASE (January 1980 to October 2012) and CINAHL Plus (January 1937 to October 2012) for randomised controlled studies. Non-randomised studies were identified by searching MEDLINE (January 1966 to October 2012) and EMBASE (January 1980 to October 2012). We also inspected the reference lists of these studies. SELECTION CRITERIA We were unable to identify any randomised controlled trials (RCTs) or quasi-RCTs. We therefore looked for high quality observational studies meeting the following criteria: (1) At least five cases of meralgia paraesthetica. (2) Follow-up of at least three months after intervention (if any). (3) At least 80% of cases followed up. DATA COLLECTION AND ANALYSIS Three authors independently extracted relevant data from each study meeting the selection criteria and transferred into a data extraction form. MAIN RESULTS We found no RCTs or quasi-RCTs in the original review or updates in 20011 and 2012. Cure or improvement have been described in high quality observational studies: (1) A single study describes spontaneous improvement of meralgia paraesthetica in 20 (69%) of 29 cases. (2) Four studies evaluating the injection of corticosteroid and local anaesthetic found cure or improvement in 130 (83%) out of a combined total of 157 cases. (3) Surgical treatments have been found to be beneficial in 264 (88%) out of 300 cases treated with decompression (nine studies); and 45 (94%) out of 48 cases treated with neurectomy (three studies). (4) Ninety-nine (97%) out of 102 patients with iatrogenic meralgia paraesthetica recovered completely (three studies). AUTHORS' CONCLUSIONS In the absence of any published RCTs or quasi-RCTs, the objective evidence base for treatment choices in meralgia paraesthetica is weak. High quality observational studies report comparable high improvement rates for meralgia paraesthetica following local injection of corticosteroid and surgical interventions (either nerve decompression or neurectomy). However, a similar outcome has been reported without any intervention in a single natural history study.
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Affiliation(s)
- Nofal Khalil
- Clinical Neurophysiology, West London Neurosciences Centre, London, UK.
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Houle S. Chiropractic management of chronic idiopathic meralgia paresthetica: a case study. J Chiropr Med 2012; 11:36-41. [PMID: 22942840 DOI: 10.1016/j.jcm.2011.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 05/18/2011] [Accepted: 06/21/2011] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES This report describes the case of a patient with chronic idiopathic meralgia paresthetica associated with bilateral sacroiliac joint dysfunction who was managed with chiropractic care. CLINICAL FEATURES A 35-year-old white woman presented to a private chiropractic clinic with a complaint of numbness in the right anterolateral thigh region. Neurological assessment revealed a diminution of sensibility and discrimination on the right lateral femoral cutaneous nerve territory. Pain was rated as 8.5 on a numeric pain scale of 0 to 10. Musculoskeletal examination of the pelvic region disclosed bilateral sacroiliac joint dysfunction. INTERVENTION AND OUTCOMES Chiropractic management included pelvic mobilizations, myofascial therapy, transverse friction massage, and stretching exercises. After 3 visits (2 weeks later), result of neurological evaluation was normal, with no residual numbness over the lateral thigh. CONCLUSION In the present case, chiropractic management with standard and applied kinesiology techniques resulted in recovery of meralgia paresthetica symptoms for this patient.
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Affiliation(s)
- Sébastien Houle
- Master's Degree Student, Biophysique et Biologie Cellulaires, Département de Chimie-Biologie, Université du Québec à Trois-Rivières, Québec, Canada G9A 5H7
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Son BC, Kim DR, Kim IS, Hong JT, Sung JH, Lee SW. Neurolysis for meralgia paresthetica. J Korean Neurosurg Soc 2012; 51:363-6. [PMID: 22949966 PMCID: PMC3424177 DOI: 10.3340/jkns.2012.51.6.363] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 04/09/2012] [Accepted: 06/13/2012] [Indexed: 11/30/2022] Open
Abstract
Objective Meralgia paresthetica (MP) is a syndrome of pain and/or dysesthesia in the anterolateral thigh that is caused by an entrapment of the lateral femoral cutaneous nerve (LFCN) at its pelvic exit. Despite early accounts of MP, there is still no consensus concerning the effectiveness of neurolysis or transaction treatments in the long-term relief for medically refractory patients with MP. We retrospectively analyzed available long-term results of LFCN neurolysis for medically refractory MP in an effort to clarify this issue. Methods During the last 7 years, 11 patients who had neurolysis for MP were enrolled in this study. Nerve entrapment was confirmed preoperatively by electrophysiological studies or a positive response to local anesthetic injection. Decompression of the LFCN was performed at the level of the iliac fascia, inguinal ligament, and fascia of the thigh distally. The outcome of surgery was assessed 8 weeks after the procedure followed at regular intervals if symptoms persisted. Results Twelve decompression procedures were performed in 11 patients over a 7-year period. The average duration of symptoms was 8.5 months (range, 4-15 months). The average follow-up period was 33 months (range, 12-60 months). Complete and partial symptom improvement were noted in nine (81.8%) and two (18.2%) cases, respectively. No recurrence was reported. Conclusion Neurolysis of the LFCN can provide adequate pain relief with minimal complications for medically refractory MP. To achieve a good outcome in neurolysis for MP, an accurate diagnosis with careful examination and repeated blocks of the LFCN, along with electrodiagnosis seems to be essential. Possible variation in the course of the LFCN and thorough decompression along the course of the LFCN should be kept in mind in planning decompression surgery for MP.
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Affiliation(s)
- Byung-Chul Son
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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Choi HJ, Choi SK, Kim TS, Lim YJ. Pulsed radiofrequency neuromodulation treatment on the lateral femoral cutaneous nerve for the treatment of meralgia paresthetica. J Korean Neurosurg Soc 2011; 50:151-3. [PMID: 22053239 DOI: 10.3340/jkns.2011.50.2.151] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 04/24/2011] [Accepted: 08/16/2011] [Indexed: 11/27/2022] Open
Abstract
We describe a rare case of pulsed radiofrequency treatment for pain relief associated with meralgia paresthetica. A 58-year-old female presented with pain in the left anterior lateral thigh. An imaging study revealed no acute lesions compared with a previous imaging study, and diagnosis of meralgia paresthetica was made. She received temporary pain relief with lateral femoral cutaneous nerve blocks twice. We performed pulsed radiofrequency treatment, and the pain declined to 25% of the maximal pain intensity. At 4 months after the procedure, the pain intensity did not aggravate without medication. Pulsed radiofrequency neuromodulation treatment on the lateral femoral cutaneous nerve may offer an effective, low risk treatment in patients with meralgia paresthetica who are refractory to conservative medical treatment.
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Affiliation(s)
- Hyuk Jai Choi
- Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Korea
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31
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Toussaint CP, Perry EC, Pisansky MT, Anderson DE. What's new in the diagnosis and treatment of peripheral nerve entrapment neuropathies. Neurol Clin 2011; 28:979-1004. [PMID: 20816274 DOI: 10.1016/j.ncl.2010.03.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Entrapment neuropathies can be common conditions with the potential to cause significant disability. Correct diagnosis is essential for proper management. This article is a review of recent developments related to diagnosis and treatment of various common and uncommon nerve entrapment disorders. When combined with classical peripheral nerve examination techniques, innovations in imaging modalities have led to more reliable diagnoses. Moreover, innovations in conservative and surgical techniques have been controversial as to their effects on patient outcome, but randomized controlled trials have provided important information regarding common operative techniques. Treatment strategies for painful peripheral neuropathies are also reviewed.
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Affiliation(s)
- Charles P Toussaint
- Department of Neurological Surgery, Loyola University Medical Center, 2160 South 1st Avenue, Maywood, IL 60153, USA
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Chung KH, Lee JY, Ko TK, Park CH, Chun DH, Yang HJ, Gill HJ, Kim MK. Meralgia paresthetica affecting parturient women who underwent cesarean section -A case report-. Korean J Anesthesiol 2010; 59 Suppl:S86-9. [PMID: 21286469 PMCID: PMC3030065 DOI: 10.4097/kjae.2010.59.s.s86] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 05/18/2010] [Accepted: 06/23/2010] [Indexed: 11/15/2022] Open
Abstract
Meralgia paresthetica is commonly caused by a focal entrapment of lateral femoral cuteneous nerve while it passes the inguinal ligament. Common symptoms are paresthesias and numbness of the upper lateral thigh area. Pregnancy, tight cloths, obesity, position of surgery and the tumor in the retroperitoneal space could be causes of meralgia paresthetica. A 29-year-old female patient underwent an emergency cesarean section under spinal anesthesia without any problems. But two days after surgery, the patient complained numbness and paresthesia in anterolateral thigh area. Various neurological examinations and L-spine MRI images were all normal, but the symptoms persisted for a few days. Then, electromyogram and nerve conduction velocity test of the trunk and both legs were performed. Test results showed left lateral cutaneous nerve injury and meralgia paresthetica was diagnosed. Conservative treatment was implemented and the patient was free of symptoms after 1 month follow-up.
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Affiliation(s)
- Kum Hee Chung
- Department of Anesthesiology and Pain Medicine, CHA University School of Medicine, Seongnam, Korea
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Fernández-Mayoralas DM, Fernández-Jaén A, Jareño NM, Pérez BC, Fernández PM, Sola AG. Meralgia paresthetica in the pediatric population: a propos of 2 cases. J Child Neurol 2010; 25:110-3. [PMID: 19458380 DOI: 10.1177/0883073809336130] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Meralgia paresthetica is a mononeuropathy affecting the lateral femoral cutaneous nerve that is extremely rare in children. Two adolescent females, aged 11 and 13 years, presented due to tingling and pain on the side of the thigh of 2 to 3 weeks duration. The general examination revealed mild obesity; the neurological examination of both patients is normal except for pain, hypo- or hyperesthesia on the side of the quadriceps. An electromyogram was performed in the first case that reveals decreased conduction velocity of the affected lateral femoral cutaneous nerve. The younger child was treated successfully with diet and topiramate; the second patient's symptoms disappeared after initiating conservative measures. Meralgia paresthetica is probably underdiagnosed in the pediatric population. First-line treatment should be conservative, but topiramate may be useful for the treatment of meralgia paresthetica, although broader studies are needed to evaluate its true effectiveness in this pathological condition.
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Abstract
Several tunnel syndromes are responsible for substantial functional impairment. The diagnosis has to be made and treatment is most often very simple--nerve decompression--with excellent results. Of these syndromes, the most common are median and ulnar tunnel syndromes of the wrist and ulnar tunnel syndrome of the elbow, but other syndromes must be identified at the risk of therapy failure due to poorly adapted treatment. Finally, good knowledge of this pathology must lead to prevention of the iatrogenic forms (sequelae of inguinal hernia treatment, ileac crest graft harvesting) by educating all surgeons interested in peripheral nerve surgery.
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Carai A, Fenu G, Sechi E, Crotti FM, Montella A. Anatomical variability of the lateral femoral cutaneous nerve: Findings from a surgical series. Clin Anat 2009; 22:365-70. [DOI: 10.1002/ca.20766] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Cho KT, Lee HJ. Prone position-related meralgia paresthetica after lumbar spinal surgery : a case report and review of the literature. J Korean Neurosurg Soc 2008; 44:392-5. [PMID: 19137086 DOI: 10.3340/jkns.2008.44.6.392] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 11/24/2008] [Indexed: 12/26/2022] Open
Abstract
Lateral femoral cutaneous neuropathy occurring during spinal surgery is frequently related to iliac bone graft harvesting, but meralgia paresthetica (MP) can result from the patient being in the prone position. Prone position-related MP is not an uncommon complication after posterior spine surgery but there are only few reports in the literature on this subject. It is usually overlooked because of its mild symptoms and self-limiting course, or patients and physicians may misunderstand the persistence of lower extremity symptoms in the early postoperative period to be a reflection of poor surgical outcome. The authors report a case of prone position-related MP after posterior lumbar interbody fusion at the L3-4 and reviewed the literature with discussion on the incidence, pathogenesis, and possible risk factors related to this entity.
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Affiliation(s)
- Keun-Tae Cho
- Department of Neurosurgery , Dongguk University College of Medicine, Dongguk University International Hospital, Goyang, Korea
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38
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Abstract
BACKGROUND Meralgia paraesthetica is a clinical syndrome for which a number of treatments are in common use, including conservative measures, injection of corticosteroid with local anaesthetic and surgery. We aimed to examine the evidence for the relative efficacy of these interventions. OBJECTIVES To assess the relative efficacy of commonly used treatments. SEARCH STRATEGY We searched the Cochrane Neuromuscular Disease Group Trials Register (April 2008), MEDLINE (January 1 1966 to April 18 2008), EMBASE (January 1 1980 to May 12 2008) and CINAHL (January 1 1980 to May 12 2008) for randomised controlled studies. Non-randomised studies were identified by searching MEDLINE (January 1 1966 to April 18 2008) and EMBASE (January 1 1980 to May 12 2008). We also inspected the reference lists of these studies to identify further studies. SELECTION CRITERIA We were unable to identify any randomised controlled or quasi-randomised controlled trials. We therefore looked for high quality observational studies meeting the following criteria:(1) At least five cases of meralgia paraesthetica.(2) Follow-up of at least three months after intervention (if any).(3) At least 80% of cases followed up. DATA COLLECTION AND ANALYSIS Relevant data from each study meeting the selection criteria were extracted independently by all three authors and transferred into a data extraction form created for the review. MAIN RESULTS We found no randomised controlled or quasi-controlled trials. Cure or improvement have been described in high quality observational studies:(1) A single study describes spontaneous improvement of meralgia paraesthetica in 20 (69%) out of 29 cases.(2) Four studies evaluating the injection of corticosteroid and local anaesthetic found cure or improvement in 130 (83%) out of a combined total of 157 cases.(3) Surgical treatments have been found to be beneficial in 264 (88%) out of 300 cases treated with decompression (nine studies); and 45 (94%) out of 48 cases treated with neurectomy (three studies).(4) Ninety-nine (97%) out of 102 patients with iatrogenic meralgia paraesthetica recovered completely (three studies). AUTHORS' CONCLUSIONS In the absence of any published randomised controlled or quasi-randomised controlled trials, the objective evidence base for treatment choices in meralgia paraesthetica is weak. High quality observational studies report comparable high improvement rates for meralgia paraesthetica following local injection of corticosteroid and surgical interventions (either nerve decompression or neurectomy). However, a similar outcome has been reported without any intervention in a single natural history study.
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Affiliation(s)
- Nofal Khalil
- Clinical Neurophysiology, West London Neurosciences Centre, Charing Cross Hospital, Fulham Palace Road, London, UK, W6 8RF.
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