Materiały źródłowe

• #1 Meralgia Paresthetica: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1141848-overview

  A painful mononeuropathy of the lateral femoral cutaneous nerve (LFCN), meralgia paresthetica is commonly due to focal entrapment of this nerve as it passes through the inguinal ligament. Rarely, it has other etiologies such as direct trauma, stretch injury, or ischemia. It typically occurs in isolation. The clinical history and examination is usually sufficient for making the diagnosis. However, the diagnosis can be confirmed by nerve conduction studies. Treatment is usually supportive. The LFCN is responsible for the sensation of the anterolateral thigh. It is a purely sensory nerve and has no motor component. […] Reviewing the anatomy of the lateral femoral cutaneous nerve (LFCN) is essential for understanding the mechanism of its injury. The LFCN originates directly from the lumbar plexus and has root innervation from L2-3. The nerve runs through the pelvis along the lateral border of the psoas muscle to the lateral part of the inguinal ligament. Here, it passes to the thigh through a tunnel formed by the lateral attachment of the inguinal ligament and the anterior superior iliac spine. The crossover into the thigh is the most common site of entrapment. The crossover typically occurs 1 cm medial to the anterior superior iliac spine; however, regional variations are common.

• #2 Meralgia Paresthetica – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK557735/

  Meralgia paresthetica is a clinical condition that includes pain and dysesthesia in the anterolateral thigh associated with lateral femoral cutaneous nerve compression. […] Describe the pathogenesis of meralgia paresthetica and consider relevant differential diagnoses. […] The condition is caused by injury or entrapment of the lateral femoral cutaneous nerve (LFCN) and is classified as spontaneous or iatrogenic. […] Injury to the lateral femoral cutaneous nerve occurs due to external compression or from internal pressure such as from obesity, pregnancy, or tumors. […] Metabolic causes from diabetes, alcohol, or lead poisoning may also result in an isolated nerve injury. […] Chronic meralgia paresthetica is associated with specific pathologic findings on LFCN biopsy, including multifocal fiber loss, loss of large myelinated fibers, thinly myelinated profiles, regenerating nerve clusters, perineurial thickening, and subperineurial edema. […] The LFCN is derived from a combination of lumbar nerve roots (posterior divisions of L2/L3 spinal nerves) and sometimes adjacent peripheral nerves.

• #3 Physical Medicine and Rehabilitation for Meralgia Paresthetica: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/308199-overview

  Meralgia paresthetica (MP) is pain or an irritating sensation felt over the anterior or anterolateral aspect of the thigh due to injury, compression, or disease of the lateral femoral cutaneous nerve (LFCN). […] The lateral femoral cutaneous nerve (LFCN) is formed by the fusion of the posterior branches of the second and third lumbar nerves. This purely sensory nerve traverses the retroperitoneum around the lateral circumference of the ileum to the inguinal ligament (IL). […] Variations in the anatomy of the LFCN, such as splitting by the inguinal ligament, are hypothesized to predispose it to neuropathic processes. […] Nerve entrapment can occur at 3 potential sites, including (1) beside the spinal column, (2) within the abdominal cavity as the nerve courses along the pelvis, and (3) as the nerve exits the pelvis.

• #4 Meralgia Paresthetica | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/76580

  Chronic meralgia paresthetica is associated with specific pathologic findings on LFCN biopsy, including multifocal fiber loss, loss of large myelinated fibers, thinly myelinated profiles, regenerating nerve clusters, perineurial thickening, and subperineurial edema. […] The LFCN is derived from a combination of lumbar nerve roots (posterior divisions of L2/L3 spinal nerves) and sometimes adjacent peripheral nerves. It emerges from the lateral aspect of the psoas muscle, passes under the iliac fascia, then crosses the anterior surface of the iliacus muscle as it travels toward the anterior superior iliac spine. […] Diabetic nerve injury of the LFCN may occur due to swelling from decreased axoplasmic transport or impaired sodium-potassium ATP activity via the sorbitol pathway activation by glucose.

• #5 Meralgia Paresthetica: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1141848-overview

  A painful mononeuropathy of the lateral femoral cutaneous nerve (LFCN), meralgia paresthetica is commonly due to focal entrapment of this nerve as it passes through the inguinal ligament. Rarely, it has other etiologies such as direct trauma, stretch injury, or ischemia. It typically occurs in isolation. The clinical history and examination is usually sufficient for making the diagnosis. However, the diagnosis can be confirmed by nerve conduction studies. Treatment is usually supportive. The LFCN is responsible for the sensation of the anterolateral thigh. It is a purely sensory nerve and has no motor component. […] Reviewing the anatomy of the lateral femoral cutaneous nerve (LFCN) is essential for understanding the mechanism of its injury. The LFCN originates directly from the lumbar plexus and has root innervation from L2-3. The nerve runs through the pelvis along the lateral border of the psoas muscle to the lateral part of the inguinal ligament. Here, it passes to the thigh through a tunnel formed by the lateral attachment of the inguinal ligament and the anterior superior iliac spine. The crossover into the thigh is the most common site of entrapment. The crossover typically occurs 1 cm medial to the anterior superior iliac spine; however, regional variations are common.

• #6 Meralgia Paresthetica: Neurolysis or Neurectomy?

  https://www.mdpi.com/2673-4095/5/3/66

  Meralgia paresthetica is a compressive neuropathy of the lateral femoral cutaneous nerve. […] The core of this clinical condition is aptly summarized by the Greek etymology of the term itself: meralgia (thigh and pain) paresthetica (similar and sensation). […] MP is classified into spontaneous and iatrogenic forms depending on the cause of the nerve injury or compression. […] According to the literature, spontaneous forms may be due to diabetes mellitus, lead poisoning, alcoholism, hypothyroidism, direct compression from seat belts or close-fitting clothes, or increased intra-abdominal pressure resulting from obesity, pregnancy, or tumors. […] The anatomical course of the LFCN is highly variable. […] The most frequently reported site of compression is between the fascia lata and the inguinal ligament.

• #7 Meralgia Paresthetica: Neurolysis or Neurectomy?

  https://www.mdpi.com/2673-4095/5/3/66

  Seven anatomical variants of the LFCN course, in its passage from the abdomen to the lower limb, have been described. […] The first diagnosis is essentially clinical and is based on the presence of typical sensory neurological impairment in the anterolateral part of the thigh with no motor involvement. […] The Pelvic Compression Test is among the most sensitive and specific maneuvers for diagnosing MP. […] The management of MP includes conservative attempts, e.g., patient education about avoiding tight clothing, weight loss, medications (e.g., NSAIDs, topical capsaicin, lidocaine, gabapentin, phenytoin, carbamazepine) and a trial of physical therapy. […] However, if symptoms persist despite conservative therapies, the gold standard of treatment is surgery. […] There is no high-level evidence on which is the best treatment to offer to MP patients.

• #8 Meralgia paraesthetica – Wikipedia

  https://en.wikipedia.org/wiki/Meralgia_paraesthetica

  Meralgia paresthetica is a specific instance of nerve entrapment. […] The nerve involved is the lateral femoral cutaneous nerve (LFCN). […] This syndrome can be caused by anything which places prolonged pressure on the LFCN, such as wearing a tight belt. […] The cause of Meralgia Paresthetica (MP) is nerve compression or injury to the lateral femoral cutaneous nerve (LFCN). […] The site of compression is often at or near the inguinal ligament as the LFCN passes between the upper front hip bone (ilium) and the inguinal ligament near the attachment at the anterior superior iliac spine (the upper point of the hip bone). […] Causes of compression can be due to tight fitting clothing at the waist, tight belts, or tight seat belts placing pressure on the LFCN. […] Anatomic variations in the course of the lateral femoral cutaneous nerve (LFCN) through the inguinal ligament, its branching level, and course through the thigh is thought to predispose the LFCN to nerve damage through injury or nerve compression.

• #9 Meralgia paresthetica (lateral femoral cutaneous nerve entrapment) – UpToDate

  https://www.uptodate.com/contents/meralgia-paresthetica-lateral-femoral-cutaneous-nerve-entrapment

  Meralgia paresthetica (from „meros,” meaning thigh, and „algo,” meaning pain) is the clinical syndrome of pain and/or dysesthesia in the anterolateral thigh associated with compression of the lateral femoral cutaneous nerve. The lateral femoral cutaneous nerve is a pure sensory nerve that is susceptible to compression as it courses from the lumbar plexus, through the abdominal cavity, under the inguinal ligament, and into the subcutaneous tissue of the thigh. […] Most cases of meralgia paresthetica arise spontaneously and are presumed to result from entrapment of the lateral femoral cutaneous nerve as it passes underneath or through the inguinal ligament. The median age at presentation is 50 years. The incidence is approximately sevenfold higher in patients with diabetes compared with the general population. […] The most commonly identified risk factors are obesity, diabetes mellitus, and older age. […] A more specific cause is identified in approximately one-third to one-half of patients. Examples related to compression at the inguinal ligament include:

• #10 Meralgia Paresthetica: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1141848-overview

  A painful mononeuropathy of the lateral femoral cutaneous nerve (LFCN), meralgia paresthetica is commonly due to focal entrapment of this nerve as it passes through the inguinal ligament. Rarely, it has other etiologies such as direct trauma, stretch injury, or ischemia. It typically occurs in isolation. The clinical history and examination is usually sufficient for making the diagnosis. However, the diagnosis can be confirmed by nerve conduction studies. Treatment is usually supportive. The LFCN is responsible for the sensation of the anterolateral thigh. It is a purely sensory nerve and has no motor component. […] Reviewing the anatomy of the lateral femoral cutaneous nerve (LFCN) is essential for understanding the mechanism of its injury. The LFCN originates directly from the lumbar plexus and has root innervation from L2-3. The nerve runs through the pelvis along the lateral border of the psoas muscle to the lateral part of the inguinal ligament. Here, it passes to the thigh through a tunnel formed by the lateral attachment of the inguinal ligament and the anterior superior iliac spine. The crossover into the thigh is the most common site of entrapment. The crossover typically occurs 1 cm medial to the anterior superior iliac spine; however, regional variations are common.

• #11 Physical Medicine and Rehabilitation for Meralgia Paresthetica: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/308199-overview

  Meralgia paresthetica (MP) is pain or an irritating sensation felt over the anterior or anterolateral aspect of the thigh due to injury, compression, or disease of the lateral femoral cutaneous nerve (LFCN). […] The lateral femoral cutaneous nerve (LFCN) is formed by the fusion of the posterior branches of the second and third lumbar nerves. This purely sensory nerve traverses the retroperitoneum around the lateral circumference of the ileum to the inguinal ligament (IL). […] Variations in the anatomy of the LFCN, such as splitting by the inguinal ligament, are hypothesized to predispose it to neuropathic processes. […] Nerve entrapment can occur at 3 potential sites, including (1) beside the spinal column, (2) within the abdominal cavity as the nerve courses along the pelvis, and (3) as the nerve exits the pelvis.

• #12 Physical Medicine and Rehabilitation for Meralgia Paresthetica: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/308199-overview

  The angulation of the LFCN across the iliac crest results in varying compressive forces with postural repositioning. […] The LFCN is subject to systemic processes that can detrimentally affect any peripheral nerve. […] Movement of the hip changes angulation and tension of the nerve, which can affect symptoms. […] A Brazilian study involving 14 patients with meralgia paresthetica (MP) and 14 control subjects found evidence that not only are the large myelinated nerve fibers of the LFCN affected in MP, but the small fibers may be as well, with the small fibers suffering a partial loss of function and causing painful symptoms.

• #13 Meralgia Paresthetica | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/76580

  The lateral femoral cutaneous nerve is a pure sensory nerve vulnerable to compression as it passes from the lumbosacral plexus towards the inguinal ligament and into the subcutaneous tissue of the anterior thigh. Meralgia paresthetica is a clinical condition that involves pain and dysesthesia in the anterolateral thigh associated with compression of the lateral femoral cutaneous nerve. […] The condition is caused by injury or entrapment of the lateral femoral cutaneous nerve (LFCN) and is classified as spontaneous or iatrogenic. Spontaneous causes include diabetes mellitus, lead poisoning, alcohol use disorder, and hypothyroidism resulting in an isolated neuropathy of the LFCN. […] Injury to the lateral femoral cutaneous nerve occurs due to external compression or from internal pressure such as from obesity, pregnancy, or tumors. Injury may also occur during surgery as the nerve enters the anterior thigh past the inguinal ligament. Metabolic causes from diabetes, alcohol, or lead poisoning may also result in an isolated nerve injury.

• #14 Meralgia Paresthetica: Neurolysis or Neurectomy?

  https://www.mdpi.com/2673-4095/5/3/66

  Meralgia paresthetica is a compressive neuropathy of the lateral femoral cutaneous nerve. […] The core of this clinical condition is aptly summarized by the Greek etymology of the term itself: meralgia (thigh and pain) paresthetica (similar and sensation). […] MP is classified into spontaneous and iatrogenic forms depending on the cause of the nerve injury or compression. […] According to the literature, spontaneous forms may be due to diabetes mellitus, lead poisoning, alcoholism, hypothyroidism, direct compression from seat belts or close-fitting clothes, or increased intra-abdominal pressure resulting from obesity, pregnancy, or tumors. […] The anatomical course of the LFCN is highly variable. […] The most frequently reported site of compression is between the fascia lata and the inguinal ligament.

• #15 Meralgia Paresthetica, Cause of Diagnostic Mistake in the Vascular Clinic

  https://www.heraldopenaccess.us/openaccess/meralgia-paresthetica-cause-of-diagnostic-mistake-in-the-vascular-clinic

  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. […] The Meralgia Paresthetica (MP) (term that come from the word Greek meros = tight and algos = pain) is an entrapment neuropathy of the Lateral Femoral Cutaneous Nerve (LFCN) characterized by pain, numbness and tingling in the anterolateral aspect of the thigh. […] MP can be classified as primary or secondary to trauma, surgical procedures or other pathologies. […] Primary MP causes includes mechanical factors than result in compression of the LCNT along its anatomical course. MP has been related to the following factors: obesity (BMI 30), wearing a tight garment such as belts, corset, trouser, jeans, military armor and police uniforms, seat belts, direct trauma, pregnancy, leg length changes, scoliosis, and muscle spasms among others. Metabolic factors reported include diabetes mellitus, alcoholism, hypothyroidism and lead poisoning.

• #16

  https://link.springer.com/article/10.1007/s10143-023-02023-2

  Meralgia paresthetica is often idiopathic, but sometimes symptoms may be caused by traumatic injury to the lateral femoral cutaneous nerve (LFCN) or compression of this nerve by a mass lesion. […] In addition, the experience from our center with the surgical treatment of unusual causes of meralgia paresthetica is presented. […] Most frequent cause of traumatic injury in the literature was iatrogenic, including different procedures around the anterior superior iliac spine, intra-abdominal procedures and positioning for surgery. […] It is important to consider traumatic causes or compression by a mass lesion in patients that present with meralgia paresthetica.

• #17 Meralgia Paresthetica | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/76580

  The lateral femoral cutaneous nerve is a pure sensory nerve vulnerable to compression as it passes from the lumbosacral plexus towards the inguinal ligament and into the subcutaneous tissue of the anterior thigh. Meralgia paresthetica is a clinical condition that involves pain and dysesthesia in the anterolateral thigh associated with compression of the lateral femoral cutaneous nerve. […] The condition is caused by injury or entrapment of the lateral femoral cutaneous nerve (LFCN) and is classified as spontaneous or iatrogenic. Spontaneous causes include diabetes mellitus, lead poisoning, alcohol use disorder, and hypothyroidism resulting in an isolated neuropathy of the LFCN. […] Injury to the lateral femoral cutaneous nerve occurs due to external compression or from internal pressure such as from obesity, pregnancy, or tumors. Injury may also occur during surgery as the nerve enters the anterior thigh past the inguinal ligament. Metabolic causes from diabetes, alcohol, or lead poisoning may also result in an isolated nerve injury.

• #18 Meralgia Paresthetica – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK557735/

  Meralgia paresthetica is a clinical condition that includes pain and dysesthesia in the anterolateral thigh associated with lateral femoral cutaneous nerve compression. […] Describe the pathogenesis of meralgia paresthetica and consider relevant differential diagnoses. […] The condition is caused by injury or entrapment of the lateral femoral cutaneous nerve (LFCN) and is classified as spontaneous or iatrogenic. […] Injury to the lateral femoral cutaneous nerve occurs due to external compression or from internal pressure such as from obesity, pregnancy, or tumors. […] Metabolic causes from diabetes, alcohol, or lead poisoning may also result in an isolated nerve injury. […] Chronic meralgia paresthetica is associated with specific pathologic findings on LFCN biopsy, including multifocal fiber loss, loss of large myelinated fibers, thinly myelinated profiles, regenerating nerve clusters, perineurial thickening, and subperineurial edema. […] The LFCN is derived from a combination of lumbar nerve roots (posterior divisions of L2/L3 spinal nerves) and sometimes adjacent peripheral nerves.

• #19 Differential Etiological Diagnosis of Meralgia Paresthetica: A Concise Review

  https://clinmedjournals.org/articles/ijnn/international-journal-of-neurology-and-neurotherapy-ijnn-10-120.php?jid=ijnn

  There are tests that we can use to help diagnose this pathology, including the neurodynamic test of the femoral nerve, in addition to pelvic compression. […] However, other diagnostic managements are used because they have greater specificity, such as evoked somatosensory potentials, high-resolution ultrasound and magnetic resonance imaging. […] In the chronic presentation, loss of multifocal and myelinated fibers can be observed in the LFCN biopsy, in addition to perineural thickening and subperineural edema. […] COVID-19 can be a cause of MP, and in a cohort study with 51 patients with COVID-19 in ICU, 10 (33%) were diagnosed with MP, and presented pain in the lateral part of the cutaneous nerves, in both sides. […] In the context of DM, the most common complication of DM is Diabetic peripheral neuropathy (DPN), and a research evaluated 381 patients with DM type 2, and 107 (28.1%) of them had DPN. […] From the perspective of diabetic neuropathy of the LFCN, we have that it can occur in two situations: I) edema from decreased axonal transport and II) transformation of glucose into sorbitol leading to an impairment in the mechanism of the sodium-potassium pump.

• #20 Meralgia Paresthetica | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/76580

  Chronic meralgia paresthetica is associated with specific pathologic findings on LFCN biopsy, including multifocal fiber loss, loss of large myelinated fibers, thinly myelinated profiles, regenerating nerve clusters, perineurial thickening, and subperineurial edema. […] The LFCN is derived from a combination of lumbar nerve roots (posterior divisions of L2/L3 spinal nerves) and sometimes adjacent peripheral nerves. It emerges from the lateral aspect of the psoas muscle, passes under the iliac fascia, then crosses the anterior surface of the iliacus muscle as it travels toward the anterior superior iliac spine. […] Diabetic nerve injury of the LFCN may occur due to swelling from decreased axoplasmic transport or impaired sodium-potassium ATP activity via the sorbitol pathway activation by glucose.

• #21 Differential Etiological Diagnosis of Meralgia Paresthetica: A Concise Review

  https://clinmedjournals.org/articles/ijnn/international-journal-of-neurology-and-neurotherapy-ijnn-10-120.php?jid=ijnn

  There are tests that we can use to help diagnose this pathology, including the neurodynamic test of the femoral nerve, in addition to pelvic compression. […] However, other diagnostic managements are used because they have greater specificity, such as evoked somatosensory potentials, high-resolution ultrasound and magnetic resonance imaging. […] In the chronic presentation, loss of multifocal and myelinated fibers can be observed in the LFCN biopsy, in addition to perineural thickening and subperineural edema. […] COVID-19 can be a cause of MP, and in a cohort study with 51 patients with COVID-19 in ICU, 10 (33%) were diagnosed with MP, and presented pain in the lateral part of the cutaneous nerves, in both sides. […] In the context of DM, the most common complication of DM is Diabetic peripheral neuropathy (DPN), and a research evaluated 381 patients with DM type 2, and 107 (28.1%) of them had DPN. […] From the perspective of diabetic neuropathy of the LFCN, we have that it can occur in two situations: I) edema from decreased axonal transport and II) transformation of glucose into sorbitol leading to an impairment in the mechanism of the sodium-potassium pump.

• #22 Meralgia Paresthetica – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK557735/

  Meralgia paresthetica is a clinical condition that includes pain and dysesthesia in the anterolateral thigh associated with lateral femoral cutaneous nerve compression. […] Describe the pathogenesis of meralgia paresthetica and consider relevant differential diagnoses. […] The condition is caused by injury or entrapment of the lateral femoral cutaneous nerve (LFCN) and is classified as spontaneous or iatrogenic. […] Injury to the lateral femoral cutaneous nerve occurs due to external compression or from internal pressure such as from obesity, pregnancy, or tumors. […] Metabolic causes from diabetes, alcohol, or lead poisoning may also result in an isolated nerve injury. […] Chronic meralgia paresthetica is associated with specific pathologic findings on LFCN biopsy, including multifocal fiber loss, loss of large myelinated fibers, thinly myelinated profiles, regenerating nerve clusters, perineurial thickening, and subperineurial edema. […] The LFCN is derived from a combination of lumbar nerve roots (posterior divisions of L2/L3 spinal nerves) and sometimes adjacent peripheral nerves.

• #23 Meralgia Paresthetica | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/76580

  Chronic meralgia paresthetica is associated with specific pathologic findings on LFCN biopsy, including multifocal fiber loss, loss of large myelinated fibers, thinly myelinated profiles, regenerating nerve clusters, perineurial thickening, and subperineurial edema. […] The LFCN is derived from a combination of lumbar nerve roots (posterior divisions of L2/L3 spinal nerves) and sometimes adjacent peripheral nerves. It emerges from the lateral aspect of the psoas muscle, passes under the iliac fascia, then crosses the anterior surface of the iliacus muscle as it travels toward the anterior superior iliac spine. […] Diabetic nerve injury of the LFCN may occur due to swelling from decreased axoplasmic transport or impaired sodium-potassium ATP activity via the sorbitol pathway activation by glucose.

• #24 Physical Medicine and Rehabilitation for Meralgia Paresthetica: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/308199-overview

  The angulation of the LFCN across the iliac crest results in varying compressive forces with postural repositioning. […] The LFCN is subject to systemic processes that can detrimentally affect any peripheral nerve. […] Movement of the hip changes angulation and tension of the nerve, which can affect symptoms. […] A Brazilian study involving 14 patients with meralgia paresthetica (MP) and 14 control subjects found evidence that not only are the large myelinated nerve fibers of the LFCN affected in MP, but the small fibers may be as well, with the small fibers suffering a partial loss of function and causing painful symptoms.

• #25

  https://link.springer.com/article/10.1007/s10143-023-01962-0

  The prevalence of meralgia paresthetica (MP), which is caused by compression of the lateral femoral cutaneous nerve (LFCN), has been increasing over recent decades. […] Meralgia paresthetica (MP) is the compression syndrome of the lateral femoral cutaneous nerve (LFCN) resulting in numbness and/or painful dysesthesia of the anterolateral thigh. […] For a long time, it was considered a rare disease, but, beginning in the 1990s, a substantial increase in its prevalence has been observed, most likely due to growing rates of obesity and diabetes mellitus (DM). […] In the absence of high-quality clinical trial data on MP, guidelines are lacking. Care for MP is determined predominantly by surgeon preference and experience. […] Most therapists agree that the diagnosis of MP is based primarily on clinical examination and patient history.

• #26 Meralgia Paresthetica: Neurolysis or Neurectomy?

  https://www.mdpi.com/2673-4095/5/3/66

  Seven anatomical variants of the LFCN course, in its passage from the abdomen to the lower limb, have been described. […] The first diagnosis is essentially clinical and is based on the presence of typical sensory neurological impairment in the anterolateral part of the thigh with no motor involvement. […] The Pelvic Compression Test is among the most sensitive and specific maneuvers for diagnosing MP. […] The management of MP includes conservative attempts, e.g., patient education about avoiding tight clothing, weight loss, medications (e.g., NSAIDs, topical capsaicin, lidocaine, gabapentin, phenytoin, carbamazepine) and a trial of physical therapy. […] However, if symptoms persist despite conservative therapies, the gold standard of treatment is surgery. […] There is no high-level evidence on which is the best treatment to offer to MP patients.

• #27 Meralgia Paresthetica: A Commonly Overlooked Cause of Thigh Pain — ChiroUp

  https://chiroup.com/blog/meralgia-paresthetica-a-commonly-overlooked-cause-of-thigh-pain

  Meralgia paresthetica is a compressive neuropathy of the lateral femoral cutaneous nerve (LFCN), a purely sensory nerve that supplies the skin of the anterolateral thigh. The LFCN originates from L2-L3 spinal roots, courses through the lumbar plexus, and exits the pelvis just medial to the ASIS beneath the inguinal ligament – a frequent site of entrapment. […] This underrecognized, yet distinct, pattern of sensory symptoms stems from compression of the lateral femoral cutaneous nerve (LFCN). […] Recent evidence supports three simple yet powerful clinical tests for meralgia paresthetica diagnosis. […] These tests are invaluable in differentiating meralgia paresthetica from conditions such as lumbar radiculopathy or thoracolumbar disc lesions, providing clarity in complex presentations.

• #28 Meralgia Paresthetica: A Commonly Overlooked Cause of Thigh Pain — ChiroUp

  https://chiroup.com/blog/meralgia-paresthetica-a-commonly-overlooked-cause-of-thigh-pain

  While meralgia paresthetica is usually diagnosed clinically, nerve conduction studies (NCS) remain the gold standard in refractory or unclear cases. […] Conservative treatment for meralgia paresthetica is effective in up to 91% of cases. […] Manual therapy plays a central role in relieving lateral femoral cutaneous nerve irritation. […] Removing compression is the top treatment strategy. […] Research shows that in many cases, simply removing the source of compression, such as excess weight or restrictive clothing, can lead to significant symptom resolution. […] Meralgia paresthetica is a commonly overlooked but highly treatable cause of anterior thigh pain.

• #29

  https://scispace.com/papers/meralgia-paresthetica-its-pathogenesis-and-management-3ltud7c24r

  Meralgia paresthetica is characterized by numbness, pain, burning, itching and/or a grabbing sensation in the anterolateral thigh. It is commonly caused by nerve compression, particularly at the inguinal region. Sensory nerve conduction velocity of the lateral femoral cutaneous nerve is often completely blocked. […] Regarding apparent predisposing and/or responsible causes, nerve compression was suspected in 7 cases, of which 6 cases were caused by tight underwear at the inguinal region and 1 case by retention of ascites in the abdomen. […] Five out of 12 lateral femoral cutaneous nerves, removed at routine autopsies, showed pathologic changes in myelinated nerve fibers in the vicinity of the inguinal ligament that may be implicated in the production of some of the symptoms of meralgia paresthetica. […] In 9 patients with meralgia paresthetica, the sensory nerve condition in the symptomatic nerves was definitely abnormal: nerve potential was absent in 6 and condition velocity was slow in 3, suggesting a possible asymptomatic entrapment neuropathy.

• #30 Differential Etiological Diagnosis of Meralgia Paresthetica: A Concise Review

  https://clinmedjournals.org/articles/ijnn/international-journal-of-neurology-and-neurotherapy-ijnn-10-120.php?jid=ijnn

  There are tests that we can use to help diagnose this pathology, including the neurodynamic test of the femoral nerve, in addition to pelvic compression. […] However, other diagnostic managements are used because they have greater specificity, such as evoked somatosensory potentials, high-resolution ultrasound and magnetic resonance imaging. […] In the chronic presentation, loss of multifocal and myelinated fibers can be observed in the LFCN biopsy, in addition to perineural thickening and subperineural edema. […] COVID-19 can be a cause of MP, and in a cohort study with 51 patients with COVID-19 in ICU, 10 (33%) were diagnosed with MP, and presented pain in the lateral part of the cutaneous nerves, in both sides. […] In the context of DM, the most common complication of DM is Diabetic peripheral neuropathy (DPN), and a research evaluated 381 patients with DM type 2, and 107 (28.1%) of them had DPN. […] From the perspective of diabetic neuropathy of the LFCN, we have that it can occur in two situations: I) edema from decreased axonal transport and II) transformation of glucose into sorbitol leading to an impairment in the mechanism of the sodium-potassium pump.

• #31

  https://link.springer.com/article/10.1007/s10143-023-01962-0

  Treatment options include local injections, open neurolysis or neurectomy, and various neuro-modulative approaches. […] If surgical therapy is necessary, a variety of techniques exist. […] Throughout the entire study period, surgical management of MP in Germany was conducted using neuropreservative techniques, such as decompression of the LFCN, rather than neurectomy procedures. […] The fact that rates of other diagnostics, such as LFCN conduction studies and somatosensory evoked potentials, have also increased over time, may reflect increasingly robust evidence on their merits in MP diagnostics. […] Decreasing rates of surgical therapy in MP may be explained by improved medical treatment, such as anti-neuropathic pain medication, which may allow patients and therapists to forgo surgery. […] Throughout the entire study period, the most frequent surgical interventions were decompressive procedures, with an annual average rate of 29%.

• #32 Differential Etiological Diagnosis of Meralgia Paresthetica: A Concise Review

  https://clinmedjournals.org/articles/ijnn/international-journal-of-neurology-and-neurotherapy-ijnn-10-120.php?jid=ijnn

  There are tests that we can use to help diagnose this pathology, including the neurodynamic test of the femoral nerve, in addition to pelvic compression. […] However, other diagnostic managements are used because they have greater specificity, such as evoked somatosensory potentials, high-resolution ultrasound and magnetic resonance imaging. […] In the chronic presentation, loss of multifocal and myelinated fibers can be observed in the LFCN biopsy, in addition to perineural thickening and subperineural edema. […] COVID-19 can be a cause of MP, and in a cohort study with 51 patients with COVID-19 in ICU, 10 (33%) were diagnosed with MP, and presented pain in the lateral part of the cutaneous nerves, in both sides. […] In the context of DM, the most common complication of DM is Diabetic peripheral neuropathy (DPN), and a research evaluated 381 patients with DM type 2, and 107 (28.1%) of them had DPN. […] From the perspective of diabetic neuropathy of the LFCN, we have that it can occur in two situations: I) edema from decreased axonal transport and II) transformation of glucose into sorbitol leading to an impairment in the mechanism of the sodium-potassium pump.

• #33 Alopecia in Meralgia Paresthetica | Actas Dermo-Sifiliográficas

  https://www.actasdermo.org/en-alopecia-in-meralgia-paresthetica-articulo-S1578219019301088

  Alopecia in Meralgia Paresthetica Alopecia en meralgia parestsica […] Meralgia paresthetica and diseases such as notalgia paresthetica and brachioradial pruritus are classed as neurocutaneous dysesthesias. Their etiology is highly varied and is divided into iatrogenic or spontaneous. These categories are in turn subdivided into idiopathic, metabolic, and mechanical (such as obesity, pregnancy, or tight clothes). The condition is due to entrapment of or damage to the lateral femoral cutaneous nerve. The paresthesia affects the upper anterolateral or lateral surface of the thigh and is characterized by a sensation of burning, cold, stabbing, mild pain, anesthesia, or hypoesthesia. It has also been associated with alopecia and it has been speculated that it may have a traumatic origin due to the patient massaging the paresthetic area or to the influence of the nervous system on the hair.

• #34 Meralgia Paraesthetica: Symptoms, and Treatment | Doctor

  https://patient.info/doctor/meralgia-paraesthetica-pro

  Meralgia paraesthetica is usually an entrapment neuropathy of the lateral femoral cutaneous nerve (LFCN). It may be iatrogenic after medical or surgical procedures, or result from a neuroma. The segmental origin is L2/L3 and it is a purely sensory nerve with no motor fibres. […] The most common cause of impingement of the LFCN is entrapment of the nerve under the inguinal ligament, which can occur spontaneously or develop after an injury. […] Meralgia paraesthetica can occur in pregnancy, in obesity and if there is tense ascites. It may be a result of trauma, surgery (such as pelvic osteotomy, spinal surgeries, laparoscopic hernia repair and bariatric surgery) or, in some cases, may arise from abduction splints used to treat Perthes’ disease, also called Calv-Legg-Perthes disease. […] The evidence base for the treatment of meralgia paraesthetica is weak; randomised controlled trials are needed.

• #35 Meralgia Paresthetica: A Commonly Overlooked Cause of Thigh Pain — ChiroUp

  https://chiroup.com/blog/meralgia-paresthetica-a-commonly-overlooked-cause-of-thigh-pain

  While meralgia paresthetica is usually diagnosed clinically, nerve conduction studies (NCS) remain the gold standard in refractory or unclear cases. […] Conservative treatment for meralgia paresthetica is effective in up to 91% of cases. […] Manual therapy plays a central role in relieving lateral femoral cutaneous nerve irritation. […] Removing compression is the top treatment strategy. […] Research shows that in many cases, simply removing the source of compression, such as excess weight or restrictive clothing, can lead to significant symptom resolution. […] Meralgia paresthetica is a commonly overlooked but highly treatable cause of anterior thigh pain.

• #36 Meralgia Paresthetica, Cause of Diagnostic Mistake in the Vascular Clinic

  https://www.heraldopenaccess.us/openaccess/meralgia-paresthetica-cause-of-diagnostic-mistake-in-the-vascular-clinic

  The clinical presentation of patients with MP consist of paresthesia or dysesthesia, patients typically describe a pain, burning, numbness, muscle aches, coldness, lightning pain, or buzzing in the upper and lateral thigh, (the distribution of the LFCN). […] The aggravating factors of the pain may be erect posture, prolonged standing and walking and alleviation with sitting but on occasions symptoms aggravated by sitting have been reported. […] Before considering MP as a cause of the patients symptoms, clinicians must to first rule out common pathologies that MP can mimic, such as lumbar stenosis, disc herniation, and nerve root radiculopathy. […] The treatment of the MP could be conservative or surgical. Initial treatment for MP often may include the use of NSAIDS, analgesics, protection of the area, avoiding compression activities, and physical therapy. Other non-surgical interventions include pulsed radiofrequency ablation and LFCN nerve block.

• #37 Meralgia Paraesthetica: Symptoms, and Treatment | Doctor

  https://patient.info/doctor/meralgia-paraesthetica-pro

  Idiopathic meralgia paraesthetica usually improves with non-operative modalities, such as removal of compressive agents, non-steroidal anti-inflammatory drugs (NSAIDs), anticonvulsants or tricyclics and, if necessary, local corticosteroid injections. […] If the pain is severe, operative decompression should be considered. A supra-inguinal or infra-inguinal approach may be used.

• #38 Diagnosis and Treatment of Meralgia Paresthetica (Literature Review)

  https://www.genesispub.org/diagnosis-and-treatment-of-meralgia-paresthetica-literature-review

  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. […] 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). […] 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.

• #39 Meralgia Paresthetica: Neurolysis or Neurectomy?

  https://www.mdpi.com/2673-4095/5/3/66

  Seven anatomical variants of the LFCN course, in its passage from the abdomen to the lower limb, have been described. […] The first diagnosis is essentially clinical and is based on the presence of typical sensory neurological impairment in the anterolateral part of the thigh with no motor involvement. […] The Pelvic Compression Test is among the most sensitive and specific maneuvers for diagnosing MP. […] The management of MP includes conservative attempts, e.g., patient education about avoiding tight clothing, weight loss, medications (e.g., NSAIDs, topical capsaicin, lidocaine, gabapentin, phenytoin, carbamazepine) and a trial of physical therapy. […] However, if symptoms persist despite conservative therapies, the gold standard of treatment is surgery. […] There is no high-level evidence on which is the best treatment to offer to MP patients.

• #40 Meralgia Paresthetica: Neurolysis or Neurectomy?

  https://www.mdpi.com/2673-4095/5/3/66

  The terms decompression and neurolysis are used in this text as synonymous, although they have two subtly different meanings. […] Neurolysis was the first-line strategy, while neurectomy was reserved for cases of decompression failure or in the case of an already damaged LFCN (usually iatrogenic). […] The quality of the studies does not provide any indication as to which is the best treatment option. […] According to a recent meta-analysis performed by Lu et al., 85% of patients improved after neurectomy versus only 63% after neurolysis. […] On this basis, some surgeons prefer neurectomy because it provides a higher rate of therapeutic success, while others favor neurolysis because it allows the preservation of sensitivity in the innervated area. […] In light of these results, it appears inappropriate to submit all the patients presenting with MP to an ablative surgery (neurectomy) as a first-line treatment only to avoid a 6.4% of repetition of an uneventful second surgical procedure.

• #41 Meralgia Paresthetica (Lateral Cutaneous Nerve Entrapment): Pathophysiology, Presentation, and Treatment Options – MSK Doctor Zaid Matti

  https://mskdoc.co.nz/meralgia-paresthetica-lateral-cutaneous-nerve-entrapment-pathophysiology-presentation-and-treatment-options/

  Meralgia paresthetica commonly called lateral femoral cutaneous nerve entrapment causes burning, tingling, or numbness along the outer thigh. […] Meralgia paresthetica occurs when the lateral femoral cutaneous nerve (LFCN) is compressed as it passes beneath the inguinal ligament near the anterior superior iliac spine. Because the LFCN is purely sensory, patients experience only altered sensation no muscle weakness. […] PRP: A Regenerative Frontier in Nerve healing What Is PRP? Platelet-rich plasma is an autologous blood derivative concentrated in platelets and growth factors (PDGF, VEGF, NGF, TGF-) that promote tissue regeneration, angiogenesis, and modulate inflammation. […] Why Consider PRP for Meralgia Paresthetica? Stimulates Schwann cell activation and myelin regeneration Improves microvascular perfusion via angiogenesis Downregulates pro-inflammatory cytokines involved in chronic neuropathic pain.

• #42 Additional Differential Diagnosis for Adult Hip Pain | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0700/p9.html

  Lateral femoral cutaneous nerve entrapment (i.e., meralgia paresthetica) be included in the differential diagnosis. […] Lateral femoral cutaneous nerve entrapment is a common clinical entity that presents as hip pain. […] This injury is amenable to nerve hydrodissection guided by point-of-care ultrasonography because it courses over the proximal sartorius muscle. […] Corticosteroids and dextrose prolotherapy have been successfully used for years to avoid surgical management.

• #43 Meralgia Paresthetica: a Very Treatable Nerve Compression Syndrome | Neuropax Clinic

  https://neuropaxclinic.com/meralgia-paresthetica-a-very-treatable-nerve-compression-syndrome/

  Meralgia Paresthetica is a constellation of symptoms caused by a compression neuropathy (pinched nerve) of the Lateral Femoral Nerve (LFN). […] This compression neuropathy (pinched nerve condition) can be caused by several different mechanisms. […] Even just having surgery in the area of the hip, groin or abdomen can lead to changes in the tissue surrounding the nerve and lead to compression. […] It is also important to recognize the affects of diabetes on this clinical problem. Diabetic patients, due to abnormal glucose metabolism, may develop swelling of the nerve, as well as narrowing of the tunnel itself. […] Surgical decompression of the nerve is successful in 80-85% of cases. […] The success of the surgery depends on how long the nerve has been compressed, the severity of the compression, the extent of nerve damage due to injury and the possible presence of underlying medical or spine problems.

• #44 Diagnosis and Treatment of Meralgia Paresthetica (Literature Review)

  https://www.genesispub.org/diagnosis-and-treatment-of-meralgia-paresthetica-literature-review

  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. […] 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.

• #45 Meralgia Paresthetica: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1141848-overview

  A painful mononeuropathy of the lateral femoral cutaneous nerve (LFCN), meralgia paresthetica is commonly due to focal entrapment of this nerve as it passes through the inguinal ligament. Rarely, it has other etiologies such as direct trauma, stretch injury, or ischemia. It typically occurs in isolation. The clinical history and examination is usually sufficient for making the diagnosis. However, the diagnosis can be confirmed by nerve conduction studies. Treatment is usually supportive. The LFCN is responsible for the sensation of the anterolateral thigh. It is a purely sensory nerve and has no motor component. […] Reviewing the anatomy of the lateral femoral cutaneous nerve (LFCN) is essential for understanding the mechanism of its injury. The LFCN originates directly from the lumbar plexus and has root innervation from L2-3. The nerve runs through the pelvis along the lateral border of the psoas muscle to the lateral part of the inguinal ligament. Here, it passes to the thigh through a tunnel formed by the lateral attachment of the inguinal ligament and the anterior superior iliac spine. The crossover into the thigh is the most common site of entrapment. The crossover typically occurs 1 cm medial to the anterior superior iliac spine; however, regional variations are common.

• #46 Meralgia Paresthetica – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK557735/

  Meralgia paresthetica is a clinical condition that includes pain and dysesthesia in the anterolateral thigh associated with lateral femoral cutaneous nerve compression. […] Describe the pathogenesis of meralgia paresthetica and consider relevant differential diagnoses. […] The condition is caused by injury or entrapment of the lateral femoral cutaneous nerve (LFCN) and is classified as spontaneous or iatrogenic. […] Injury to the lateral femoral cutaneous nerve occurs due to external compression or from internal pressure such as from obesity, pregnancy, or tumors. […] Metabolic causes from diabetes, alcohol, or lead poisoning may also result in an isolated nerve injury. […] Chronic meralgia paresthetica is associated with specific pathologic findings on LFCN biopsy, including multifocal fiber loss, loss of large myelinated fibers, thinly myelinated profiles, regenerating nerve clusters, perineurial thickening, and subperineurial edema. […] The LFCN is derived from a combination of lumbar nerve roots (posterior divisions of L2/L3 spinal nerves) and sometimes adjacent peripheral nerves.

• #47 Meralgia Paresthetica | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/76580

  Chronic meralgia paresthetica is associated with specific pathologic findings on LFCN biopsy, including multifocal fiber loss, loss of large myelinated fibers, thinly myelinated profiles, regenerating nerve clusters, perineurial thickening, and subperineurial edema. […] The LFCN is derived from a combination of lumbar nerve roots (posterior divisions of L2/L3 spinal nerves) and sometimes adjacent peripheral nerves. It emerges from the lateral aspect of the psoas muscle, passes under the iliac fascia, then crosses the anterior surface of the iliacus muscle as it travels toward the anterior superior iliac spine. […] Diabetic nerve injury of the LFCN may occur due to swelling from decreased axoplasmic transport or impaired sodium-potassium ATP activity via the sorbitol pathway activation by glucose.

• #48 Meralgia Paresthetica: Neurolysis or Neurectomy?

  https://www.mdpi.com/2673-4095/5/3/66

  The terms decompression and neurolysis are used in this text as synonymous, although they have two subtly different meanings. […] Neurolysis was the first-line strategy, while neurectomy was reserved for cases of decompression failure or in the case of an already damaged LFCN (usually iatrogenic). […] The quality of the studies does not provide any indication as to which is the best treatment option. […] According to a recent meta-analysis performed by Lu et al., 85% of patients improved after neurectomy versus only 63% after neurolysis. […] On this basis, some surgeons prefer neurectomy because it provides a higher rate of therapeutic success, while others favor neurolysis because it allows the preservation of sensitivity in the innervated area. […] In light of these results, it appears inappropriate to submit all the patients presenting with MP to an ablative surgery (neurectomy) as a first-line treatment only to avoid a 6.4% of repetition of an uneventful second surgical procedure.

• #49 Meralgia Paresthetica: Neurolysis or Neurectomy?

  https://www.mdpi.com/2673-4095/5/3/66

  Indeed, an incomplete nerve decompression, even in light of the above-mentioned mechanism, could be responsible for therapeutic failure and could therefore explain, at least in part, the lower success rate reported in the literature of neurolysis compared to that of neurectomy. […] According to our results, the combination of a carefully performed surgical approach with neurolysis and the decompression of the LFCN should be considered the first choice in MP.

• #50 Lateral femoral cutaneous syndrome (meralgia paresthetica) | Southern Pain SpecialistsAccessibility ToolsIncrease TextDecrease TextGrayscaleHigh ContrastNegative ContrastLight BackgroundLinks UnderlineReadable FontReset

  https://southernpainspecialists.com/lateral-femoral-cutaneous/

  At Southern Pain and Spine Specialists in North Carolina, we explore Lateral Femoral Cutaneous Syndrome, also known as Meralgia Paresthetica. This condition causes burning thigh pain, tingling, and numbness in the anterolateral thigh due to lateral femoral cutaneous nerve entrapment. […] We focus on Meralgia Paresthetica, which affects the lateral femoral cutaneous nerve. This pure sensory nerve is prone to entrapment, causing significant discomfort and sensory disturbances in the outer thigh area. […] Our overview of Meralgia Paresthetica highlights its impact on the lateral femoral cutaneous nerve. This condition results in thigh pain, numbness, and tingling, often exacerbated by tight clothing or prolonged standing. […] We identify the primary causes and symptoms of Meralgia Paresthetica, including nerve compression near the inguinal ligament and symptoms like dysesthesia in the anterolateral thigh. These issues arise from the compression of the lateral femoral cutaneous nerve.

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