Meralgia paresthetica

Diagnosis

Diagnosing meralgia paresthetica involves conducting a physical examination and obtaining a comprehensive understanding of the patient’s symptoms, medical and surgical history, and lifestyle. Since this condition can be triggered by various factors and conditions, healthcare providers may ask a series of targeted questions to help identify the underlying cause of the symptoms.

During the physical exam, a healthcare provider will typically conduct a hands-on test known as a pelvic compression test. This involves applying pressure to the affected thigh to assess sensation. They may also ask for a description of the pain and instruct the patient to outline the numb or painful region on the thigh. Additionally, other tests such as light touch and reflex assessments may be performed as part of the examination.

To confirm the diagnosis and to rule out other possible reasons of the symptom, several tests may be required, such as:

• Imaging tests: An X-ray of the pelvis and thigh may be requested to exclude the possibility of other medical conditions such as bone tumors. Other imaging procedures like a CT scan or magnetic resonance imaging (MRI) scan might be recommended to examine potential spinal or nerve problems like a herniated disc. Or if the healthcare provider feels that a tumor is causing the pain.
• Electromyography: This test involves inserting a slender needle electrode into the muscle to record its electrical activity. While the results of this test typically appear normal in cases of meralgia paresthetica, it may still be necessary to conduct the test in order to rule out other disorders when the diagnosis is uncertain.

Electromyography is utilized to assess and diagnose muscle and nerve disorders by measuring the electrical discharges generated within the muscles.

• Nerve conduction study: This test may be required to rule out other possible explanations of the symptoms. A comparison of the lateral femoral cutaneous nerves on both sides is performed. During the procedure, patch-style electrodes are applied to the skin to deliver a moderate mild electrical impulse to the nerve. The electrical impulse aids in the diagnosis of damaged nerves.
• Nerve blockade: Meralgia paresthetica can be confirmed by obtaining pain relief through an anesthetic injection into the precise location where the lateral femoral cutaneous nerve enters the thigh. This injection, guided by ultrasound imaging, if necessary, serves as a diagnostic measure to validate the presence of the condition.
• Blood tests: To assess potential underlying causes that can impact nerve function, blood tests may be prescribed. These tests can include checking thyroid hormone levels to identify signs of hypothyroidism, assessing B vitamin levels to detect deficiencies in vitamin B12 or folate, which can affect nerves. Furthermore, a hemoglobin or hematocrit test may be conducted to investigate signs of anemia. Blood tests can also examine lead levels to detect signs of lead poisoning and measure blood glucose levels to identify signs of diabetes.

Treatment

The majority of meralgia paresthetica cases show improvement with conservative treatment and may even resolve spontaneously. The primary objective of treatment is to alleviate nerve compression.

• With conservative treatment, most of persons with meralgia paresthetica recover. Techniques may include:
  • Weight loss and maintaining a healthy weight
  • Dressing in looser garments
  • Using over-the-counter pain medicines such as acetaminophen, ibuprofen, and aspirin
• Medications: Severe pain or symptoms that lasts longer than two months may be relieved with medications, such as:
  • Gabapentin, pregabalin, duloxetine, phenytoin, or carbamazepine: These medications may help treat neuropathic pain. Constipation, nausea, dizziness, drowsiness, and lightheadedness are some of the side effects.
  • Corticosteroid injections: Injections can alleviate pain by minimizing inflammation. However, there are potential side effects associated with these injections, including joint infection, nerve damage, pain, and discoloration of the skin surrounding the injection site.
  • Tricyclic antidepressants: These drugs are effective in helping pain. Drowsiness, dry mouth, constipation, and reduced sexual function are some of the side effects.
• Radiofrequency nerve ablation: This therapy employs radio waves to generate a current, which then heats a targeted section of nerve tissue. By doing so, the heat effectively destroys that specific area of the nerve, preventing it from transmitting pain signals to the brain.
• Surgery: Healthcare providers only suggest surgery for individuals who have attempted alternative treatments but continue to experience symptoms. Surgical intervention will address compression on the lateral femoral cutaneous nerve.