Meralgia paraesthetica is a rare nerve entrapment in the thigh area. This can cause pinprick-like pain, discomfort and sometimes also numbness. Meralgia paraesthetica is usually treated as part of an inpatient operation. It is estimated that this type of meralgia paraesthetica surgery leads to a cure in 70 to 80% of cases. Here you will find further information and selected meralgia paresthetica specialists and centers.
Meralgia paraesthetica is a nerve entrapment with pain in the so-called lateral femoral cutaneous nerve. This nerve supplies the skin of the thigh region at the front and slightly on the outside up to about the knee.
Electrifying shooting pain occurs in this region, which is associated with numbness in half of the cases. The knee and lower leg are not affected by meralgia paresthetica. The pain is caused by an extended hip joint, i.e. mainly when standing. It is reduced when the hip joint is flexed forcefully.
The nerve affected by meralgia paresthetica is at best as thick as a pencil lead. It pulls forward at the base of the pelvis towards the inguinal ligament region. Between the leaves of the inguinal ligament, it bends downwards towards the skin on the front of the thigh.
The nerve affected by meralgia paresthetica can be seen here in red © SciePro | AdobeStock
This bend is the problem: it exists when the hip joint is in an extended position and is reversed when the hip joint is bent.
The rough edges of the individual tendinous leaves of the inguinal ligament can pinch at right angles to its course, depending on the positioning of the nerve.
The symptoms of meralgia paraesthetica are rare, but it was described by Sigmund Freud, who suffered from it himself. The pain can be very intense and can simulate a slipped disc with sciatic pain.
The nerve contains only sensitive fibers, which
to the spinal cord and brain. However, it does not contain motor fibers that control muscles. There is therefore never a loss of strength in the leg.
Instead, patients with meralgia paraesthetica only notice damage to the three sensory qualities.
There is practically no instrumental examination to prove that the nerve is affected. It is too small to be visualized in magnetic resonance imaging(MRI).
Nerve conduction velocity measurements by a neurologist can facilitate the diagnosis of meralgia paresthetica. The doctor compares the conduction velocity between the right and left thigh.
When testing the sensation in a side-by-side comparison on the front and outside of the thigh, the following can be detected
can be indicated.
The best way to prove meralgia paresthetica is by the following very simple measure: The patient should first observe on themselves which leg positioning or movements provoke the pain easily.
During the examination, the doctor injects an anesthetic at the site of the nerve directly at the inner edge of the anterior iliac crest. He then instructs the patient to perform exactly these provocative maneuvers on the road.
The patient observes whether the pain occurs during the anesthetic's effective period of approximately 2 hours. If not, this proves that the small nerve is actually affected by meralgia paresthetica.
Meralgia paresthetica is characterized by pain in the thigh © SENTELLO | AdobeStock
Drug therapy for meralgia paraesthetica is not possible. Repeated cortisone-containing infiltrations can be carried out at the same site as the test infiltration described above. However, the chances of improving the pain syndrome are very limited.
Pain therapies with morphine-like drugs are definitely not a permanent solution for the treatment of meralgia paresthetica. Conventional painkillers (anti-inflammatory drugs) can only have a temporary effect at best, but cannot solve the actual problem.
Surgical intervention is therefore necessary in order to relieve the patient's symptoms.
However, if permanent burning pain has already developed in the area on the front and outside of the thigh, it is too late for meralgia paraesthetica surgery. In this case, touching the skin leads to additional pain ("neuropathic pain").
Due to the permanent stimulus from the nerve in the central nervous system (spinal cord), changes have already occurred that no longer respond to surgery.
In the past, the nerve was severed during meralgia paraesthetica surgery. On the one hand, this numbs the area supplied by the nerve. On the other hand, the resulting nerve end can become highly sensitive. After a nerve has been severed, the nerve cell located near the spinal cord becomes very active, which gives the nerve cell process located in the nerve the ability to grow back peripherally into its former supply area.
However, after a nerve has been severed, the several thousand nerve fibers do not know where they can grow again. This is why a tangle-like thickening of tangled nerve fibers (neuroma) forms at the end of the nerve.
This accumulation of sensitive nerve fiber endings reacts highly sensitively to tissue pressure and can provoke new pain. The brain projects these into the former supply area of the nerve.
For this reason, the nerve should not be severed during meralgia paresthetica surgery.
The current aim of meralgia paraesthetica surgery is to surgically prevent the nerve from being crushed. To do this, the surgeon cuts the sections of the leaves of the inguinal ligament directly on the inside of the anterior tip of the iliac crest in such a way that the small nerve is no longer pinched by movements and positioning of the hip joint.
This is achieved by making a relatively small incision directly above the tip of the iliac crest. However, if the abdominal wall contains very fatty tissue, it may be necessary to widen the incision considerably in order to reach the structures of the inguinal ligament and the anterior tendon plate covering the thigh.
It remains to be seen whether keyhole surgery can also be used here and whether it will prove successful.
After the operation, wound secretions from inside the pelvic floor can spread under the skin through the small opening created by the operation. Therefore, suction drainage should remain in the surgical area for up to 3 days. This allows the usual adhesion of the wound to set in and healing is not delayed by the accumulation of wound fluid.
Although meralgia paresthetica surgery is theoretically possible on an outpatient basis, it is very unfavorable due to the need to monitor the wound situation.
No follow-up treatment is required after meralgia paresthetica surgery. It may be necessary to protect the surgical area.
There are no serious risks associated with meralgia paraesthetica surgery.
A complication of the decompression procedure is the risk of injury or severing of the nerve in the event of anomalies in its course. This would result in complete numbness in the area supplied by the nerve. As described, a neuroma forms at the newly created nerve end. However, such a neuroma only causes permanent pain in 10% of cases. Cutting the nerve can therefore eliminate the pain under certain circumstances.
To avoid wound complications at this site, which is frequently used in everyday life, prolonged suction drainage is advisable. If possible, this should also include inpatient follow-up observation.
There are no reliable statistical findings on the possible course of meralgia paraesthetica without surgery. Therefore, there is also a lack of information on the success rate with surgery.
However, it is estimated that meralgia paraesthetica surgery leads to a cure in 70 to 80% of cases.
The symptoms and the procedure are so rare that any surgeons can only make personal statements about success rates.
The problem is that it is not possible to reliably examine the condition preoperatively using equipment.
Meralgia paresthetica is an extremely annoying and debilitating symptom. The diagnosis is made by means of a test injection and only secondarily by instrumental examinations.
Treatment focuses on meralgia paraesthetica surgery, which is a minor and often truly effective procedure. The surgical site, which is under permanent strain due to all the movements involved, requires careful wound monitoring, meaning that outpatient treatment measures are more likely to pose risks than inpatient treatment.
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