Meralgia Paraesthetica
1. Introduction
Meralgia paraesthetica (MP) is a nerve injury, usually from compression and inflammation of the nerve which can cause pain, tingling, numbness and sensation loss on the outside of the thigh. The area on the outside of the thigh is supplied by the lateral femoral cutaneous nerve (1-2). The lateral femoral cutaneous nerve originates from the lumbar spine (lower back), travels across and underneath the structures at the front of the hip and into the thigh (3-4).
Meralgia paraesthetica can be a difficult condition to diagnose as it has similar symptoms to other nerve conditions coming from the lumbar spine such as lumbar stenosis, disc herniation, and nerve root radiculopathy (5-7).
Meralgia paraesthetica typically resolves in 3 months (11). To help recovery lifestyle factors should be addressed such as obesity and the wearing of tight clothing. If symptoms persist longer than this then other treatment options may be considered (9).
Frequently Asked Questions
- Meralgia paraesthetica is described as pain on the outside thigh caused by compression and inflammation of the nerve that supplies that area (1).
- Meralgia paraesthetica is a very rare condition.
- It affects less that 0.01% of the general population (1).
- It has similar presentation to other more common nerve conditions (1, 5-7).
- No.
- Meralgia paraesthetica is a treatable condition with conservative methods such as exercise, manual therapy and acupuncture (1).
- It is most commonly found in people aged 30–40 (1)
- You are more likely to suffer from this condition if you are diabetic (4)
- Wearing tight clothing (1, 4)
- Being overweight (1, 4)
- Had recent surgery on the hip or back (4)
- Pain, numbness, burning sensation on the outside of the thigh (1, 2, 8).
- Pain may worsen with prolonged standing and walking whilst being eased with sitting (8).
- Avoid wearing tight clothing that may compress the nerve (1-11).
- Lose weight if you are overweight or obese (1-11).
- Exercise to maintain function of the leg and improve nerve symptoms (4).
- Anti-inflammatory medication (1-11).
- Symptoms typically resolve in 3 months (11).
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk.
2. Signs and Symptoms
Nerve injuries often present with similar symptoms that affect the lower limbs however in Meralgia paraesthetica symptoms are usually specific to the upper outside aspect of the thigh. This may include pain, burning, numbness, aching muscles, a cold sensation, sharp shooting pain or a buzzing sensation (1, 2, 8). Pain may persist for a prolonged period after initial injury and worsen with prolonged standing and walking whilst being eased with sitting (8).
3. Causes
There are certain mechanical factors that can cause Meralgia paraesthetica. Compression of the nerve at any point along its path can cause symptoms, commonly around the structures of the front of the hip (1,8). Meralgia paraesthetica can also be a complication of surgery, particularly hip joint replacement or spinal surgery (1).
4. Risk Factors
There are several risk factors for Meralgia paraesthetica some of which may not always be obvious but can cause compression of the nerve. These include wearing tight fitting clothes such as skinny jeans, tight-fitted seatbelts, military armour and police uniforms or direct trauma (1,4).
Some other risk factors which may not be avoidable but can cause Meralgia paraesthetica include pregnancy, scoliosis (curvature of the spine) and leg length changes (1,4). In the case of pregnancy, symptoms typically resolve postpartum (11).
Other risk factors which can cause Meralgia paraesthetica include obesity, diabetes, alcoholism, and lead poisoning (1,8).
5. Prevalence
Meralgia paraesthetica is very rare but can affect anyone, with an incidence rate of 4.3 per 10,000 (1). Typically, it is more common in 30–40-year-old males and more common in those with diabetes (1-4).
6. Assessment & Diagnosis
Musculoskeletal physiotherapists and other appropriately qualified health care professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.
Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent re-assessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made. If a diagnosis cannot be made by the physiotherapist, then you may be referred for further testing, which may include a nerve conduction study or an MRI scan (9-10).
7. Self-Management
Managing Meralgia Paraesthetica should aim to reduce the aggravating factors, such as wearing tight compressive clothing, losing weight if you are overweight and managing other risk factors identified during your consultation. Exercise can be useful in desensitising the nerve and reducing the symptoms felt as well as maintaining function. Non-steroidal anti-inflammatory medications (such as ibuprofen) can be used to help reduce pain and inflammation around the nerve (1). Symptoms typically resolve within 3 months (11).
8. Rehabilitation
Rehab programmes should address any functional problems identified during the consultation. General exercise is as well as specific rehabilitation is also beneficial, particularly in those looking to lose weight.
Below are three rehabilitation programs created by our specialist physiotherapists targeted at addressing meralgia paraesthetica. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point as well as clearly highlighting exercise progression.
9. Meralgia Paraesthetica
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
Initially the focus is on increasing the movement in the lumbar spine to reduce any compression on the nerve.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
At this stage we look to progress to more function exercises to enhance the strength and movement of the hips, pelvis and lower back.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
10. Return to Sport / Normal life
For patients wanting to achieve a high level of function or return to sport we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage. Before returning to sport, a rehabilitation programme should incorporate plyometric based exercises including things like bounding, cutting, and sprinting exercises.
As part of a multi-modal treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from further assessment to ensure you are making progress and establish appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future re-occurrence.
11. Other Treatment Options
Acupuncture and manual therapy techniques can be useful in reducing pain and reducing the numbness felt in the thigh. Anti-neuropathic medication may also be recommended by a GP to help reduce nerve symptoms (11). Should symptoms not improve other treatment options considered at consultant level may include a nerve block or a nerve resection (1).
References
- Cheatham, S.W., Kolber, M.J. and Salamh, P.A., 2013. Meralgia paresthetica: a review of the literature. International journal of sports physical therapy, 8(6), p.883.
- Ivins, G.K., 2000. Meralgia paresthetica, the elusive diagnosis: clinical experience with 14 adult patients. Annals of surgery, 232(2), p.281.
- Horan, F., 2009. Gray’s Anatomy: the anatomical basis of clinical practice: Edited by Susan Standring Pp. 1551. Illinois: Churchill Livingstone Elsevier, 2008. ISBN: 978-0-443-06684-9
- Üzel, M., Akkin, S.M., Tanyeli, E. and Koebke, J., 2011. Relationships of the lateral femoral cutaneous nerve to bony landmarks. Clinical Orthopaedics and Related Research®, 469(9), pp.2605-2611.
- Erbay, H., 2002. Meralgia paresthetica in differential diagnosis of low-back pain. The Clinical journal of pain, 18(2), pp.132-135.
- Tokuhashi, Y., Matsuzaki, H., Uematsu, Y. and Oda, H., 2001. Symptoms of thoracolumbar junction disc herniation. Spine, 26(22), pp.E512-E518.
- Trummer, M., Flaschka, G., Unger, F. and Eustacchio, S., 2000. Lumbar disc herniation mimicking meralgia paresthetica: case report. Surgical neurology, 54(1), pp.80-81.
- Grossman, M.G., Ducey, S.A., Nadler, S.S. and Levy, A.S., 2001. Meralgia paresthetica: diagnosis and treatment. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 9(5), pp.336-344.
- Seror, P., 1999. LATERAL FEMORAL CUTANEOUS NERVE CONDUCTION V SOMATOSENSORY EVOKED POTENTIALS FOR ELECTRODIAGNOSIS OF MERALGIA PARESTHETICA1. American journal of physical medicine & rehabilitation, 78(4), pp.313-316.
- Chhabra, A., Andreisek, G., Soldatos, T., Wang, K.C., Flammang, A.J., Belzberg, A.J. and Carrino, J.A., 2011. MR neurography: past, present, and future. American Journal of Roentgenology, 197(3), pp.583-591.
- Coffey R, Gupta V. Meralgia Paresthetica. StatPearls [Internet]. 2020 May 18.
Other Conditions in
Hips & Pelvis, Upper Legs, Neurological
Sacroiliac Joint Dysfunction
Pain originating from the sacroiliac joint at the base of your back where the spine joins the pelvis.
Proximal Hamstring Tendinopathy
Pain and weakness under the buttock or the back of your upper thigh caused by tendon issues.
Pelvic Girdle Pain
Typically seen in pregnancy causing pain, instability and limitation of mobility and functioning of the pelvic joints.
Pelvic Floor Dysfunction
The inability to effectively control the muscles of your pelvic floor, leading to issues with continence and pain.
Lumbar Disc Injury
Lumbar discs sit between each of the bones of the spine. Problems can occur when these discs become irritated.
Low Back Pain and Sciatica
Sciatica is a symptom describing pain and/or pins and needles down the back of the leg.
Iliotibial Band Syndrome
Presents as pain on the outside of the knee, normally occurring because of overload due to prolonged or repeated bouts of exercise.
Hip Replacement Surgery
Replacement of the hip ball and socket joint, typically as a result of severe osteoarthritis or trauma.
Hip Osteoarthritis
Common age-related changes to the structure of the hip joint may be associated with pain, stiffness and loss of function.
Hamstring Strain/Tear
Hamstring strain injuries are an over-stretch or tear to one or more of the muscles located at the back of the thigh.
Greater Trochanteric Pain Syndrome
A condition affecting the tendons that insert into outside of the hip. A common cause of pain felt around the hip and pelvis.
Femoroacetabular Impingement
A condition that results in pain in the groin, hip and down the front of the thigh.
Femoral Nerve Radiculopathy
This is where the nerve that supplies the front of the leg is irritated and causes pain/numbess.
Coccydynia
Coccydynia is the medical term used to describe pain in your coccyx (tail bone).
Benign Joint Hypermobility Syndrome
Common age related changes to the structure of the knee joint which may be associated with pain, stiffness and loss of function.
Adolescent Hip Dysplasia
A result of an abnormality of the hip joint anatomy resulting in pain in the hip with occasional instability.
Adductor-Related Groin Pain
Localised discomfort to the inner upper thigh and groin.