[headline style=”1″ align=”center” headline_tag=”h2″]Introduction to Meralgia Parasthetica
Recently I came across a patient that I diagnosed with meralgia parasthetica. This condition is extremely rare, and, in fact, is the first one that I have seen clinically. Frequently this is often misdiagnosed for a disc lesion or sciatica. However, it is just an entrapment of the lateral femoral cutaneous nerve. In this post I am going to disclose the history and examination findings, the functional anatomy of this nerve, how I treated it, and, finally, the outcome.
[headline style=”1″ align=”center” headline_tag=”h2″]History and Examination Findings
History: A 69 YO female patient came into the clinic with a CC of right proximal thigh pain which she described as “shooting”. Sitting felt worst while standing felt better. Sleeping increased her symptoms when lying on her left side with right leg up but felt better supine and legs straight. Patient denied any MOI and gradually started to notice condition was worsening. No signs and symptoms of malignancy present.
Decreased weight bearing in right leg.
No increase in symptoms with spinal movement.
Increase in symptoms with active hip flexion
Increase in symptoms with passive range of motion of hip into flexion and extension.
No increase with spinal movement or accessory.
Increase in symptoms with proximal hip flexor length.
MMT: Pain with contraction of hip flexors in inner and outer range
Palpation for Tenderness:
Medial ASIS and Iliacus
Normal myotomes except pain with L2 (hip flexor)
SLUMP Femoral nerve bias negative
[headline style=”1″ align=”center” headline_tag=”h2″]Anatomy of Meralgia Paresthetica
Meralgia Paresthetica is a fancy term for saying an entrapment of the lateral femoral cutaneous nerve. This originates from the ventral rami of L2 and L3 and travels between the iliacus and psoas muscles. It crosses just medial to the ASIS where it then goes on to innervate the proximal thigh with two branches one anterior and one posterior.
One of the biggest distinguishing factors of this nerve is it only provides sensory and no motor. This is one of the many ways to discern from femoral nerve entrapments or a disc lesion. (More to come later)
Clinically, this nerve can be entrapped anywhere along the path it travels. The most common areas are superior or inferior to the inguinal ligament or between the psoas and iliacus muscles. See picture below.
[images style=”0″ image=”http%3A%2F%2Fwww.scottgraypt.com%2Fwp-content%2Fuploads%2F2017%2F03%2FLateral-Femoral-Cutaneous-.png” width=”508″ align=”center” top_margin=”0″ full_width=”Y”]
[headline style=”1″ align=”center” headline_tag=”h2″]How I Discerned Between Sciatica and Disc Lesion…
This patient had been to three doctors before arriving at my clinic. She was diagnosed initially with sciatica and a disc lesion after an MRI.
I was able to discern this wasn’t her problem right way because she had no pain with spinal movement, normal neurological examination including SLUMP test, and didn’t have back or posterior leg pain.
After further inspection this patient had abnormal sensation to proximal lateral thigh and had increase is symptoms with proximal hip flexors contraction and lengthening. This is usually where the nerve gets entrapped so stretching or contracting of these muscles naturally is going to reproduce symptoms.
Finally, this patient was also super tender to palpation just medial to the ASIS and inguinal ligament. This is another area where the nerve runs before going to the proximal thigh.
[headline style=”1″ align=”center” headline_tag=”h2″]Interventions for Meralgia Parasthetica
Since this patient had pain with hip flexor contraction and stretching, it only made sense to start going after the muscles and fascia surrounding this area. After two treatments of isolated soft tissue with Active Release and Myofascial Manipulation this patient was 80% better.
On this patient’s third visit I used the TRUE stretch and lunge matrix to further lengthen this myofascial chain with different lunge variations and arm drivers.
Her HEP consisted of her husband doing PNF contract relax to the psoas and iliacus followed by her lunges to use this new mobility and to generate length.
Finally, the patient was also told to reduce sittiing as much as possible which further impinges on the nerve. Sleeping postures were also modified.
[headline style=”1″ align=”center” headline_tag=”h2″]Outcome for Meralgia Parasthetica …
This patient progressed tremendously over 5 visits. She is now able to walk, bend, lift, and perform other functional movement patterns without pain or compensation. Better yet, she was able to avoid surgery, get peace of mind, and resume her normal life. 🙂
[headline style=”1″ align=”center” headline_tag=”h2″]Conclusion on Maralgeia Parasthetica
Maralgeia parasthetica is a condition that is frequently misdiagnosed for a disc lesion or sciatica. If you understand the anatomy and provide a sound physical examination it is easy to discern. Next time your patient has shooting pain across the the lateral and anterior thigh don’t forget about this condition. By the way, if you are looking for a step-by-step guide on how I came to this diagnosis you can claim my FREE blueprint on how I assess all of my patients by Clicking Here.
Have you come across this diagnosis? If so, leave me a comment below and let me know how you treated or assessed your patient.