Meralgia paresthetica
Meralgia paresthetica is a mononeuropathy from entrapment of the lateral femoral cutaneous nerve near the inguinal ligament, causing anterolateral thigh numbness, tingling, and burning pain without motor weakness. Diagnosis is clinical, and first-line treatment is weight loss and avoiding tight clothing, with gabapentin or injection reserved for persistent symptoms.
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What this article covers
- Overview
Definition: meralgia paresthetica is a compressive mononeuropathy of the lateral femoral cutaneous nerve, a purely sensory nerve, producing numbness, tingling, and burning pain over the anterolateral thigh without motor weakness.
- Epidemiology
Common cause of lateral hip and thigh pain: meralgia paresthetica is one of the more common causes of anterolateral hip and thigh pain evaluated in general internal medicine and musculoskeletal clinics.
- Risk factors
Obesity: increased abdominal and pelvic girth raises mechanical pressure on the nerve at the inguinal ligament, the single most common contributing factor.
- Pathophysiology
Anatomic vulnerability: the lateral femoral cutaneous nerve arises from the L2-L3 nerve roots, crosses the pelvic brim, and passes near the anterior superior iliac spine before piercing or passing…
- Clinical features
Anterolateral thigh numbness, tingling, or burning pain: symptoms are confined to the distribution of the lateral femoral cutaneous nerve over the anterolateral thigh, typically extending from the hip toward the knee.
- Differential diagnosis
Lumbar radiculopathy (L2-L3): can also cause anterior or lateral thigh pain, but typically includes back pain, a positive straight-leg or femoral stretch test, and, unlike meralgia paresthetica, can…
- Diagnosis
First, establish the diagnosis clinically: the combination of anterolateral thigh numbness, tingling, or burning pain confined to the lateral femoral cutaneous nerve distribution, with normal…
- Management
First, address the reversible mechanical or contributing factor: counsel on weight loss if obesity is present, avoidance of tight belts, waistbands, or corsets, and avoidance of prolonged postures…
- Complications
Chronic pain: a minority of patients develop persistent, bothersome anterolateral thigh pain despite conservative management, requiring escalation to pharmacologic or procedural therapy.
- Prognosis
Generally favorable: the majority of patients experience significant improvement or full resolution of symptoms once the provoking mechanical or metabolic factor is addressed.
- Prevention
Maintain a healthy body weight: working toward a body mass index under 30 kg/m2 reduces the mechanical strain on the lateral femoral cutaneous nerve at the inguinal ligament, the most common modifiable risk factor.
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