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Meralgia Paresthetica Cheat Sheet (DRAFT) by

Presentation, management etc

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Meralgia Parest­hetica

- Picture shows affected area in this condition - burning pain and parest­hesia
- Pts complain of "­feels like someone is placing a tennis racquet on my leg"
- Lateral femoral cutaneous (L2 & L3) nerve affected (entra­pment beneath inguinal ligament or sartor­ius­/TFL)

Demogr­aph­ics­/Risk factors

- Occurs at any age - most often affects middle aged adults
- Diabetics
- Can be bilateral
- Can be either side if unilateral
- Men more than women (work - carpentry tool belts, police duty belts, soldier body armour)
- Excessive compre­ssi­on/­isc­hemic stretch
- Tight clothing
- Pregnancy
- Obesity (>30 BMI)
- Seatbelt compre­ssion
- Excessive prone lying on hard surface
- Athletes (gymna­stics, baseball, soccer, bodybu­ilding, strenuous exercise)
- Excessive anterior pelvic tilt , Leg length inequality


- Middle aged patient with >1 of risk factors
- Isolated pain/p­ara­est­hes­ia/­hyp­ers­ens­itivity on outside of thigh
- Dull, aching, itching, buzzing, burning
- Can impair sleep + ADLs
- Aggravated by walking , hip/lx ext
- Relieved by sitting (decreases tension on inguinal ligament)
- Screen for diabetes (family hx, hypert­ension, age, gender, ethnicity, physical activity level, SOB, BMI frequent thirst, pulses, vibration sensation
- TTP over lateral inguinal ligament (1 - 2 finger widths inferior and medial to ASIS)
- +ve Yeomans, +ve Tinels , +ve NTT of LFCN
- Assess for hypertonic iliopsoas, TFL, Sartorius
- Assess for joint dysfun­ction of Lx, SI, hip
- Assess for lower crossed, leg length inequa­lity, parado­xical breathing
- Neurol­ogical exam - numbne­ss/­hyp­ere­sthesia over distri­bution of LCFN (above picture)
- If motor/­reflex signs present, consider other diagnosis - disc/r­adi­cul­opathy - LFCN is a purely sensory nerve


- Not usually required (well defined)
-Nerve conduction study gold standard
- MRI if mass/l­esion in retrop­eri­toneal space/lx radicu­lopathy


- Lx radicu­lopathy
- Trigger point referral (glut medius/TFL
- Retrop­eri­toneal, abdominal, pelvic pathology
- Lx disc lesion
- Diabetes


- Highly successful (>90%)
- Advise patient to wear looser clothing
- Rest from aggrav­ating activity (repet­itive hip flexion
- Loosing weight
- Carrying a toolbox instead of a belt
- Not wearing high heels (causes excessive anterior pelvic tilt)
- Myofascial releas­e/s­tre­tching of hip flexors, sartorius, TFL, Quads, thigh adductors
- Nerve mobili­sation
- Stabil­isation of core and pelvis
- Ice and NSAIDs
- Severe cases - anesthetic block/­steroid injection
- If not better, surgical decomp­ression is indicated