Do you feel pins and needles feeling in the front or side of the thigh? it could be Meralgia Paresthetica
What is it?
Meralgia Paresthetica, also called Bernhardt-Roth Syndrome, is a painful compression of the lateral femoral cutaneous nerve (LFCN) causing a “burning” sensation and paresthesia in the thigh. The LFCN is a pure sensory nerve, supplying a large area of skin in the front outside thigh. The most common site of entrapment of this nerve is under the inguinal ligament which is right where the nerve begins to merge into the thigh. However, in some cases the nerve can be trapped further down into the thigh underneath muscles such as the tensor fascia lata.
Meralgia Paresthetica may occur at any age but is the most common in middle-aged adults. Those with diabetes have an increased risk of developing this condition. This condition is present bilaterally (both sides) in only about 20-25% of cases. Men are three-times more likely to develop this than women.
The increased risk in males could come from their occupations such as carpenters, police officers, and military because of their duty belts they wear which causes compression. Other ways of compression include excessively tight clothes, pregnancy, and obesity.
Another potential cause is direct trauma, including seat belt compression from an accident. Spending an excessive amount of time in a prone position (on your belly) on a hard surface may tigger symptoms as well. Athletes who participate in strenuous exercise and participate in high activity sports such as bodybuilding, soccer, and gymnastics may be predisposed.
Biomechanical factors such as excessive anterior pelvic tilt or a leg length inequality may increase one’s risk of obtaining this condition.
Symptoms
A primary complaint with Meralgia Paresthetica is isolated pain and paresthesia on the outside of the anterior thigh. The pain can also be described as dull, aching, itching, buzzing, or burning and may range from mildly uncomfortable to disabling pain. There may be hypersensitivity within the thigh as well.
Symptoms may impair normal day function and sleep. Complaints may be exacerbated when walking, whereas sitting may decrease symptoms. Sitting may decrease the tension on the inguinal ligament that is trapping the nerve. Wearing tight clothes and/or a belt will likely increase complaints.
A clinical evaluation will show that there is tenderness when palpating (pushing/touching) on the area where the inguinal ligament is located. Symptoms will get worse with hip and/or lumbar extension whereas it will be relieved with flexion. Joint dysfunction within the lumbar, sacroiliac, and hip regions may coexist with this condition.
Diagnosis
Meralgia Paresthetica has very distinct symptoms and a clear way to clinically assess the condition therefore a clinical evaluation is usually only needed. However, if conservative treatment is unresponsive a NCS (nerve conduction study) is considered the gold standard for differential diagnosing.
Management
Conservative management is the main type of treatment for Meralgia Paresthetica and is successful in up to 91% of cases. The primary goal for treatment is to remove or loosen the cause of the compression.
Some ways to help alleviate complaints would be wearing loose fitting clothing and utilizing selective rest from activities, like excessive hip flexion, that aggravate the problem. Other ways to help would be to lose weight or start carrying tools instead of wearing a belt. Wearing high heels should be avoided because they can cause an excessive anterior pelvic tilt, which can link to the problem.
Myofascial release and stretching may be appropriate for tightness. IASTM ( instrument assisted soft tissue mobilization) may be utilized on some of the tighter muscles as well. Clinicians may help by performing a nerve mobilization. Stabilization exercises that involve the core and pelvis should be performed with this condition.
The application of therapeutic exercise tape (kinesiotape) may be utilized for helping improve symptoms. Patients may consider using ice, over-the-counter analgesics (aspirin, ibuprofen, etc), and NSAIDs (non-steroidal anti-inflammatory drugs) for symptomatic relief.