Hip Conditions

Paresthetica

Meralgia paresthetica or Berhhardt-Roth Syndrome is a nerve condition resulting from compression of the lateral femoral cutaneous nerve (LFCN). This nerve is close to the skin around the lower waist and supplies sensation to the front and side of your thigh. Meralgia paresthetica results in sensations of aching, burning, numbness, or stabbing in the thigh area.

Causes

Meralgia paresthetica is caused by compression or pressure on the LFCN as travels from your spinal cord through the front of your pelvic region and down the outside of your thigh. Meralgia paresthetica symptoms occur when the LFCN is compressed (squeezed). A variety of factors cause compression of the LFCN. These can include injury or trauma to the hip area; medical conditions like obesity, pregnancy, and diabetes; and wearing clothing that is too tight or belts in the waist area.

Risk Factors

Anyone can develop meralgia paresthetica. Somethings are more commonly found with people who develop the condition such as:

  • Wear tight clothing, girdles, or tight stockings or wear a heavy utility belt (like a tool belt or police gun belt)
  • Have unequal leg lengths
  • Overuse alcohol
  • Injured by your seatbelt during a car accident
  • Recovering from a recent surgery
  • Some medical conditions can cause Meralgia Paresthetica:
  • Hypothryoidism
  • Diabetic
  • Lead toxicity
  • Overweight or obese
  • Pregnant

Symptoms

The most common symptoms of meralgia paresthetica include:

  • Burning, aching, tingling, stabbing pain on the outer thigh, which may extend down to the outer side of the knee
  • Numbness in the thigh
  • Symptoms typically only occur on one side.
  • The pain typically worsens when your thigh is touched lightly
  • Walking or standing for long periods of time usually worsen the pain
  • Groin pain and buttock pain can also occur but less frequently.

Diagnosis

Meralgia paresthetica is diagnosed typically by reviewing your medical and surgical history. Often the pain is associated with new types of belts and clothing you wear for work and recreation. Dr Faucett will also ask about exposures to lead and alcohol use. A thorough physical examination will be performed including a hands-on test called a pelvic compression test, in which the Dr. Faucett applies pressure on your thigh to rule out other causes of your symptoms. Other nerve tests such as determining your sensitivity to light touch and reflex tests may also be performed.

Sometimes Dr. Faucet will order blood tests to check thyroid hormone levels, B vitamin levels, lead levels, and for signs of anemia and diabetes which can all affect nerve function.

Usually an X-ray of your pelvis and hip will be ordered to rule out other medical conditions, like bone tumors, or bony impingement of the nerve. Other imaging tests such as an MRI or CT will need to be ordered to evaluate for the source of the nerve injury or other spinal or nerve problems, like a herniated disc.

If you are a woman of childbearing age, your doctor may order a pelvic ultrasound. This test can rule out uterine fibroids, noncancerous growths in the uterus.

Rarely, Dr. Faucett order a nerve conduction study (NCS). This test evaluates how well your LFCN sends small electrical impulses to the surrounding muscles. To measure electrical impulses, your doctor places electrodes along the nerve and are used to measure the function of the nerve.

Treatment

Most often myalgia paresthetica can be relieved by addressing the factors that caused the pain. Changes in the type of clothing, losing weight or avoiding certain activities or constrictive items like belts.

In many cases therapy is needed. These types of therapy can help improve the symptoms:

  • Physical therapy, specialized exercises and stretches
  • Nonsteroidal anti-inflammatory medications (NSAIDs)
  • Some antidepressants can affect the nerve impulses lessening the pain
  • Anticonvulsants
  • Transcutaneous electrical nerve stimulation (TENS) to provide symptom relief by using an electric current to stimulate your nerve
  • Phonophoresis, which uses ultrasound waves to help your body absorb topically applied pain medications
  • In more severe cases, corticosteroid injections or injectable pain medications may relieve symptoms.

Surgery is rarely needed. If it is necessary, the nerve needs to be decompressed and, in some cases, severed. This can leave the thigh numb but usually NOT painful.

Complications

  • Meralgia paresthetica may cause chronic pain, numbness, or other sensations like burning. These effects may interfere with your ability to walk or move normally.

Prevention

You can reduce the chances of developing meralgia paresthetica by:

  • Losing weight
  • Wearing loose clothing
  • Avoiding girdles or belts, including tool belts
  • What is the prognosis (outlook) for people with meralgia paresthetica?
  • People with meralgia paresthetica typically have a complete recovery with treatment.

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