What is femoral cutaneous neuropathy

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Meralgia paresthetica is the term that describes a painful neuropathy of the lateral femoral cutaneous nerve (LFCN).

It is an entrapment neuropathy that develops as the nerve runs through the inguinal ligament. The entrapment may occur due to direct trauma, stretch injury, or loss of blood flow to the nerve. The clinical history and examination is usually enough to make the diagnosis. The LFCN is a purely sensory nerve and is responsible for sensation of the anterolateral thigh. The LFCN has no motor component.

The LFCN originates from the lumbar plexus. The nerve runs through the pelvis along the lateral border of the psoas muscle to the lateral part of the inguinal ligament. Here, it passes to the thigh through a tunnel formed by the lateral attachment of the inguinal ligament and the anterior superior iliac spine. This is the most common site of entrapment.

When meralgia paresthetica develops, it causes tingling, burning, and numbness of the upper outer thigh area. The tingling can be quite uncomfortable.

Symptoms are usually on one side only. Walking or standing may aggravate the symptoms, while sitting tends to relieve them.

Examination reveals numbness of the anterolateral thigh. Sometimes, patients are very sensitive in this area.

Tapping over the upper and outer aspects of the inguinal ligament or extending the thigh and stretching the nerve may reproduce or worsen the symptoms.

Muscle strength in the involved leg is normal.

Common causes are pregnancy, tight clothing, and obesity.

Meralgia paresthetica is more common in diabetics than in the general population.

Rarely, pinching of the LFCN by masses, eg, neoplasms, iliopsoas hematomas in the retroperitoneal space before it reaches the inguinal ligament can cause the same symptoms.

A lumbar disk bulge or herniation should be excluded as part of the work-up.

Most patients with meralgia paresthetica will have mild symptoms that respond to conservative management.

The treatment involves removing the cause of compression, weight loss and wearing loose clothing, if these are suspected.

When the pain is severe, a nerve block can be done at the inguinal ligament with a combination of lidocaine and corticosteroid. This injection should be done using ultrasound guidance. This may relieve the symptoms for several days to weeks.

In rare and particularly painful cases that are unresponsive to nerve block, surgical decompression may be necessary. This is rare.

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