Meralgia Paresthetica

Thigh Pain Seen After Weight Gain or During Pregnancy

meralgia pregnant
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Meralgia paresthetica is a condition that can cause burning pain and numbness over the front and outside of the thigh. There is a nerve that passes just over the brim of the pelvis and down the front of the thigh. This nerve, called the lateral femoral cutaneous nerve, supplies the brain with information about sensation over the front and outside of the thigh.

Causes of Meralgia

Meralgia paresthetica is the condition that is caused by compression of the lateral femoral cutaneous nerve.

There can be a number of different causes to this problem, but it is frequently seen in pregnancy, individuals who suddenly gain weight, patients who wear tight clothing or belts, and some other conditions.

Sometimes, meralgia paresthetica can be caused by various medical treatments.  For example, this condition is sometimes seen after patients have surgery and are in an unusual position for a lengthy time period where there is direct external pressure on the nerve.  Another surgical cause is if the nerve is damaged while performing another surgical procedure.  This can occur when bone graft is obtained from the pelvis, or during some surgical procedures such as an anterior hip replacement surgery.

Signs of Meralgia Peristhetica

People who have meralgia paresthetica may complain of some or all of the following symptoms:

  • Pain or burning over the outside of the thigh
  • Numbness over the outside of the thigh
  • Sensitivity to light touch over the outside of the thigh
  • Worsening of symptoms with certain positions
  • Increased symptoms when wearing tight belts, work belts, or tight-waist clothes
  • Recent weight gain or pregnancy

The symptoms may be transient (meaning they come and go) or they may be persistent. In some people they are hardly noticeable, and in others they are very bothersome.

Most people say that while they don't like the symptoms, it does not impact their life or activities or cause significant pain. In these situations, treatments are usually kept simple. However, there are others who are very bothered by the symptoms of meralgia, and these are the individuals who may require more aggressive treatment.

Treatment of Meralgia Paresthetica

It depends on which of these factors may be contributing to your symptoms. If the cause is due to tight-fitting clothing, belts, or work belts, then modifying these garments should alleviate your symptoms. Patients who are pregnant usually have complete resolution of their symptoms after delivery. If recent weight gain is thought to contribute to the condition, then a weight loss program may be recommended. While these steps are often the most difficult (waiting for delivery or a baby or losing weight) they are typically the most effective treatments. Most people find significant relief once the nerve has less pressure on it.

If simple steps do not relieve your symptoms of meralgia paresthetica, then a cortisone injection around the nerve may be helpful. The goal of injecting cortisone is to reduce inflammation that may be contributing to the pressure on the nerve. Cortisone injections may be a definitive treatment (meaning the problem goes away after the shot), or it may be a temporary treatment. However, even if the treatment is temporary, it can often be useful. If a cortisone shot is helpful, but the symptoms return, these are the individuals who may benefit from surgical treatment.

Surgery is rarely necessary in the treatment of meralgia paresthetica. Only when all conservative treatments fail to provide relief, a surgical procedure may be considered. Your surgeon would dissect and identify the nerve, look for locations of compression, and try to free the nerve from any areas where it may be pinched.  Alternatively, some surgeons actually transect (cut) the nerve, so that it will no longer cause problems.  If the transection procedure is performed, you would have a permanent area of numbness over the front of the thigh.

Source:

Grossman MG, et al. "Meralgia Paresthetica: Diagnosis and Treatment" J Am Acad Orthop Surg, Vol 9, No 5, September/October 2001, 336-344.

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