Management of meralgia paresthetica

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✓ Meralgia paresthetica is a syndrome of pain or dysesthesia, or both, in the anterolateral thigh caused by entrapment or neurinoma formation of the lateral femoral cutaneous nerve. Conservative treatment was successful in relieving symptoms in 91% of 277 patients with this syndrome; however, 24 patients required surgical treatment for intractable symptoms. Although neurolysis with transposition is the most common procedure, sectioning of the lateral femoral cutaneous nerve was performed in 24 cases and was successful in 23. One patient had early symptomatic relief, but subsequently developed different neurological signs and symptoms because of an undetected pelvic neoplasm.

Anatomical variations of the nerve and neurinomas, which occur frequently, are easily handled with sectioning but may lead to recurrence with neurolysis and transposition.

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Address reprint requests to: Paul H. Williams, M.D., 1388 Madison Avenue, Memphis, Tennessee 38104.

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Figures

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    Drawing of an extremely hairy individual who had rubbed his thigh so much that the hair had been rubbed off the area supplied by the lateral femoral cutaneous nerve.

  • View in gallery

    Anatomical variations of the lateral femoral cutaneous nerve (LFCN). A: Lateral view of the pelvis with neurinoma formation as the LFCN passes through a notch between the anterior superior and inferior areas of the iliac spine. B: The LFCN exiting the pelvis over the iliac crest with neurinoma formation. C: The LFCN exiting the pelvis through the inguinal ligament with neurinoma formation. D: The LFCN exiting the pelvis as two branches with neurinoma formation on one branch. E: The LFCN exiting the pelvis as three branches with neurinoma formation on the middle branch. F: The LFCN exiting the pelvis far medially in close proximity to the femoral nerve.

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