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Meralgia paresthetica (MP) is a painful condition of the front and side
of the thigh, especially the upper thigh in which there is exquisitely
sensitive skin to light touch and a burning pain in the front and side of
the thigh. There may be some pain into the groin, but this is less
commonly seen. The lateral femoral cutaneous nerve is a branch of
the lumbar plexus nerves. It comes out of the spine and angles
downward through the abdomen and the pelvis, travels under the
inguinal ligament and sartorius muscle of the front of the thigh to
reach the skin of the front and side of the thigh. Excessive pressure
placed on this nerve due to trauma to the nerve (such as a seatbelt), a
direct impact to the nerve, wearing too tight clothes or belts, and
obesity with rolls of fat causing nerve compression are all causes of
MP. It is also thought other contributing factors include diabetes
mellitus and variations in the anatomy of the inguinal ligament may
cause some compression of the nerve. Other contributing factors
include automobile accidents, pregnancy, or surgery in the area of the
nerve.
    The diagnosis is usually readily evident if the patient is asked to
draw with a pen on the thigh the area of pain or abnormal sensation.
Unless a pelvic fracture is suspected after an automobile accident, no
definitive xrays are needed. Diagnostic blocks into the area usually
confirm the diagnosis. Rarely nerve conduction studies are used to
differentiate the condition from other possible causes such as a
plexopathy or spinal nerve compression. Comparison of nerve
conduction in the lateral femoral cutaneous nerve comparing one side
to the other is often sufficient to make the diagnosis.
    The incidence of MP varies but is estimated to be 3/10,000
population and is on both thighs simultaneously in 20%.
    Treatments of MP include rest, adjustment of tight clothing, weight
loss, use of lidoderm patches, anticonvulsant therapy, injections of
medications into the lateral femoral cutaneous nerve, destruction of
the nerve via pulsed radiofrequency or cryoneurolysis, or in extreme
cases surgical interruption of the nerve.   Physical therapy with
application of trigger point therapy, TENS, soft tissue mobilization may
be useful.