Meralgia paraesthetica (UK spelling), or meralgia paresthetica (US spelling) (me-ral'-gee-a par-es-

thet'-i-ka) — also called Bernhardt-Roth syndrome[1] — is numbness or pain in the outer

thigh not caused by injury to the thigh, but by injury to a nerve that extends from the thighto the spinal
column.

This chronic neurological disorder involves a single peripheral nerve, namely the lateral cutaneous nerve
of thigh (also called the Lateral femoral cutaneous nerve). The term meralgia paraesthetica comprises
four Greek roots, which together denote "thigh pain with anomalous perception".
Contents
[hide]

1 Aetiology

2 Signs and symptoms

3 Diagnosis

4 Treatment

5 Running with Meralgia paraesthetica

6 See also

7 External links

8 References

[edit]Aetiology

Lateral cutaneous nerve of thigh and other structures passing between the left inguinal ligament and ilium, top view.

The lateral cutaneous nerve of thigh most often becomes injured by entrapment or compression where it
passes between the upper front hip bone (ilium) and the inguinal ligament near the attachment at
the anterior superior iliac spine (the upper point of the hip bone). Less commonly, the nerve may be
entrapped by other anatomical or abnormal structures, or damaged by diabeticor other neuropathy or
trauma such as from seat belt injury in an accident.

The nerve may become painful over a period of time as weight gain makes underwear, belting or the
waistband of pants gradually exert higher levels of pressure. The pain may be acute and radiate into the
rib cage, into the groin and thigh.
Or, weight loss or aging may remove protective fat layers under the skin compressing the nerve against
underwear, outer clothing but more commonly by belting. Pressure may also be caused by long periods of
standing or leg exercise which increase tension on the inguinal ligament.

[edit]Signs and symptoms

 Pain on the outer side of the thigh, occasionally extending to the outer side of the knee, usually
constant.
 A burning sensation, tingling, or numbness in the same area
 Multiple bee-sting like pains in the affected area
 Occasionally, aching in the groin area or pain spreading across the buttocks
 Usually more sensitive to light touch than to firm pressure
 Hyper sensitivity to heat (warm water from shower feels like it is burning the area)

[edit]Diagnosis

Diagnosis is largely made on the description given by the patient and relevant details about recent
surgeries, injury to the hip, or repetitive activities that could irritate the nerve. An examination will check
for any sensory differences between the affected leg and the other leg. An abdominal and pelvic
examination may be required to exclude any problems in those areas.

Electromyography (EMG) nerve conduction studies may be required. X-rays may be needed to exclude
bone abnormalities that might put pressure on the nerve; likewise CT or MRI scans to exclude soft tissue
causes such as a tumor.

[edit]Treatment

Treatments will vary. In most cases, the best treatment is to remove the cause of the compression by
modifying patient behavior, in combination with medical treatment to relieve inflammation and pain. The
following treatments are examples. Whatever the cause, recovery typically requires several weeks to
months, depending on the severity of nerve damage, and is facilitated by using looser clothing and
suspenders rather than belting.

Non-steroidal anti-inflammatory drugs (NSAIDs) will reduce inflammatory pain, plus narcotic pain killers
may be required as the level of pain can become disabling and prevent sleep. Reduction of physical
activity is mandatory, in relationship to the pain level. Absolute bed rest is required for acute pain levels.

The lateral cutaneous nerve of the thigh can occasionally be damaged during laparoscopic hernia repair,
or scarring from the operation can lead to meralgia paraesthetica. [2]

Whatever the cause, recovery typically requires 4 to 6 weeks, and is speeded by using looser clothing
and suspenders rather than belting.

Reduction of physical activity is mandatory, in relationship to the pain level. Absolute bed rest for several
days is required for acute pain levels.
Anti-inflammatory medicine such as an NSAID will reduce inflammatory pain, plus narcotic pain killers
may be required if the level of pain becomes disabling and prevents sleep.

For lower pain levels, treatment may involve:


Rest periods to interrupt long periods of standing, walking, cycling, or other aggravating activity

Weight loss in overweight individuals and exercise to strengthen abdominal muscles [3]

Wearing clothing that is loose at the upper front hip area

Heat, ice, or electrical stimulation[4]

Nonsteroidal anti-inflammatory medications for 7–10 days[3]

It may take significant time (weeks) for the pain to stop and, in some cases, numbness will persist despite
treatment. In severe cases a local nerve block can be done at the inguinal ligament using a combination
of local anaesthetic (lidocaine) and corticosteroids to give relief that may last several weeks. Pain modifier
drugs for neuralgic pain (such as amitriptyline, carbamazepine or gabapentin) may be tried,[4] but are
often not as helpful in the majority of patients.[5]

In persistent and severe cases, surgery may be needed to decompress the nerve [5] or as a last resort to
resect the nerve.[4] The latter treatment results in permanent numbness in the area.

[edit]Running with Meralgia paraesthetica

For the few unlucky athletes who suffer from Meralgia paresthetica and are unwilling to take time off for
this to heal, they should at least make some effort towards taking pressure off the nerve (cross-training,
taking it easy). For optimizing performance with this injury, it is usually best to have an extended warm up
(approximately twenty minutes) before competition. In running the race itself, runners might want to
experiment with utilizing different muscle groups by altering their form. For instance, if your hip-flexor and
upper quads are numb, try utilizing your glutes by staying taller and striding out more with the leg. Of
course if any negative results are yielded by this change, runners should return to their original form.