SmartHealthForLife.com

Meralgia paraesthetica is a pain condition which is relatively common but not well recognised and which gives pain, numbness and tingling in the front and outer side of the thigh. Described many years ago in the 19th century, it was soon deduced that this syndrome was due to compression of a nerve in the nearby area, the lateral cutaneous nerve of the thigh. This nerve is a sensory nerve which transmits feelings and has no muscular activation powers, supplying the feeling in the described areas of the thigh. The frequency of this condition is not clear but it does not appear to be common, however it may be under diagnosed.

This condition can be mistaken for a series of other musculoskeletal conditions such as nerve root compression, referred spinal pain and trochanteric bursitis and may be bilateral at times. The most common cause of this syndrome is inappropriate pressure on the on the nerve at particular points where it can be trapped. Being overweight may be a risk factor for this condition and it has been recorded as being caused by a tight belt. Various surgical procedures can be aggravating factors such as hip replacement, bone grafting and surgery to the quadriceps.

The compression points somewhere along the nerve\’s course can occur at various anatomical locations, including the point of emergence from the psoas muscle, the close relationship with the inguinal ligament, where it is running close to the bony prominences at the front of the pelvis and finally where it comes out of the fascia lata, a wide connective tissue sheet at the side of the thigh. The classification of nerve injury starts with the mildest result from compression which is a neurapraxia where the myelin insulation can be lost.

The nerve axon itself is not affected in this injury and this is the nerve injury which recovers well and most quickly, taking a very short time up or to several months to resolve. A more severe injury, where the axon is disrupted, is known as axonotmesis and results in the whole nerve axon degenerating along its length. It then has to regrow at its very slow speed, meaning this kind of injury can take a long period to resolve even though it may do so in the long term. If a nerve is so badly injured that its ends are not in contact any longer then the chances of recovery without surgical intervention are very low.

During the examination the patient should be questioned about the occurrence of any injuries which could have contributed to their problems. The physical examination should record an altered ability to feel skin sensations on the lateral and anterior parts of the thigh with symptoms such as numbness, burning pain, pins and needles and reduced sensation. Typically symptom onset is insidious, coming on slowly at an initially low level and not referring further than knee level. Pain can vary from a dull aching to the more recognisable burning and sharp sensations. Symptom area can be variable depending on how severe it is.

The initial goal of treatment is to establish where and what the problem of compression is likely to be, as correcting a tight belt, fitted clothing or heavy objects carried on the waist can be a useful first strategy. Loss of weight in obese patients can be sufficient to change things so that some symptom resolution is achieved. The ergonomics of work may also be important to eliminate obviously risky postures or movements. A doctor may give corticosteroids or anaesthetic drugs by local injection to limit the inflammatory changes or break the pain cycles.

The surgeon has to be very aware of the variations in the anatomical position of the lateral cutaneous nerve in order to inject or operate successfully. On release of the nerve compression the syndrome tends to recover without further intervention. If changes in functional activity do not resolve the pain, injections or surgery are further options, with neurolysis, cutting the nerve and decompression potential options. Decompression may be necessary at several different sites where the nerve is vulnerable. Scientific reports following groups of patients after surgery have generally reported good recoveries.

Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapy, back pain, orthopaedic conditions, neck pain, injury management and physiotherapists in Gloucester. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

Possibly Related Posts:

• Inexpensive Tips To Reduce And Prevent Back Pains
• The Chiropractic Secrets To Why It Hurts So Much.
• Facts About Early Pregnancy Back Pains
• Spinal Development And Balance Of Children
• Relief From Sciatica Through Chiropractic Therapy