Meralgia paresthetica caused by entrapment of the lateral femoral subcutaneous nerve at the fascia lata of the thigh: a case report and literature review

Entrapment neuropathies are debilitating clinical conditions, creating significant morbidity in the upper and lower extremities in terms of pain, sensory abnormalities, and motor weakness, becoming a challenge to diagnose and treat. Because entrapments can have multiple origins, a misinterpretation of anatomy during examination can lead to incorrect diagnosis and treatment. This review addresses understanding of the anatomy of fascia that can play an important role in this syndrome. There is a specific microenvironment around the nerve composed of connective tissues that include deep fascia, intermuscular septa, epineurium, and perineurium. The microenvironmental modifications can be translated into change in mobility with consequence decreasing of the independency of the nerve from the surrounding structures lading to entrapments and “internal stretch lesion.” The entrapments reported in this article reinforce the importance of fascia tissue in generating common symptoms that pose more difficult diagnostic challenges and may often be confused with more common clinical conditions. Clin. Anat. 32:883–890, 2019. © 2019 Wiley Periodicals, Inc.

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“…Omichi et al () also reported a case of meralgia paresthetica caused by entrapment of the LFCN at the fascia lata level.…”

Section: Resultsmentioning

confidence: 97%

“…This canal extends distally until the LFCN branches and pierces its walls toward the subcutaneous tissue. Omichi et al (2015) also reported a case of meralgia paresthetica caused by entrapment of the LFCN at the fascia lata level.…”

Section: Lower Extremity Entrapment Neuropathiesmentioning

confidence: 96%

Fascial entrapment neuropathy

2019

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“…Then LFCN pierces the deep fascia inferior to the inguinal ligament usually at a point about 2-3 cm distal to the ASIS. Then it runs laterally and distally within the subcutaneous tissue of the anterolateral aspect of the thigh where it is divided into two terminal braches (i.e., the anterior and posterior branches) [22,23].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of neural prolotherapy in treatment of meralgia paresthetica: a case series

Saba

2022

Egypt J Neurosurg

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Background Meralgia paresthetica is an entrapment neuropathy. Neuropathic pain was reported to be improved by using neural prolotherapy. Aim of the research was to assess and evaluate the short-term efficacy of neural prolotherapy on relieving pain, paresthesia and improving function and quality of life of patients with meralgia paresthetica. The study included 19 lower limbs with idiopathic meralgia paresthetica obtained from 15 patients. Subcutaneous perineural injection of dextrose (5%) in sterile water was given once. All patients were evaluated for outcome measures twice, at baseline visit and at follow-up visit four weeks after the injection which included: patient assessment of overall symptoms of meralgia paresthetica, patient assessment of meralgia paresthetica pain, patient assessment of meralgia paresthetica paresthesia and patient assessment of meralgia paresthetica effect on function and quality of life using visual analogue scale. Results There was a statistically significant improvement in the visual analogue scale of patient assessment of overall meralgia paresthetica symptoms, patient assessment of meralgia paresthetica pain, patient assessment of meralgia paresthetica paresthesia and patient assessment of meralgia paresthetica effect on function and quality of life when the findings at the postinjection visit were compared to the preinjection assessment among all patients. All the patients tolerated the injection procedure-induced pain. All the patients experienced immediate postinjection relieve of the meralgia paresthetica pain. At the postinjection assessment visit, all patients were satisfied with the procedure. There were 12 lower limbs (63.2%) from 10 patients (66.6%) that showed improvement and recovery. Two patients of them had bilateral meralgia paresthetica. There was no patient withdrawal, and no patients were lost to follow-up. There was one lower limb (5.3%) from one patient (6.7%) who had bruises at the injection sites that resolved within few days after the procedure. Conclusions Neural prolotherapy is easy, safe, tolerable, effective and successful in treatment of meralgia paresthetica. It is effective in relieving pain, paresthesia and improving function and quality of life of patients with meralgia paresthetica. Neural prolotherapy injection should be included in the conservative treatment armamentarium of meralgia paresthetica. Trial registration : NCT04499911. Registered 5 August 2020—retrospectively registered.

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“…This condition may also be caused by compression of the LFCN at the level of the inguinal ligament, and there are rare reports of MP after compression below the level of the inguinal ligament. 1 Neurophysiological investigations can be used to assess the integrity of the LFCN with both sensory nerve conduction studies and somatosensory evoked potentials described. Somatosensory evoked potentials have been reported to be both more sensitive than nerve conduction studies (81.3% vs 65.2%) and are better tolerated.…”

mentioning

confidence: 99%

“…Common causes of MP include mechanical pressure exerted on the LFCN, including prone positioning during surgery, obesity (body mass index [calculated as weight in kilograms divided by height in meters squared] >30), pregnancy, and the wearing of tight clothing, military uniforms, or lumbar braces. This condition may also be caused by compression of the LFCN at the level of the inguinal ligament, and there are rare reports of MP after compression below the level of the inguinal ligament …”

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confidence: 99%