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Supplies sensation to the anterolateral thigh (more lateral than anterior) – see image ICD-9 code: 355.1 “meralgia paresthetica” ICD-10 code: G57.1 “meralgia paresthetica” (lateral cutaneous nerve of thigh syndrome) History Patients typically complain of paresthesias (abnormal sensations – burning, tingling) and numbness in the anterolateral thigh Hyperesthesias and dysesthesias possible Patients normally say, “ thigh numbness ” or “ thigh tingling “ May be mild to severe pain Unilateral, but can be bilateral in 20% of cases Walking and standing (hip extension movements) can make worse Physical exam Numbness may be noted over the anterolateral thigh Tapping over the lateral femoral cutaneous nerve as it passes under the inguinal ligament just medial to the ASIS may reproduce the symptoms (with the patient in a femoral nerve stretch position) Pelvic Compression Test (see photo below) With patient in side-lying position, press downward and slightly forward, in a manner to slacken the inguinal ligament – hold for 45 seconds Resolution or reduction in symptoms is considered positive for meralgia paresthetica This should also help differentiate the symptoms anterior thigh symptoms from upper lumbar radiculopathy Sensitivity of 95% and a specificity of 93.3% for meralgia paresthetica (abstract here) Causes Anything that causes compression of the LFCN at the lateral inguinal ligament Examples: Obesity (abdominal pannus), pregnancy, tight clothing (women in tight, low-rise jeans), leaning against table for hours while working, tool belts, policemen belts, body armor of soldiers Also seen in patients with recent weight loss Diabetes – as with most neuropathies Rare causes: neoplasms, hematomas, other masses in retroperitoneal space Differential Diagnoses Femoral neuropathy, upper lumbar radiculopathy (L2/3) Workup May perform nerve conduction studies (comparing both sides) of the lateral femoral cutaneous nerve, and needle electromyography (to rule out radiculopathy) Treatment #1 : Avoidance of aggravating activity / cause of the compression Weight loss, work station adjustment, loose jeans Medications Neuropathic pain medications are rarely helpful NSAIDs for 7-10 days Lidoderm patches – if significant dysesthesias Injections Inject the lateral femoral cutaneous nerve with local anesthetic and corticosteroid at the entrapment site Peripheral nerve stimulator may be used to localize the nerve (b/c of anatomical variance) Ultrasound-guidance can also be used very effectively

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[Pernicious anemia: masking of B12 vitamin deficiency by folic acid]