Meralgia Paraesthetica

Definition / Description

Meralgia Paraesthetica (MP) also known as Bernhardt-Roth or LFCN (femoral lateral cutaneous nerve) neuralgia comes from the Greek meros algos, meaning thigh pain. MP results from injury to the lateral femoral cutaneous nerve (LFCN). The most common cause of damage to this nerve is entrapment At the level of the inguinal ligament. [1]

Clinically Relevant Anatomy

The femoral lateral cutaneous nerve (LFCN) of the thigh is usually a branch of the posterior disunity of the L2 and L3 spinal nerves. It passes through the pelvis towards the anterior superior iliac spine (ASIS) and exits the lesser pelvis below the inguinal ligament (IL) ASIS. It then divides along the length of the thigh into anterior and posterior portions; there it provides sensory innervation to the skin on the anterolateral and lateral thighs. [2]

Epidemiology / Etiology

Although idiopathic MP can occur in any age group, it is most common in the 30s to 40s. Its incidence in children may be higher than previously recognized. One third of all children treated for osteoid osteoma develop MP. [3] There is no consensus on whether there is gender or race Advantage. But in a study evaluating 150 cases of MP, men had a higher incidence. [4] As noted previously, mononeuropathy in the LFCN is usually due to compression of this nerve as it passes through the inguinal ligament. Entrapment may have idiopathic or iatrogenic causes.

•  Idiopathic (or spontaneous) causes

– Mechanical factors: Obesity and other conditions that increase the volume of the abdominal cavity, such as corset pregnancy and ascites, where nerves may be kinked or compressed by the distended abdomen as they leave the pelvis. [4] – Metabolic factors: diabetes, alcoholism and lead poisoned. [4]

•  Iatrogenic causes

The iatrogenic cause may be hip replacement or spinal surgery. During back surgery, when the patient is prone, the front hip may be compressed by the surgical equipment used during the procedure. also occurs when receiving direct lateral and rearward Lumbar surgery can cause MP.

Characteristics / Clinical Presentation

Patients may have symptoms such as pain in the anterolateral thigh, burning, numbness, muscle aches, cold, lightning pain, or a buzzing. [5] As previously mentioned in “Clinically Relevant Anatomy”, it provides sensory innervation to the anterolateral and lateral skin thigh. Patients with MP experience symptoms in both superficial and deep tissues in this part of the thigh.

Patients may experience mild pain that resolves spontaneously, or more severe pain that limits function. Patients may experience pain when standing or walking for long periods of time. Sitting can reduce pain because there is less tension in the LCTN or inguinal ligament while sitting. This reduction in tension may lead to a reduction in symptoms. [6] Each patient has its own specific clinical presentation and distribution of symptoms. [5] As previously stated, in “clinically relevant anatomy”, the LFCN provides sensory innervation to the skin Anterior and outer sides of the thigh.

Differential Diagnosis

The differential diagnosis includes L3 lumbar radiculopathy or femoral neuropathy, although both cause loss of movement in addition to sensory symptoms. [7] Radiculopathy is a disorder in which compression of nerves in the spine causes pain, numbness, tingling, or nervous breakdown. [8] Femoral neuropathy occurs when you cannot move or feel your leg because of damaged nerves. The cause may be long-term pressure on the nerve from the injury or damage from disease. [9]

Diagnostic Procedures

The diagnosis of MP is usually based on the clinical diagnosis of symptoms found in the relevant history and physical examination. [5] In addition to the examination the diagnosis can be based on other additional tests such as nerve conduction testing for the LFCN. It is very important to note that MP sometimes occurs in Combine certain red flags. These red flags could be the presence of a tumor or a herniated disc in the area described. MRI or ultrasonography is done when pelvic tumors, including retroperitoneal tumors, are suspected. Therefore, they must be recognized during the exam, and Treat properly. [4]

Outcome Measures

Quantifying Overall Health• SF-12• Neuropathic Pain Score Quantifying Activity Level• UCLA Activity Scale

Quantifying Pain Stiffness and Body Function • WOMAC[1]

Examination

• Coherent History Examination

MP is characterized by the presence and history of the different symptoms mentioned in “Characteristics and clinical presentation”.

• Physical examination

Palpation of the lateral portion of the inguinal ligament—at the point where the nerve passes through the inguinal ligament—is often painful during a physical exam. Some patients also experience hair loss in the LFCN area because they rub the area too often.

• Additional tests

To rule out red flags, a pelvic x-ray is used to rule out bone tumors. When a metabolic cause is expected, blood tests and thyroid function tests are done. [5]

Medical Management

The therapeutic goal of MP is to relieve compression of the LFCN. The first step is conservative treatment. If that doesn’t help, the next step is medication. When all the above methods fail to relieve symptoms, surgery is required.

• Conservative management

With conservative management, contributing factors can be identified. We try to influence these factors in a conservative manner. This conservative management requires f.e. informing and advising the patient to lose weight (encourage wearing loose clothing and not wearing tight belts). Pain can be relieved by Apply a cold compress to the painful area. [2] (Level of Evidence 2c)

•  Medical management

Nerve block: local infiltration of the LFCN. This injection of corticosteroid and pain reliever or more commonly corticosteroid and local anesthetic will reduce pain and improve mobility in most people with MP. [2] (Evidence Level 2c) Anti-inflammatory drugs and pain relievers Medicines to reduce (inflammatory) pain. [2] (Evidence level 2b) In patients with MP who are refractory to conservative management and have no other cause, we considered pulsed radiofrequency (PRF) neuromodulation with LFCN. [4] (Evidence Level 4) PRF is a treatment that reduces pain by Generates radio waves that generate heat. These radio waves are passed through the needles and into the skin above the spine. Using an imaging scan can help determine where the needle should be inserted.

•  Surgery

Surgery should be used only after all nonsurgical treatments have failed. [3] (Evidence Level 4) Conservative management of MP is effective in more than 90% of patients, but surgery should be considered in patients with severe and persistent pain despite adequate conservative management. [4] (Horizontal Evidence 4) Two surgical techniques have been developed to cure MP. [1] (Level of Evidence 4) • Decompression (also called neurolysis): The process by which nerves are released from surrounding tissue. • Neurectomy: A short section of the nerve is removed as it passes through the neural tube Inguinal ligament. [1] (Level of Evidence 4)

Neurectomy removes the positive symptoms but leaves a patch of numbness in the anterolateral thigh that usually shrinks over time and is usually reserved for patients with long-lasting MP, especially those who fail early decompression. [1] (Level of Evidence 4) Successful Pain The degree of relief was significantly higher with neurectomy than with neurolysis. [10] (evidence level 4)

Physical Therapy Management

• Kinesio-Taping

Small pilot studies assert that Kinesio-Taping must be part of the treatment of MP patients. Kinesio-Taping can reduce symptoms in patients. The exact physiological mechanism remains unknown. It is hypothesized that this approach helps to increase lymphatic and vascular flow Reduce pain Enhance normal muscle function Increase proprioception and help correct possible joint misalignment. Despite the supposed benefits, current evidence is insufficient to support MP. Future randomized placebo-controlled trials are needed. [11] (evidence level 5)

•  Acupuncture

The benefits of acupuncture as an MP intervention such as acupuncture and cupping have been demonstrated in clinical trials. Existing literature suggests that acupuncture may be effective in treating MP. However, the exact physiological mechanism is still under investigation. further Need to investigate. [5][6] (evidence level 5)

• transcutaneous electrical nerve stimulation

Transcutaneous electrical nerve stimulation (TENS or TNS) is effective in treating painful peripheral neuropathies such as MP. [7] (evidence level 1a) suggest that TENS activates central mechanisms to provide analgesia. Low-frequency TENS activates mu-opioid receptors in the spinal cord and brainstem, while high-frequency TENS acts through delta-opioid receptors. [8] (evidence level 1a)

•  Neurostimulation Techniques

Neurostimulation techniques including transcranial magnetic stimulation (TMS) and cortical electrical stimulation (CES), spinal cord stimulation (SCS) and deep brain stimulation (DBS) have also been found to be effective in treating neuropathic pain such as MP. [8] (evidence level 1a)

•  Exercise

Exercising at least 3 to 4 days a week for 30 minutes a day can help you manage chronic pain by increasing:[9] (evidence level 5)

– Muscle strength – Stamina – Joint stability – Mobility of muscles and joints

Possible examples of sports training are: 1. Aerobic exercise [4] (evidence level 5) – brisk walking (outdoor or indoor treadmill) – low-impact aerobic exercise class – swimming or water aerobics – indoor stationary bike2. Flexibility exercises (stretching) [4] (evidence level 5) This includes exercises against increasing resistance, using weights and isometric exercises. Nerve stretches can reduce tightness in the nerves and can also help relieve pain associated with pinched nerves. [10] (evidence level 5)

3. Strength training [4] (evidence level 5) A muscle training program (using a linear pressure resistance device) can improve inspiratory muscle strength and regulate autonomic function in patients with DAN (diabetic autonomic neuropathy). (Level of Evidence 1B)

4. Balance exercises [4] (evidence level 5) Programs that incorporate multisensory balance training have the potential to elicit adaptive responses in the neuromuscular system that enhance postural control balance and functional capacity in women. Training with BOSU may help improve static balance and female functional capacity. [10] (evidence level 2B)

•  Low level laser therapy (LLLT)

Based on existing studies, LLLT has a positive effect on analgesia to control neuropathic pain, but further research with a high degree of scientific rigor is needed to identify treatment options that optimize the role of LLLT in neuropathic pain. [1] (Level of Evidence 4)

• Weight loss in obese patients

Physiotherapists aim to promote successful weight management and improve general health by appropriately increasing a patient’s level of physical activity. They perform an assessment to determine the patient’s current activity level and any impairments the patient must increase Activity. A physical therapist then provides a treatment plan designed to address these impairments and promote optimal mobility for the patient. [2] (evidence level 5)

• Manual therapy

There are a few case studies of the use of manual therapy for MP. The techniques used in these studies were: Active_Release_Techniques (ART) Pelvic myofascial mobilization/manipulation Rectus femoris and iliopsoas muscles Lateral friction massage for inguinal ligament stretching Works the glute and pelvic musculature and pelvic stabilization/abdominal core exercise. Based on available evidence, these interventions are likely to be effective and safe in alleviating MP symptoms. Further high-quality studies are needed to evaluate these treatment options. there is a study Terret cites a case where chiropractic manipulation of the hip and pelvis resulted in MP. [6] (evidence level 4)

Key Research

Jin DM Xu Y Geng DF Yan TB (2010) Effect of transcutaneous electrical nerve stimulation on symptomatic diabetic peripheral neuropathy: a meta-analysis of randomized controlled trials. Diabetes Clinical Practice 89: 10-15

Resources

Clinical Bottom Line

MP is also known as Bernhardt-Roth or LFCN neuralgia. It results from injury to the lateral femoral cutaneous nerve. Diagnosis is made on the basis of a coherent history and physical examination. MP is primarily treated by physiotherapists using TENS. All other treatment techniques such as KT Acupuncture LLT and There is a lack of strong scientific evidence for manual therapy and further research is needed. In addition to using TENS physiotherapists can also treat the cause of MP by increasing activity levels in obese patients.