The aim of this article is to provide advice and self-help for people diagnosed with Meralgia Paraesthetica, which is a fairly uncommon condition that causes symptoms of pain and pins and needles in the front of the thigh. The information can also be seen in video format below.
What is Meralgia Paraesthetica (MP) ?
MP is a compression neuropathy, meaning a condition where a nerve is being squashed to the point where its function is affected. The nerve in question is called the ‘lateral femoral cutaneous nerve’ and the place where is tends to get compressed is in the groin region.
The nerve travels through the pelvis, under a ligament in the groin and then up towards the skin where it supplies the outside and front of the thigh with sensation. Its purely a sensory nerve so the symptoms are always going to involve sensory changes in that area are of the thigh.
Usually its pins & needles or a shooting pain but it can sometimes be a burning or even a cold sensation. A feeling of water trickling has also be described but one of the more commonly reported sensations is a vibration, like having your mobile phone on vibrate in your front pocket. You might notice that your thigh feels different when you touch it when compared to the other side.
What causes Meralgia Paraesthetica?
MP is caused by a compression of the lateral femoral cutaneous nerve in the groin. So a direct blow to the groin area such as a kick in football or a seatbelt digging in after a car accident could be a cause. It could also be caused after surgery to that region (eg. an inguinal hernia repair) if the nerve gets irritated by the scar. More commonly though it’s due to repetitive minor compression over weeks or months. The classic text book cause is wearing tight trousers or a tight belt which can put pressure on the nerve in the groin region. Skinny fit or low hung jeans have been found to increase the risk of developing this condition.
Being overweight with a large abdomen is also one the most common causes, and for the same reason it’s also more common in pregnancy. Wearing a heavy tool belt at work has also been described as a cause in the literature.
So as you can see there are may different causes of this conditions and you might need to have think about your work or hobbies to find what you might doing that’s is irritating the nerve.
Also, you might have an underlying condition which makes your nerve more vulnerable to injury, such as diabetes or certain vitamin and mineral deficiencies. If you’re not sure, then a neuropathy screening blood test can determine if this is an issue for you.
How is it Diagnosed ?
Meralgia paraesthetica is usually diagnosed clinically, meaning that a clinician will listen to your history, examine you and then make the diagnosis. A change in sensation when touching the skin over the nerves territory is good evidence of the condition. Some people may also have a positive tinels test. This where the symptoms are reproduced by tapping nerve at the point of compression.
There is no medical test or investigation which can reliably diagnose this condition. The nerve can been seen clearly on ultrasound or MRI but it can look completely normal and yet you can still have the condition. Nerve conduction tests are perhaps the most useful investigation but its a difficult nerve to access especially if you have a large abdomen and so the result can vary in their accuracy.
What are the Treatment Options ?
Well if you're the classic patient with meralgia paraesthetica caused by wearing tight clothing or because you are overweight then it’s no surprise that weight loss and avoiding restrictive clothing are going to be your first priority. Or you might have worked out another cause relevant to you.
But in an nutshell, If you know the cause, then stopping it is the answer and will generally cure the problem over a few weeks or months, because the nerve will only be able to start the healing process when the aggravating factor is removed. Also, if you have diabetes and it’s poorly controlled, then improving your control should be your priority. You’re going to be fighting an uphill battle otherwise.
There are also a few self-help treatments you can then try in order to stimulate nerve recovery and settle symptoms. If the nerve is very irritable then you could use an anti-inflammatory gel such as ibuprofen to try and calm it down. Just check with a pharmacist first as not everyone can use anti-inflammatories.
The nerve is very close to the skin, in most people less than 1cm - so an anti-inflammatory gel can easily penetrate to the right depth and work on any inflammation around the nerve. Just make sure you apply it regularly at the dose suggested on the tube - to the area around the skin crease in the groin region. You could also use an ice pack applied to the area for 20 minutes 2-3 times daily.
If the anti-inflammatory treatment doesn’t work for you then another type of gel called capsaicin can sometimes help. This is prescription only in the UK but it might be available over-the-counter in your country. It’s based on chilli pepper extract and is used to help settle down the symptoms of irritable nerve conditions. Just make sure you wash your hands thoroughly after using it - as you don’t want to then touch your eyes or other sensitive areas with chilli extract on your fingers.
The next thing to try are the Exercises which can help to move the nerve and prevent it getting stuck down, which can occur if it’s been inflamed or irritated for a while. So called ‘nerve flossing’ exercises can help get the nerve sliding though the area of compression. I have made a video to demonstrate these exercise which can be seen in the video below.
Exercises generally involves some form of hip extension movements and stretches but one of the easiest things you can do is regular walking but with deliberately longer stride length. Walking in this way for 20 mins a day is a good start.
Ok so For the vast majority of you, this will be all you need to do to settle the condition down. Stop doing the thing that’s irritating the nerve, and then try using some ice or anti-inflammatory medication and then doing some simple exercises. It might take a few weeks or months as nerves don’t get better instantly - but once the thing that’s irritating them has gone away then they will have a much better chance of recovery.
Im now going to discuss some of the treatments that an expert clinician can provide if you’re unlucky and your symptoms haven’t settled down. And the first thing they might want to try a stronger prescription strength anti-inflammatory or neuropathic pain killer. After that, the next treatment step would be to inject around the nerve with some local anaesthetic and steroid. This is best done under ultrasound guidance as there are variations in the exact location of this nerve amongst different people, and it’s going to work much better if the injection is delivered accurately.
The last treatment would be surgery. This is rarely needed and I’ve only seen a handful of people who have had surgery for this condition in my 25 years of practice. Surgery involves carefully freeing the nerve from any surrounding scar tissue in a procedure called neurolysis. It’s not guaranteed to help and there’s a risk of permanent nerve damage but if you’ve had persistent and intrusive symptoms for a few years despite having tried all of the other treatments we’ve discussed, then it might be worth talking to a surgeon.
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This article provides general information related to various medical conditions and their treatment. It is intended for informational purposes only and not a substitute for professional advice, diagnosis or treatment provided by a doctor or other qualified health care professional. The information provided does not constitute personal advice or guarantee of outcome and should not be used to diagnose yourself or others. You should never ignore advice provided by a health care professional because of something you have seen or read on this website. You should always consult a doctor or other qualified health care professional for personal medical advice.