Abstract
Introduction: Meralgia paresthetica (MP) is a mononeuropathy of the lateral femoral cutaneous nerve, mainly associated with either injury or pressure to the nerve. Although this entity is well described, most clinical series have employed numerous treatment methods; therefore, the efficacy of individual modalities is unclear.
We describe our experience of 79 patients with complaints consistent with MP, treated, by the senior author, over a 13-year period.
Materials and Methods: Patients were managed in accordant to a structured protocol:
Initial management consisted of anti inflammatory agents, rest and redaction of aggravating factors.
Diagnostic nerve block test was carried out for those who were refractory to the above treatment. All patients who responded to the local anesthetic test were treated with local infiltration of corticosteroids.
Surgical intervention was reserved for patients who responded to the lidociane test but were refractory to repeated corticosteroids injections. Patients who failed to respond to the test injection were evaluated by CT-scan of the lumbar spine and by abdominal ultrasound (for female patients only). Follow-up ranged 1–13 years.
Results: Twenty-one patients (27%) reported satisfactory results flowing initial management. Local anesthetic yielded rapid relief of symptoms in 50 patients (86%), two additional patients responded to a second nerve block test (where a wider area was infiltrated).
In forty-two out of 52 patients (81%) who responded to the nerve block test and received treatment with corticosteroid injections, Long-lasting relief was obtained.
Three patients refractory to repeated injections of corticosteroid underwent surgery (neurolysis in one patient and nerve resection in two).
CT-scan of the lumbar spine revealed significant spinal stenosis and nerve root compression at the level of L1–3 in 3 out of 6 patients.
Conclusion: Idiopathic MP usually improves with nonoperative modalities. Temporary relief of symptoms following LFCN block is a specific diagnostic test, and is a good predictor of success following local corticosteroid injection. Surgery is seldom necessary and should be considered only if intractable pain persists despite such measures.
The abstracts were prepared by Ms Orah Naor. Correspondence should be addressed to Israel Orthopaedic Association at PO Box 7845, Haifa 31074, Israel.
