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Meralgia paresthetica refers to the entrapment of the lateral femoral cutaneous nerve at the level of the inguinal ligament. The lateral femoral cutaneous nerve - a purely sensory nerve - arises from the L2 and L3 spinal nerve roots, travels downward lateral to the psoas muscle, and then crosses the iliacus muscle. Close to the anterior superior iliac spine, the nerve courses in contact with the lateral aspect of the inguinal ligament and eventually innervates the lateral thigh. The entrapment syndrome is usually idiopathic but can also ensue due to trauma/overuse, pelvic and retroperitoneal tumors, stretching of the nerve due to prolonged leg/trunk hyperextension, leg length discrepancies, prolonged standing, external compression by belts, weight gain, and tight clothing. The diagnosis of Meralgia paresthetica is usually clinical, i.e., based on the following symptoms: paresthesia, numbness, burning sensation, dysesthesia, and pain over the anterolateral aspects of the thigh. These complaints may be worsened by walking or prolonged standing and typically disappear after weight loss, abdominal muscle strengthening, or elimination of the underlying cause. Although there are several reports on the confirmatory role of electrodiagnostic studies in the diagnosis of Meralgia paresthetica, electromyographers would usually prefer/suggest not to perform nerve conduction studies in daily clinical practice. Herewith, due to its several advantages, ultrasound imaging has been proposed as an alternative diagnostic method in the recent literature. It not only confirms the entrapment morphologically, but also uncovers a likely underlying cause and provides immediate interventional guidance. The pertinent sonographic findings would be hypoechoic and swollen lateral femoral cutaneous nerve.
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Meralgia paresthetica refers to the entrapment of the lateral femoral cutaneous nerve at the
level of the inguinal ligament. The lateral femoral cutaneous nerve – a purely sensory nerve –
arises from the L2 and L3 spinal nerve roots, travels downward lateral to the psoas muscle, and
then crosses the iliacus muscle. Close to the anterior superior iliac spine, the nerve courses in
contact with the lateral aspect of the inguinal ligament and eventually innervates the lateral
thigh. The entrapment syndrome is usually idiopathic but can also ensue due to trauma/
overuse, pelvic and retroperitoneal tumors, stretching of the nerve due to prolonged leg/trunk
hyperextension, leg length discrepancies, prolonged standing, external compression by belts,
weight gain, and tight clothing. The diagnosis of Meralgia paresthetica is usually clinical, i.e.,
based on the following symptoms: paresthesia, numbness, burning sensation, dysesthesia,
and pain over the anterolateral aspects of the thigh. These complaints may be worsened by
walking or prolonged standing and typically disappear after weight loss, abdominal muscle
strengthening, or elimination of the underlying cause. Although there are several reports on
the confirmatory role of electrodiagnostic studies in the diagnosis of Meralgia paresthetica,
electromyographers would usually prefer/suggest not to perform nerve conduction studies in
daily clinical practice. Herewith, due to its several advantages, ultrasound imaging has been
proposed as an alternative diagnostic method in the recent literature. It not only confirms
the entrapment morphologically, but also uncovers a likely underlying cause and provides
immediate interventional guidance. The pertinent sonographic findings would be hypoechoic
and swollen lateral femoral cutaneous nerve.
Key words: Meralgia paresthetica, ultrasound, diagnosis, treatment
Pain Physician 2016; 19:E667-E669
Brief Commentary
Ultrasound-Guided Diagnosis and Treatment of
Meralgia Paresthetica
From: 1Ankara Physical and
Rehabilitation Medicine,
Training and Research Center,
Ankara, Turkey; 2Hacettepe
University Medical School
Department of Physical
Medicine and Rehabilitation
Ankara, Turkey
Address Correspondence:
Ayse Merve Ata, MD
Hacettepe University Medical
School
Department of Physical
Medicine and Rehabilitation
Ankara, Turkey
E-mail:
amerveata@hotmail.com
Disclaimer: There was no
external funding in the
preparation of this manuscript.
Manuscript received:
09-02-2015
Accepted for publication:
10-20-2015
Free full manuscript:
www.painphysicianjournal.com
Şule Şahin Onat, MD1, Ayşe Merve Ata, MD2, and Levent Özçakaar, MD2
www.painphysicianjournal.com
Pain Physician 2016; 19:E667-E669 • ISSN 2150-1149
Meralgia paresthetica (MP) refers to the
entrapment of the lateral femoral
cutaneous nerve (LFCN) at the level of
the inguinal ligament. The LFCN – a purely sensory
nerve – arises from the L2 and L3 spinal nerve roots,
travels downward lateral to the psoas muscle, and then
crosses the iliacus muscle (Fig. 1A). Close to the anterior
superior iliac spine (ASIS), the nerve courses in contact
with the lateral aspect of the inguinal ligament and
eventually innervates the lateral thigh (1).
The entrapment syndrome is usually idiopathic but
can also ensue due to trauma/overuse, pelvic and retro-
peritoneal tumors, stretching of the nerve due to pro-
longed leg/trunk hyperextension, leg length discrep-
ancies, prolonged standing, external compression by
belts, weight gain, and tight clothing (1,2).
The diagnosis of MP is usually clinical, i.e., based
on the following symptoms: paresthesia, numbness,
burning sensation, dysesthesia, and pain over the an-
terolateral aspects of the thigh. These complaints may
be worsened by walking or prolonged standing and
typically disappear after weight loss, abdominal mus-
cle strengthening, or elimination of the underlying
cause (3). Although there are several reports on the
confirmatory role of electrodiagnostic studies in the
diagnosis of MP, electromyographers would usually
prefer/suggest not to perform nerve conduction stud-
ies in daily clinical practice (4). Herewith, due to its sev-
Pain Physician: May/June 2016; 19:E667-E669
E668 www.painphysicianjournal.com
eral advantages, ultrasound (US) imaging
has been proposed as an alternative di-
agnostic method in the recent literature
(4). It not only confirms the entrapment
morphologically, but also uncovers a
likely underlying cause and provides im-
mediate interventional guidance (5). The
pertinent sonographic findings would be
hypoechoic and swollen LFCN (4).
Imaging Technique
The patient is placed in the supine
position. Use of a high-frequency linear
array transducer is suggested. Axial scan-
ning of the nerve is easier for initial lo-
calization. The transducer is oriented par-
allel/over the inguinal ligament whereby
the outer edge is placed on the ASIS (Fig.
1B). With cranio-caudal fine movements
of the probe, the nerve (a small anechoic
ovoid structure) can be localized pass-
ing over, under, or through the inguinal
ligament (Fig. 1C). It is not uncommon
to visualize it as 2 fascicles that bifurcate
while tracing distally.
Injection of the LFCN
While the conservative treatment
comprises removal of the source of com-
pression, physical therapy, nonsteroidal
anti-inflammatory drugs, tricyclic anti-
depressants, and anticonvulsants (4); for
patients irresponsive to initial treatment,
local anesthetic and/or corticosteroid in-
jection may be necessary/therapeutic.
Although the injection of the LFCN
has been classically described using ana-
tomic landmarks, owing to the anatomic
variability of the nerve, failure rates have
been reported as high as 60% (1). On
the other hand, similar to any other US-
guided injections, real-time imaging with
US definitely avoids such an untoward
eventuality.
US-guided injection can be per-
formed either using the direct or indirect
approach (5). The former refers to either
in-plane (long axis) or out-plane (short-
Fig 1. A: Anatomic position of the lateral femoral cutaneous nerve. B:
Photograph that shows transducer positions for ultrasonographic imaging
axial scanning over the inguinal ligament. C and D: When compared
with normal side (small white arrowhead) (D), ultrasonographic imaging
revealed swollen, edematous lateral femoral cutaneous nerve (big white
arrowhead) (C). ASIS: anterior superior iliac spine, inguinal lig.:
inguinal ligament. E and F: Direct in-plane technique during axial
scanning injection, the sonographic image (axial view) of injection around
lateral femoral cutaneous nerve. Dashed arrow: needle, black arrowhead:
lateral femoral cutaneous nerve, asterisks: injectate, inguinal lig.: inguinal
ligament
www.painphysicianjournal.com E669
Ultrasound-Guided Diagnosis and Treatment of Meralgia Paresthetica
axis) technique and the latter refers to a blind injection
after precise sonographic measurements have been ac-
quired. The injection can be performed using the direct
in-plane technique whereby the long axis of the needle
is visualized during the whole injection (Fig. 1E,F).
In daily clinical practice, the use of static/dynamic
US imaging for the diagnosis and treatment of MP is
noteworthy.
Conflict of interest
Each author certifies that he or she, or a member
of his or her immediate family, has no commercial asso-
ciation (i.e., consultancies, stock ownership, equity in-
terest, patent/licensing arrangements, etc.) that might
pose a conflict of interest in connection with the sub-
mitted manuscript.
RefeRences
1. Tagliafico A, Serafini G, Lacelli F, Perrone
N, Valsania V, Martinoli C. Ultrasound-
guided treatment of meralgia paresthet-
ica (lateral femoral cutaneous neuropa-
thy): Technical description and results of
treatment in 20 consecutive patients. J
Ultrasound Med 2011; 30:1341-1346.
2. Korkmaz N, Ozçakar L. Meralgia pares-
thetica in a policeman: The belt or the
gun. Plast Reconstr Surg 2004; 114:1012-
1013.
3. Dureja GP, Gulaya V, Jayalakshmi TS,
Mandal P. Management of meralgia
paresthetica: A multimodality regimen.
Anesth Analg 1995; 80:1060-1061.
4. Özçakar L, Kara M, Yalçın B, Yalçın E,
Tiftik T, Develi S, Yazar F. Bypassing the
challenges of lower-limb electromyog-
raphy by using ultrasonography: Anato-
MUS-II. J Rehabil Med 2013; 45:604-605.
5. De Muynck M, Parlevliet T, De Cock K,
Vanden Bossche L, Vanderstraeten G,
Özçakar L. Musculoskeletal ultrasound
for interventional physiatry. Eur J Phys
Rehabil Med 2012; 48:675-687.
... A further advantage of US is real-time imaging, which makes it a useful tool for image guidance. US is an important imaging modality in the diagnostic work-up as well as a treatment guidance tool for pelvic entrapment syndromes (9)(10)(11) . Ultrasound-guided injections can be divided into diagnostic and therapeutic procedures. ...
... Tracing the nerve both cranially and caudally helps to localize the course of the nerve. The LFCN separates into its branches caudally and the region just proximal to the branching is the optimal location to prevent block failure (1,11,13,18) . The needle is advanced towards the LFCN in plane with the transducer by penetrating the skin and subcutaneous fat (Fig. 2). ...
... Studies have shown a high degree of symptom resolution after US-guided perineural injections of the LFCN (11,18) . Perineural injections are predominantly performed with a mixture of a local anesthetic and corticosteroids. ...
Article
Full-text available
Pelvic entrapment neuropathies represent a group of chronic pain syndromes that significantly impede the quality of life. Peripheral nerve entrapment occurs at specific anatomic locations. There are several causes of pelvic entrapment neuropathies, such as intrinsic nerve abnormality or inflammation with scarring of surrounding tissues, and surgical interventions in the abdomen, pelvis and the lower limbs. Entrapment neuropathies in the pelvic region are not widely recognized, and still tend to be underdiagnosed due to numerous differential diagnoses with overlapping symptoms. However, it is important that entrapment neuropathies are correctly diagnosed, as they can be successfully treated. The lateral femoral cutaneous nerve, ischiadic nerve, genitofemoral nerve, pudendal nerve, ilioinguinal nerve and obturator nerve are the nerves most frequently causing entrapment neuropathies in the pelvic region. Understanding the anatomy as well as nerve motor and sensory functions is essential in recognizing and locating nerve entrapment. The cornerstone of the diagnostic work-up is careful physical examination. Different imaging modalities play an important role in the diagnostic process. Ultrasound is a key modality in the diagnostic work-up of pelvic entraptment neuropathies, and its use has become increasingly widespread in therapeutic procedures. In the article, the authors describe the background of pelvic entrapment neuropathies with special focus on ultrasound-guided injections.
... Meralgia paresthetica (MP) is a condition caused by entrapment of the lateral femoral cutaneous nerve (LFCN) at the level of the inguinal ligament. 1 The LFCN is a purely sensory nerve that originates at the L2 and L3 spinal nerve roots and provides innervation to the anterolateral portion of the thigh. 1 Some causes of MP include obesity, pregnancy, pelvic masses, and external compression by tightfitted clothing or belts. 2 In addition, MP can be caused iatrogenically after laparoscopic surgeries and orthopedic procedures involving the pelvis. 2 Risk factors for MP include obesity, diabetes mellitus, and older age. 1 The incidence of MP is approximately 32.6 per 100,000 person-years. ...
... 1 The LFCN is a purely sensory nerve that originates at the L2 and L3 spinal nerve roots and provides innervation to the anterolateral portion of the thigh. 1 Some causes of MP include obesity, pregnancy, pelvic masses, and external compression by tightfitted clothing or belts. 2 In addition, MP can be caused iatrogenically after laparoscopic surgeries and orthopedic procedures involving the pelvis. 2 Risk factors for MP include obesity, diabetes mellitus, and older age. 1 The incidence of MP is approximately 32.6 per 100,000 person-years. ...
... 2 Risk factors for MP include obesity, diabetes mellitus, and older age. 1 The incidence of MP is approximately 32.6 per 100,000 person-years. 3 It is typically diagnosed clinically with numbness, paresthesia, dysesthesia, and pain over the anterolateral aspect of the thigh, which are exacerbated with walking, standing, and hip extension. ...
Article
Full-text available
Meralgia paresthetica is a condition caused by entrapment of the lateral femoral cutaneous nerve at the level of the inguinal ligament. This nerve is a purely sensory nerve and provides innervation to the anterolateral portion of the thigh. The condition can lead to numbness, paresthesia, dysesthesia, and pain over the anterolateral aspect of the thigh, which are exacerbated with walking, standing, and hip extension. First-line treatment for MP includes conservative measures such as weight loss and eliminating tight-fitted clothing. Neuropathic pain medications and corticosteroid injections are also treatment options for some patients with significant pain complaints. In more refractory cases, surgical intervention can be considered. Peripheral nerve stimulation has also been shown to be a helpful treatment modality for patients with refractory meralgia paresthetica. Here we report our experience utilizing peripheral nerve stimulation in patients with significant pain complaints related to refractory meralgia paresthetica.
... None of the patients in Group 2 had recurrence of the symptoms at the end of the follow-up period. The mean period until pain relief and improvement in cutaneous sensitivity was 14.8 ± 1.8 months (range: [12][13][14][15][16][17][18][19] in Group 1 and 14.5 ± 2.0 months (range: 12-18) in Group 2. At the end of the follow-up period the post-injection mean VAS score in Group 1 was 2.9 ± 2.3 (range: 1-7), and in Group 2 was 1.8 ± 0.7 (range: 1-3). The differences between the post-injection mean VAS scores of the two groups at the end of the follow-up period was due to the recurrence of the symptoms of 4 patients in Group 1. ...
... Meralgia paresthetica is usually idiopathic but it can ocur due to trauma, overuse, obesity, pregnancy, tight fitting clothing, wearing heavily loaded hip belts, pelvic and retroperitoneal tumors, streching of the nerve due to prolonged leg hyperextension, prolonged standing, leg length discrepancies, scoliosis, periostitis of the ilium, lower abdominal and pelvic incisions (Pfannenstiel incisions and appendectomies), laparoscopic hernia repairs, Chiari pelvic osteotomies, and iliac bone graft harvesting. 3,16,17 The diagnosis of meralgia paresthetica is based on the clinical findings and the diagnosis can be confirmed by nerve conduction studies showing decrease in the amplitude of SNAP with side-to-side amplitude difference. 1,11 In some cases the diagnosis can be confirmed by the LCFN block with local anaesthetic. ...
Preprint
Objectives Meralgia paresthetica is a very rare sensory mononeuropathy of the lateral femoral cutaneous nerve (LFCN). The purpose of this study was to evaluate the outcomes and compare the results of ultrasound-guided corticosteroid injection and ultrasound-guided alcohol neurolysis in the treatment of meralgia paresthetica. Methods We performed a retrospective clinical study of 26 patients with a diagnosis of marelgia paresthetica with a duration of ≥10 months. The patients were divided into 2 groups, with the Group 1 receiving ultrasound-guided local corticosteroid injection and Group 2 receiving ultrasound-guided alcohol neurolysis to the entrapment site of the LFCN. Results The mean age of the patients in Group 1 was 42.2 years and in Group 2 was 40.8 years. The mean follow-up period of Group 1 was 28.7 months and Group 2 was 28.4 months. At the end of the follow-up period 9 patients in Group 1 and 10 patients in Group 2 declared full pain relief and improvement in cutaneous sensitivity. Conclusion Once meralgia paresthetica has persisted corticosteroid injection and alcohol neurolysis are both effective methods. Although the recurrence rates are higher in corticosteroid injection, both treatment methods decreased the pain and improved the patients’ satisfaction and long-term curative effect.
... After the LFCN is identified, the needle is inserted into the field with an ultrasound probe ( Figure 4). Alternatively, the needle can be removed from the field using a nerve stimulation needle to confirm needle placement [8,9,24]. In situations where the LFCN cannot be found using those techniques, 2 other techniques can be tried. ...
... It can also be iatrogenic, as a complication from some surgical procedures. [3,4] Sensory polyneuropathies, such as diabetes, can also involve the LFCN. Clinically, it is characterized by pain, paresthesia, dysesthesia, and numbness in the anterolateral thigh, as a direct result of LFCN compression. ...
Article
Meralgia paresthetica (MP) is one of the most common mononeuropathies of the lower limb, characterized by injury or compression of the lateral cutaneous femoral nerve at the level of the anterior superior iliac spine and inguinal ligament. Many predisposing factors, such as weight gain, obesity, and restrictive clothing, contribute to the injury of the lateral cutaneous femoral nerve along its course from the pelvis towards the thigh. Although a great number of cases are successfully treated with conservative measures, a subgroup of patients suffer chronic dysesthetic pain with intermittent flare-ups in their lifetime, with a negative impact on quality of life, requiring additional treatment. The purpose of this case report is to describe the successful management of MP with ultrasound-guided pulsed radiofrequency of the lateral cutaneous femoral nerve.
... Many studies have reported that damage to LFCN can be avoided by the preoperative identification of its distribution using ultrasound, which has higher sensitivity and equal specificity to magnetic response imaging (MRI) in noninvasive peripheral nerve visualization [16,[19][20][21]. Preoperative ultrasound maps the distribution of LFCN in the skin and the distal incision. ...
Article
Full-text available
Background The postoperative complaints of hypoesthesia or a burning sensation due to lateral femoral cutaneous nerve (LFCN) injury in patients are not yet solved. The present study aimed to identify the three-dimensional (3D) distribution of LFCN using preoperative ultrasound and evaluate the rate of injury in direct anterior approach for total hip arthroplasty. Methods A total of 59 patients (28 males and 31 females, age 69.0 ± 4.6 years, BMI 24.7 ± 3.0 kg/m ² ) were randomly allocated to the ultrasound group and 58 patients (28 males and 30 females, age 68.5 ± 4.5 years, BMI 24.8 ± 2.8 kg/m ² ) were in the control group. Surgeons received the data of 3D distribution of LFCN only in the ultrasound group before surgery with respect to the direction, the depth on the skin, and the length to tensor fasciae latae (TFL). The anatomical characteristics of LFCN in the surgical region were summarized. At 1 and 3 months of post surgery, the rate of LFCN injury and abnormal sensitive area was evaluated in both groups. Results There was a significant consistency in gender, age and BMI of these two groups ( P > 0.05). Based on the data from the ultrasound group, over 90% of patients had one or two branches of LFCN. LFCN always courses in the fascia layer, the depth ranged from 6.8 ± 2.6 (3.0–12.0) mm to 11.1 ± 3.4 (4.0–17.0) mm and depended on the thickness of the subcutaneous fat, and length was 3.3 ± 4.6 (− 5.0–10.0) mm at proximal part and − 2.7 ± 4.7 (− 10.0–8.0) at distal end to the medial edge of TFL. Both the rate of LFCN injury and abnormal sensory area in the ultrasound group was significantly lower than those in the control group (3.4% vs. 25.9%, P = 0.001, at 1 month; 3.4% vs. 22.4%, P = 0.005, at 3 months). Conclusions LFCN mostly courses along the medial border of TFL in the fascia layer. The 3D distribution of LFCN using preoperative ultrasound mapping could help the surgeons to evaluate the risk of injury preoperatively and decrease the rate of injury during the operation. However, some branch injuries, especially for the fan type LFCN, could not be avoided.
... Many studies have reported that damage to LFCN can be avoided by the preoperative identi cation of its distribution using ultrasound, which has higher sensitivity and equal speci city to magnetic response imaging (MRI) in noninvasive peripheral nerve visualization[16, [19][20][21]. Preoperative ultrasound maps the distribution of LFCN in the skin and the distal incision. However, the position of LFCN marking on the skin is easily changed with the skin in different positions of the hip joint, especially in the elderly with loose and wrinkled skin. ...
Preprint
Full-text available
Background:The postoperative complaints of hypoaesthesia or a burning sensation due to lateral femoral cutaneous nerve (LFCN) injury in patients is not yet solved. The present study aimed to identify the three-dimensional (3D) distribution of LFCN using preoperative ultrasound and evaluate the rate of injury in direct anterior approach for total hip arthroplasty. Methods: A total of 59 patients ( 28 males and 31 females, age 69.0 ± 4.6 years,BMI 24.7 ± 3.0 kg/m²) were randomly allocated to the ultrasound group and 58 patients ( 28 males and 30 females, age 68.5 ± 4.5 years, BMI 24.8 ± 2.8 kg/m²) were in the control group. Surgeons received the data of 3D distribution of LFCN only in the ultrasound group before surgery with respect to the direction, the depth on the skin, and the length to tensor fasciae latae (TFL). The anatomical characteristics of LFCN in the surgical region were summarized. At 1 and 3 months post-surgery, the rate of LFCN injury and abnormal sensitive area were evaluated in both groups. Results: There was a significant consistency in gender, age and BMI of these two groups (P>0.05). Based on the data from the ultrasound group, over 90% of patients had one or two branches of LFCN. LFCN always courses in the fascia layer, the depth ranged from 6.8±2.6 (3.0 ~12.0) mm to 11.1±3.4 (4.0 ~17.0) mm and depended on the thickness of the subcutaneous fat, and length was 3.3±4.6 (-5.0 ~10.0) mm at proximal part and -2.7±4.7 (-10.0 ~8.0) at distal end to the medial edge of TFL. Both the rate of LFCN injury and abnormal sensory area in the ultrasound group were significantly lower than those in the control group (3.4% VS 25.9%, P=0.001, at 1 month; 3.4% VS 22.4%, P=0.005, at 3 months). Conclusions: LFCN mostly courses along the medial border of TFL in the fascia layer. The 3D distribution of LFCN using preoperative ultrasound mapping could help the surgeons to evaluate the risk of injury preoperatively and decrease the rate of injury during the operation. However, some branch injuries, especially for the fan type LFCN, could not be avoided.
... In daily clinical practice, electrodiagnostic studies are not commonly preformed due to their variable results 66 . In the recent literature, ultrasound imaging has been proposed as useful modality as it confirms nerve entrapment with sonografic findings of swollen and hypoechoic lateral femoral cutaneous nerve 67 .Magnetic resonance imaging (MRI) or computed tomography (CT) are useful in the diagnosis of eventual causes of the syndrome because of the compression of the nerve in the abdomen and pelvis 68,69 . The differential diagnosis includes femoral neuropathy, lumbosacral plexus pathology, extra-spinal radiculopathies L2 and L3 nerve roots, pelvic tumors or metastasis that compress the nerve, chronic appendicitis 70 . ...
Article
Full-text available
Meralgia paresthetica (MP) is a neuropathy that involves pain and sensory symptoms in the distribution of the lateral femoral cutaneous nerve and is mostly caused by entrapment of the lateral femoral cutaneous nerve. The etiology of MP includes pregnancy, trauma, tumors, surgical complications and other conditions with increased intraabdominal pressure. The diagnosis of MP is usually based primarily upon clinical signs and symptoms, but other diagnostic tools can be used in patients with atypical clinical presentations. Treatment focuses on relieving symptoms caused by nerve compression and usually involves conservative approach. Surgical treatment may be considered it conservative methods fail. Sažetak: Meralgia paresthetica-kanalikularni sindrom nervus cutaneus femoris lateralis Meralgia paresthetica je neuropatija koja nastaje kompresijom ili traumom lateralnog femoralnog kožnog živca. Simptomi karakteristični za ovo stanje su isključivo osjetni i u većini slučajeva unilater-alni. MP uzrokuje žareću bol u vanjskom dijelu bedra, uz paresteziju i disesteziju. Etiološki čimbenici povezani sa nastankom MP jesu stanja koja uzrokuju povećanje intraabdominalnog tlaka poput trudnoće i pretilosti, tumora, trauma i komplikacije kirurških zahvata. Dijagnoza se u većini slučajeva postavlja na temelju detaljne anamneze i karakteristične kliničke slike, no u nejasnim slučajevima potrebne su i druge dijagnostičke metode. Liječenje se temelji na uklanjanju predisponirajućih
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Meralgia paresthetica is a sensory neuropathy characterized by anterolateral thigh pain associated with paresthesiae. It is hypothesized that entrapment, compression, or stretching of the lateral femoral cutaneous nerve as it exits through the inguinal ligament. Often times life style modification, neuropathic pain medications, and or steroid injections can help relieve the pain. In some circumstances, the pain is refractory and more invasive procedures such as radiofrequency ablation and or even surgery may need to be pursued. The authors report the successful use of 10% lidocaine for chemical neurolysis for Meralgia paresthetica in a 47-year-old female refractory to conventional treatment. In this case report, we will discuss the risk factors, pathomechanics, diagnostic challenges, therapeutic options and novel approach employed by the authors. Key words: 10% lidocaine, chemical neurolysis, meralgia, aresthetica, neuropathic pain
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More and more physiatrists are interested in learning how to use musculoskeletal ultrasonography in their clinical practice. The possibility of high resolution, dynamic, comparative and repeatable imaging makes it an important diagnostic tool for soft tissue pathology. There is also growing interest to use sonography for guiding interventions such as aspirations and infiltrations. In daily practice these are often done blindly or palpation-guided. To improve the accuracy of interventions, fluoroscopy or computed tomography were traditionally used for guidance. Since sonography is non-ionizing, readily available and relatively low cost, it has become the first choice to guide many musculoskeletal interventions. Ultrasound allows real-time imaging of target and needle as well as surrounding vulnerable structures such as vessels and nerves. Many different techniques are proposed in the literature. Interventions under ultrasound guidance have been proven to be more accurate than unguided ones. Further studies are required to prove better clinical results and fewer complications. Infection is the most dreaded complication. This review wants to highlight technical aspects of ultrasound guidance of interventions and give a survey of different interventions that have been introduced, with emphasis on applications in Physical Medicine and Rehabilitation. Results and complications are discussed. Finally training requirements and modalities are presented.
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The purposes of this study were to describe a technique for treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy) using ultrasound guidance and to report the results of treatment. Twenty consecutive patients (7 male and 13 female; age range, 23-66 years; mean, 39 years) with meralgia paresthetica confirmed by electromyography were treated with perineural injection of 1 mL of methylprednisolone acetate (40 mg/mL) and 8 mL of mepivacaine, 2%, under direct ultrasound guidance. Main outcome measures included the technical success of the procedure, visual analog scale score for the lateral femoral cutaneous nerve (pain, burning sensation, and paresthesia), and visual analog scale global quality of life score. Technical success (successful nerve block at the distribution of the lateral femoral cutaneous nerve) was achieved in all patients. Five patients felt slight sharp pain during needle insertion. The symptoms in 16 patients (80%) diminished progressively after the first week. The 4 remaining patients (20%) required a further perineural injection. The symptoms disappeared in all patients 2 months after injection (mean visual analog scale score ± SD for lateral femoral cutaneous neuropathy at baseline, 8.1 ± 2.1; at 2 months, 2.1 ± 0.5; t = 6.2; P < .001). The mean visual analog scale quality of life scored decreased from 6.9 ± 3.2 to 2.3 ± 2.5 (t = 5.3; P < .002). Treatment of meralgia paresthetica with ultrasound-guided perineural injections resulted in substantial symptom relief in most patients 2 months after injection. Randomized placebo-controlled trials of this treatment should be considered in the future.