- The nerve may be angulated or compressed against a sharp edge of fascia as it pierces the iliac fascia prior to exiting the pelvis beneath the inguinal ligament.
- The nerve may be subjected to friction where it is wedged between the attachment of the inguinal ligament with the ASIS.
- The nerve may pass through the tendinous fibers of the inguinal ligament and be pinched at this site.
- The nerve may be compressed as it crosses the iliac crest or may be compressed within the substance of the sartorius muscle or tensor fascia lata muscle.
Drawing depicts the sensory field for the lateral femoral cutaneous nerve.
These findings may be accompanied in three-fourth of cases by a tender spot over the inguinal ligament that is two finger widths medial to the anterior superior iliac spine.1,6 Symptoms may also be aggravated by clinically reproducing hip extension through orthopedic tests such as Nachlas' test.1
In diagnosing meralgia paresthetica, care should be taken to rule out intraspinal, retroperitoneal, abdominal, or pelvic pathologies, diabetes mellitus, and L3 disc prolapses.1,3,5,6 Clinically, the L3 disc prolapse may produce alteration of the patellar reflex. In contrast, the reflex will not be altered in meralgia paresthetica.5
Most cases of meralgia paresthetica will respond to conservative care. Modalities that may prove helpful in the treatment of this condition may include ultrasound, electrical stimulation, or transverse friction techniques to break up possible adhesions affecting the lateral femoral cutaneous nerve at the inguinal region. Postural alterations and functional spinal problems should also be addressed in the management of this condition.
- Mumenthaler M: Neurology. Thieme-Stratton, Inc., New York, 1983.
- Sunderland S: Nerves and Nerve Injuries, ed 2. Churchill-Livingstone, New York, 1978.
- Turek SL: Orthopedics: Principles and Their Application, ed 4. J.B. Lippincott, New York, 1984.
- Mohr JP: Manual of Clinical Problems in Neurology, ed 2. Little, Brown and Company, Boston, 1989.
- Kramer J: Intervertebral Disc Disease: Causes, Diagnosis, Treatment, and Prophylaxis. Year Book Medical Publishers, Chicago, 1981.
- Bradley WG, Daroff RB, Fenichel GM, and Marsden CD: Neurology in Clinical Practice: The Neurological Disorders. Butterworth-Heinemann, Boston, 1991.
Brad McKechnie, D.C., DACAN