What You Should Know About Thigh Pain and Meralgia Paresthetica

The term “meralgia paresthetica” may not mean much to you at the moment, but “thigh pain” sure may if you have been experiencing it.

While some pain is normal in everyday life, any form of chronic and severe pain that interferes with daily activities is not normal and deserves to be evaluated by a professional.

Chronic burning pain and numbness in the outer thigh is a nerve-related condition we see and treat frequently. This is often caused by a pinched nerve at the level of the hip, known as meralgia paresthetica or compression of the lateral femoral cutaneous nerve.

Do any of the additional symptoms below sound familiar?

thigh pain

A Few Questions About Your Thigh Pain

Are you experiencing pain on the outer thigh, within the range of the beltline to the knee?

Would you describe this pain as a burning or “pins and needles” feeling? Do you sometimes feel a numbness or tingling, or even a sensation like bugs are crawling over your thigh?

Does the outside of your thigh feel hypersensitive? Are you aware of every hair on your thigh? Can it hurt when wearing pants or loose dresses? Have you stopped carrying change in your pocket because it bothers your thigh? If you shave, has doing so become painful? Does water running down your leg bother you?

Does your thigh burn while you are sitting down, especially in the car, on a toilet seat, or at the dining room table? Do you tend to recline while seated to prevent your thigh from burning?

Have these symptoms occurred after an injury or surgery to the outside or front of your hip, or at your beltline? For instance, did this begin after a C-section, a hip replacement/surgery, a pelvic surgery, or a hernia repair?

Have you seen a spine team or a pain management team who has told you the pain is not coming from your back?

If some of these symptoms sound familiar to you or to someone you know, it may be the result of meralgia paresthetica—and we may be able to help.

What is Meralgia Paresthetica?

Pain, numbness, and hypersensitivity along the outer thigh can be caused by compression, pinching, or squeezing of the lateral femoral cutaneous nerve. This nerve runs through the front of the pelvis, near the beltline, to the outer thigh, and its sole function is to provide sensation to this area, from the beltline to the outer knee. It does not control any muscle functions.

Normally, the lateral femoral cutaneous nerve performs its duties without a hitch. We are not consciously aware of the outside of our thigh on a regular basis.

It is possible, however, for the nerve to become trapped by the inguinal ligament, a relatively thick band of tissue that separates the pelvis from the upper thigh, and the anterior pelvis in the region known as ASIS (anterior superior iliac spine).

Furthermore, direct Injury to this nerve by trauma or surgery can cause the same symptoms.

What Can Increase One’s Risk for Meralgia Paresthetica?

Factors that add weight or force to the lateral femoral cutaneous nerve can cause it to become pinched or trapped. These may include:

  • Obesity or weight gain.
  • Pregnancy. Pressure on the groin (which should be familiar to any expectant mother who needs to use the bathroom more often) can also place pressure on the nerve. In these cases, the problem may resolve itself following birth.
  • Overly tight clothing.
  • Heavy belts that weigh on the hips and beltline. (In fact, one nickname for meralgia paresthetica is “gun belt palsy,” as the condition can be common in police officers who are wearing heavily loaded utility belts.)
  • Scar tissue built up around the nerve or damage caused by previous injuries or surgeries. These can include C-sections, abdominoplasty (tummy tucks), hernia repairs, fracture repairs, and other procedures performed in the abdomen near the lower pelvis.

It is also possible for complications from diabetes to cause nerve injury that results in meralgia paresthetica.

doctor and patient

What Should I Do If I Have Thigh Pain and Suspect Meralgia Paresthetica?

When it comes to matters of pain such as this, it is important to confirm the cause and rule out any other potential factors that might be causing your pain. That way, we can take the best route toward relief with fewer risks of taking the wrong path of treatment.

We will want to know about your medical history leading up to the present, as well as whether you have discussed your pain with other specialists. For example, similar symptoms can result from a herniated disc in your lower back. If you do have substantial back pain associated with thigh pain, we must rule out a herniated disc before proceeding. If you have already seen a spine specialist who ruled this possibility out, it increases the likelihood that the problem is related to the lateral femoral cutaneous nerve.

If your outer thigh pain seems to be more related to movement and centers around the hip joint, you will likely need to see an orthopedic hip specialist to make sure there are no problems with the hip joint.

Standard evaluation for meralgia paresthetica (compression of the lateral femoral cutaneous nerve) often includes testing of strength and reflexes, measurement of sensation, and physical manipulation of the lateral femoral cutaneous nerve at the hip.

Other tests frequently include:

  • Imaging tests such as MRIs or MR neurography, or CAT scans to help rule out conditions such as tumors.
  • Electromyography, in which a thin needle electrode is placed into a muscle to record electrical activity. This will confirm or rule out other neuromuscular disorders.
  • A nerve conduction study, in which electrode patches are placed on the skin to mildly stimulate the nerves. This helps diagnose the health and condition of a nerve.
  • A nerve block, in which an anesthetic is injected where the lateral femoral cutaneous nerve enters into the thigh. If this creates relief, this provides supporting evidence that the nerve itself may be involved in the pain syndrome.

Just because you have pain in your outer thigh does not always mean that the matter is related to the lateral femoral cutaneous nerve. As mentioned above, there are other causes that can be treated by other appropriate specialists. However, if a firm diagnosis of meralgia paresthetica can be made, we can shift attention toward treatment.

Early treatment of meralgia paresthetica will focus on allowing the nerve to recover on its own. In some cases—such as pregnancy—the symptoms can be eased within a few months after the baby is born and pressure is removed. Treatment will focus on aiding this relief and allowing the nerve to recover.

Other changes might include wearing looser clothing, avoiding tight or heavy belts, losing excess weight, and taking OTC pain relievers. Gentle physical therapy with nerve gliding may also be recommended.

If symptoms persist for more than 2 months, or the pain is severe enough to require more advanced treatment to reduce pain and inflammation (if needed), we may use some of these additional methods:

  • Corticosteroid injections.
  • Anti-seizure medications.
  • Topical pain-relieving creams.
  • Pain patches.

As is always the case, medicinal options may sometimes come with side effects.

If necessary, surgery to decompress or remove the nerve may be considered. These are very reasonable options, but are intended only for those who have severe and long-lasting symptoms, and when other measures have failed to provide relief.

If meralgia paresthetica sounds like a problem you are potentially experiencing, we may be able to help you. Contact our Towson office by calling (410) 709-3868 to speak with our staff. We’ll be happy to answer your questions and schedule an appointment.

Eric H. Williams MD
Specializing in reconstructive surgery and pain relief in the Greater Baltimore area.
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