How a Peripheral Nerve Surgeon Helps Meralgia Paresthetica Patients Find Relief

While meralgia paresthetica can greatly affect your quality of life, you don’t need to resign yourself to living with the pain and discomfort. As a board-certified plastic surgeon with additional fellowship training in peripheral nerve surgery, Dr. Eric H. Williams has helped many meralgia paresthetica sufferers get the relief they deserve—and he may be able to do the same for you. 

What Is Meralgia Paresthetica?

Meralgia paresthetica, sometimes referred to as Bernhardt‐Roth syndrome, is caused by a compressed lateral femoral cutaneous nerve. For most people, the lateral femoral cutaneous nerve passes to the upper thigh through the groin without any issue. In the case of this particular condition, however, the nerve can become trapped under the inguinal ligament which spans the gap from the outside of the hip to the pubic bone. This ligament separates the abdominal compartment from the thigh.   

Living with meralgia paresthetica is a challenge. As you go about your day, you might first notice a subtle tingling or mild pins-and-needles sensation on the outer side of one of your thighs. Gradually, this sensation intensifies, and you might start feeling burning or stinging pain in the same area. It's as if tiny pins are repeatedly pricking your skin, sending discomfort through the affected leg.

As time goes on, the pain might become more persistent and radiate downwards, making it feel like a severe sunburn or searing burning and electrical pain in the outside of the upper thigh. More “colorful” descriptions patients have used include:

  • “Feels like battery acid down my leg”
  • “Little tiny soldiers with knives stabbing the outside of my thigh”
  • “Like someone has plugged my thigh into an electric socket”
  • “It feels like a hive of bees on my thigh”  

Milder forms may feel more like:

  • “Bugs crawling on my skin” 
  • “Water dribbling down the thigh” 

Some patients with mild meralgia paresthetica have very little pain and have mostly numbness to the outside half of the thigh. The skin may just feel “like a piece of leather” or just tingly.  

These symptoms would include the typical location of the entire nerve, which can involve a lower portion of the outside of the hip and lower buttock extending down the entire outer thigh down the top of the knee. It does not cross the vertical midline of the thigh.   

Classically, many find that the symptoms are worse when they are sitting, and many get relief by standing or leaning back in a chair in a reclined position. But there have been many patients who “did not read the textbooks”—they have pain that is present at all times and in all positions.  Early on, the symptoms may be intermittent, and as the compression gets worse, the symptoms become more constant.  

Many patients may notice these symptoms because clothing touching the thigh can be uncomfortable. Dresses or skirts or the cuff of a pair of shorts rubbing against the skin, or objects in a pocket touching the thigh can be very annoying for these patients. They may notice it when bed sheets touch the thigh or when they rub their hand across the thigh. Sitting in a chair for a meal or meeting or even sitting on the toilet may make their thigh burn “like it is on fire.”      

Causes of Meralgia Paresthetica

Common causes of meralgia paresthetica include anything placing increased pressure on the groin region, such as:

  • Tight pants, belts, and other articles of clothing. Wearing tight belts, tool belts, gun belts, or clothing around the waist can compress the nerve, especially when sitting or standing for extended periods. The term “gun belt palsy” is sometimes used to refer to meralgia paresthetica when it occurs in police officers who must wear a heavy gun belt for a long period of time, and may lead to them having to adjust their gear.  
  • Weight gain or obesity. Excessive weight can exert pressure on the lateral femoral cutaneous nerve, leading to symptoms.
  • Pregnancy. The added weight and pressure on the pelvis during pregnancy can contribute to nerve compression.
  • Diabetes. Poorly regulated blood sugar can cause nerve injury or neuropathic damage. This can cause the nerves to swell significantly, which frequently can lead to meralgia paraesthetica as well as other forms of nerve compression.
  • Injury or trauma. Accidents or injuries in the hip or thigh region, such as seat belt injuries from a motor vehicle accident, crush injuries, fractures, or a direct blow to the region, may cause nerve damage resulting in meralgia paresthetica.
  • Surgery. Surgeries involving the pelvic or abdominal area may inadvertently lead to nerve compression. For example, damage to the lateral femoral cutaneous nerve is a recognized complication of anterior hip replacement surgery

Meralgia paresthetica can affect people of all ages but is most common in those between the ages of 30 and 60.

Symptoms of Meralgia Paresthetica 

As we mentioned earlier, the symptoms of meralgia paresthetica can make it difficult to enjoy everyday activities. Symptoms can vary from person to person but often include: 

  • Pain on the surface of the outer thigh accompanied by numbness.  By definition, the burning pain of meralgia paresthetica, as well as the numbness and tingling is experienced on the skin of the outer thigh.
  • Pain on one side of the body. Typically, meralgia paresthetica symptoms will only present on one side of the body instead of on both sides simultaneously.  However, there are patients, especially if they are overweight and have diabetes that present with bilateral symptoms simultaneously.  
  • Pain that is worse when sitting. The pain and discomfort associated with meralgia paresthetica is generally worse when sitting, with riding in a car or sitting on a toilet seat being particularly painful. However, some patients find they actually have more pain when they move so this symptom may not be present.
  • Trouble sleeping. Meralgia paresthetica pain can make it hard to sleep at night. Most people say sleeping on the side opposite the discomfort with a pillow between their legs is best.  If they sleep with a partner, some will actually change sides of the bed if the partner has a tendency to rub up against the thigh.  
  • Paresthesia. This signifies an atypical sensation often characterized as tingling, prickling, numbness, or a sensation similar to "pins and needles." Many individuals liken it to a sensation of "creepy crawlies."
  • Dysesthesia. This term refers to intensely hypersensitive sensations felt in response to regular stimuli. Those with dysesthesia resulting from a lateral femoral cutaneous nerve compression might have extreme discomfort when wearing loose pants that touch the thigh or when they have items in their pockets that are rubbing up against the skin.

Note that patients don’t have low back pain. If a patient is suffering from low back pain, it is more likely that they are suffering from a spinal lesion as opposed to meralgia paresthetica. However, there are always exceptions to every rule. Patients could even have both, hence a good medical workup is needed for these patients. 

It is also important to note that weakness is not a symptom of compression of the lateral femoral cutaneous nerve by definition. Because this nerve goes only to the skin, it never causes weakness. There could be another problem present simultaneously that may be causing weakness, but it will not be this nerve. This can cause delays in diagnosis, as most folks with weakness may have a more proximal level at the spine compressing a nerve root there. Additionally, it is important to differentiate between true weakness and the fact that it might really hurt just to move the thigh due to this compressed nerve. Therefore, the patient may choose not to move the thigh much and thus “feels weaker” because they are not as active or walking as far due to the pain alone.  

Diagnosing Meralgia Paresthetica

A meralgia paresthetica diagnosis can often be made with a physical exam and study of your medical history—along with hearing you describe the symptoms you’re experiencing—but we do have additional diagnostic options, like imaging studies, electromyography, nerve conduction studies, and nerve blocks (which we may perform here in our office).

Several other conditions cause symptoms related to meralgia paresthetica, which can sometimes make it difficult to obtain a diagnosis. For example, if you have a herniated disc or other spinal problem, you may need an MRI of the back or pelvis to correctly diagnose the problem.  

Conservative Treatments for Meralgia Paresthetica

Conservative treatments for meralgia paresthetica focus on providing symptom relief.

  • Physical therapy. A physical therapist will demonstrate exercises that focus on decreasing muscle tension and encourage nerve gliding or nerve flossing to help restore normal motion in the back, hip, and leg.
  • Medication. Gabapentin, Lyrica, or Cymbalta are non-narcotic medications that are sometimes prescribed to treat pain from meralgia paresthetica. However, it’s important to keep in mind that these medications don’t cure the problem—they only cover it. The nerve is still dying even if you no longer experience the same level of pain. 
  • Weight loss. Weight loss can be helpful for those patients who are diabetic and/or overweight.
  • Lifestyle or clothing changes. Lifestyle and clothing changes can improve those patients with occupational compression like “gun belt” or “tool belt palsy.” 

Surgical Treatment of Meralgia Paresthetica

Surgery is the only way to permanently address the effects of meralgia paresthetica. The primary goal of surgery is to relieve the compression or entrapment of the nerve. Dr. Williams will gently release any structures, such as tight fascia or ligaments, that are pressing on the nerve and causing the symptoms. 

In advanced cases of meralgia paresthetica, the lateral femoral cutaneous nerve may need to be removed due to damage. Surgically removing the nerve and burying or hiding it inside the pelvis helps relieve pain, but the patient will have numbness from the middle of the groin crease through the top of the knee through the outside of the hip (the same distribution that the nerve covers). Over time, the area of numbness does shrink as other neighboring nerves grow into the region, but it never goes away completely. 

When you meet with Dr. Williams, he can explain whether nerve decompression or nerve removal is the best option for your unique needs. This depends on many factors such as the severity of symptoms, your weight, your occupation, and the duration the symptoms have been present.   

After surgery, it is recommended that you limit your activity level for one to two weeks. In most cases, you can resume all normal activities within four weeks of the surgery. Water therapy may be recommended to help with desensitization.

What Results Can You Expect From Meralgia Paresthetica Surgery?

Individual results will vary, but the surgical treatment of meralgia paresthetica is generally quite successful.

Before surgery, one of our patients described feeling as if someone poured lighter fluid on his leg and lit it. It was the most severe pain he had ever experienced, but he could tell the pain was gone immediately after surgery to remove the nerve. He now has zero pain and minimal numbness—results that are much better than he anticipated.

Another patient said her meralgia paresthetica made sitting in any type of chair painful and caused continued difficulty sleeping at night. Three months after surgery, she said her pain level had dropped from a nine to a one with almost no numbness. 

Surgery works even when patients feel like other doctors haven’t listened to their struggles. After seeing seven other doctors, our patient was able to find relief from three years of constant thigh pain. She’d rate her pain a five or six, with some days being an eight or nine. After nerve decompression of the lateral femoral cutaneous nerve in the right thigh, her pain dropped to a one or two. 

Don't Let Meralgia Paresthetica Dictate Your Life Any Longer

If you've been silently suffering from the relentless grip of meralgia paresthetica, it's time to reclaim your life! No longer do you need to endure the numbness, tingling, or burning sensations that hamper your daily activities. It's time to embrace a future where pain and discomfort are just distant memories.

Your journey to a pain-free future starts with The Dellon Institutes for Peripheral Nerve Surgery. If you would like more information or want to request your appointment with Dr. Eric H. Williams, simply call our office at (410) 709-3868 or fill out a contact form here