General
- AKA
- Bernhardt-Roth syndrome
- More common
- Men
- Overweight patients.
- May be related to anatomical variability of the nerve as it passes through the fascial tunnel leaving it susceptible to compression with variation of movement.
- Associated with prone positioning in spinal surgery
- A complication of bone graft harvesting from the iliac crest and anterior pelvic procedures.
Definition
- Entrapment of the lateral cutaneous nerve of the thigh as it passes from the pelvis to the lateral thigh
Anatomy
- Lateral cutaneous nerve does not have any motor component
- Symptoms are mainly sensory
Clinical presentation
- Anterolateral thigh
- Pain
- Tingling
- Paraesthesia
- Symptoms are aggravated by
- External compression with
- Clothing or belts,
- Hyperextension of the hip,
- Standing for prolonged periods.
- Provocative tests reproduce the tingling and pain;
- Tinel- Hoffman, which is pressure over the nerve as it passes adjacent to the anterior superior iliac spine.
- Diagnostic test
- Is to inject some local anaesthetic into the site of the positive Tinel Hofmann’s test.
- If the patient then experiences relief of symptoms and associated numbness in the distribution of the nerve, then the diagnosis is confirmed.
Investigations
- The diagnosis is clinical. If clinical evaluation is inconclusive can try
- Nerve conduction studies
- Ultrasound
- MRI
- To exclude the differential diagnoses of proximal spinal nerve compression, intraneural and extraneural tumours.
Management
- Conservative
- Option
- Removal of external compressors such as
- Tight clothing or
- Belts,
- Losing weight
- Anti- inflammatory medication.
- Ultrasound - guided steroid injection
- Operative
- Indication
- For those cases that have failed non-operative strategies but where significant symptoms persist.
- It is also useful for those cases with symptoms after previous pelvic surgery.
- Aim
- Diagnosis of meralgia paresthetica
- Treatment
- Outcome
- Exploration and neurolysis is effective.
- Technique
- Neurolysis
- Neurolysis of the constricting tissue,
- Neurolysis and transposition of normal tissue with the potential for nerve gliding should
- Neurectomy
- Can be as effective if not more effective that neurolysis in some cases (de Ruiter and Kloet, 2015)