Meralgia paresthetica, the elusive diagnosis - Clinical experience with 14 adult patients

Objective To discuss the diagnosis and treatment of meralgia paresthetica as reported in the literature and as experienced by the author. Summary Background Data Meralgia paresthetica is a mononeuropathy of the lateral femoral cutaneous nerve that can lead to significant disability when the diagnosis and treatment is delayed or missed. This condition is relatively common but is frequently mistaken for other disorders. Methods Fifteen cases of meralgia paresthetica were identified in 14 patients in a private surgical practice during a 4-year period. All patients were initially treated conservatively and seven patients subsequently underwent surgical treatment. Follow-up ranged from 3 to 6 years. Results Conservative management consisting of local analgesics, steroids, nonsteroidal antiinflammatories, rest, and reduction or elimination of aggravating factors yielded long-lasting improvement in five patients with meralgia paresthetica. Nine patients with 10 cases of meralgia paresthetica did not benefit in the long term from conservative management. Seven of these patients, representing eight cases of meralgia paresthetica, ultimately opted for surgical management, and all obtained good long-term relief of symptoms. Conclusion Surgical management of meralgia paresthetica is a viable option for patients in whom medical management fails. Based on the published literature and the author's experience, a rationale is presented for determining the appropriate surgical management of these patients.