The injection can be performed using the direct in-plane technique whereby the long axis of the needle is visualized during the whole injection (Fig. Your doctor may suggest conservative methods such as weight control and wearing loose clothing. Department of Radiology, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy. For Neurology and Musculoskeletal Disorders info@alimranmed.c om +964 780 1926801 +964 770 6774773. Learn about our remote access options. 1E,F). Methods Department of Radiology, Santa Corona Hospital, Pietra Ligure, Italy. | The needle was advanced under direct ultrasound visualization in a longitudinal view, whereas the lateral femoral cutaneous nerve was visualized in a short‐axis view. In persistent cases a steroid injection around the nerve may help. More severe cases which do not respond to conservative measures … The LFN arises from the second and third lumbar spinal levels (L2,L3). La ropa ajustada, la obesidad o el aumento de peso, y el embarazo son causas frecuentes de meralgia parestésica. In addition, local anesthetic/steroid injection of the lateral femoral cutaneous nerve provided only short-term relief. Objectives: The aim of this study was to evaluate the efficacy of ultrasound (US)-guided LFCN injection in the management of MP by comparing with transcutaneous electrical nerve stimulation In Short: If you have Meralgia The transducer was gently moved in a mediocaudal direction while the operator searched for the echo signature of the lateral femoral cutaneous nerve. On the contrary, no patient reported paresthesia during injection, suggesting that the needle did not come in direct contact with the nerve for a time sufficient to cause sensory alterations. Meralgia paresthetica is a lateral femoral cutaneous nerve entrapment syndrome causing burning, numbness, and paresthesias along the proximolateral aspect of the thigh. Department of Neurology, Santa Corona Hospital, Pietra Ligure, Italy. It has been reported that femoral and obturator nerve involvements are possible complications of lateral femoral cutaneous nerve injections.10 A possible explanation for this difference may have been that the injectate volume was less than the 10‐ to 15‐mL range that has been considered as a cutoff to avoid complications. Objective: What increases my risk for MP? In this study, real‐time visualization of the nerve resolved the problem of anatomic variability and probably increased the effectiveness of the procedure. Ultrasound guidance has been shown to be particularly suitable for injection of tiny and superficial structures such as the lateral femoral cutaneous nerve, overcoming the anatomic variability in most patients.6–10 It has recently been suggested that ultrasound guidance can facilitate blockade of the nerve for diagnostic and therapeutic purposes and may be particularly beneficial in patients with challenging surface anatomic landmarks and when low‐volume injections are desired.10 However, that suggestion arose from a retrospective evaluation of 10 patients treated without a standardized protocol.10 Moreover, in a very preliminary study, it was reported that treatment of lateral femoral cutaneous neuropathy under ultrasound guidance was effective in reducing patient discomfort.11,12 No defined “evidence‐based” treatment exists for this condition. Alimran Medical center. The diagnosis of meralgia paresthetica was established from the following indicators: clinical history, physical examination, electromyographic findings (lateral cutaneous nerve amplitude potential <10 μV, latency >3.5 milliseconds, and normal thigh muscle needle examination findings), symptoms lasting for at least 6 weeks, no evidence of other specific diseases of the musculoskeletal system after physical examination (eg, normal strength and no thigh muscle atrophy), and exclusion of other causes of pain or sensory disturbances.13,14 The diagnosis was made by a neurologist and a neurosurgeon with 15 and 11 years of experience, respectively. Medications commonly utilized in the treatment of neuropathic pain, such as gabapentin, may be used. 2016 Mar26(3):764-70. doi: 10.1007/s00330-015-3874-1. The study provides another example of how a ultrasound‐guided technique increases accuracy.18 We believe that an ultrasound‐guided approach may enhance the therapeutic effect of the injected drugs. Clipboard, Search History, and several other advanced features are temporarily unavailable. Diagnosis of meralgia paresthetica is typically made clinically and is based on the characteristic location of pain or dysesthesia, sensory abnormality on exam, and absence of any other neurological abnormality in the leg. Meralgia paresthetica is a condition caused by compression of the nerve that supplies sensation to the thigh’s skin surface. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, By continuing to browse this site, you agree to its use of cookies as described in our, I have read and accept the Wiley Online Library Terms and Conditions of Use, The lateral femoral cutaneous nerve block, Management of meralgia paresthetica: a multimodality regimen, Evaluation of local anaesthetic blockade of the lateral femoral cutaneous nerve, Lateral femoral cutaneous nerve block revisited: a nerve stimulator technique, Anatomic study of the lateral femoral cutaneous nerve with respect to the ilioinguinal surgical dissection, Anatomical variations of the lateral femoral cutaneous nerve and the consequences for surgery, Lateral femoral cutaneous nerve: an anatomic study, Anatomical course of the lateral femoral cutaneous nerve and its susceptibility to compression and injury, Ultrasound-guided blockade of the lateral femoral cutaneous nerve: technical description and review of 10 cases, Peripheral nerves: ultrasound-guided interventional procedures, US-guided treatment of meralgia paresthetica (lateral femoral cutaneous nerve neuropathy): results of treatment in 9 patients, Ultrasound of the lateral femoral cutaneous nerve: normal findings in a cadaver and in volunteers, Relieving symptoms of meralgia paresthetica using Kinesio taping: a pilot study, Operative treatment of meralgia paresthetica: transection versus neurolysis, Ultrasound-guided visco-supplementation of subacromial space in elderly patients with cuff tear arthropathy using a high weight hyaluronic acid: prospective open-label non-randomized trial, https://doi.org/10.7863/jum.2011.30.10.1341. Background: Meralgia paresthetica (MP) is an entrapment mononeuropathy of the lateral femoral cutaneous nerve (LFCN), in which conservative treatment options are not always sufficient. Symptoms may be worsened by walking or prolonged standing and typically disappear with weight loss, abdominal muscles exercises, or delivery. Moreover, the results of this study were both clinically and statistically significant. After injection, no local or general complications were observed. First, lateral femoral cutaneous neuropathy symptoms (pain, burning sensation, and paresthesia) were evaluated by a 10‐point visual analog scale ranging from 0 (no symptoms) to 10 (intolerable symptoms). The pain physicians at OPTIMAL Pain & Regenerative Medicine, proudly serving the Dallas, Fort Worth and Arlington, Texas area, are experienced at diagnosing and treating this condition. ltrasounduided iagnosis and Treatment of Meralgia aresthetica axis) technique and the latter refers to a blind injection after precise sonographic measurements have been ac-quired. Schweiz Rundsch Med Prax. Rev Mex Neuroci 2007; 8(2): 205-210 INTRODUCCIÓN La consulta por dolor o parestesias en los miem-bros inferiores es frecuente en la práctica neurológica The 4 remaining patients (20%) required a further perineural injection. Another possible limitation was the relatively low number of patients evaluated; however, to the best of our knowledge, this study included the largest number of patients treated under ultrasound guidance to date. J Pain Res. The procedure in all cases was performed by 3 sonographers with expertise in interventional musculoskeletal procedures (G.S., F.L., and A.T.) using a commercially available ultrasound scanner equipped with a 7‐ to 17‐MHz transducer. Injection can be diagnostic and therapeutic aiding in the diagnosis. ICD-9 code: 355.1 “meralgia paresthetica” ICD-10 code: G57.1 “meralgia paresthetica” (lateral cutaneous nerve of thigh syndrome) CPT code: 64450 “Injection, anesthetic agent; other peripheral nerve or branch” Should NOT use 64447, which is for injection of the femoral nerve, not the lateral femoral cutaneous nerve. Epub 2015 Jun 21. Please check your email for instructions on resetting your password. In most instances, the injection is performed just inferior to the inguinal ligament and 1 cm medial to the anterior superior iliac spine (ASIS). Pulsed radiofrequency neuromodulation treatment on the lateral femoral cutaneous nerve for the treatment of meralgia paresthetica. Second, the influence of lateral femoral cutaneous neuropathy on the global quality of life was evaluated by a 10‐point visual analog scale ranging from 0 (no influence on quality of life) to 10 (very low quality of life). An alternative to surgery may be administration of local lidocaine with steroids around the course of the lateral femoral cutaneous nerve.15 Ultrasound‐guided injections allow real‐time visualization of relevant anatomy and needle positioning. eCollection 2014. This nerve provides sensation to the skin along the outer thigh starting from the inguinal ligament and extending down toward the knee. C, Illustration of the procedure. Many cases of meralgia paresthetica settle with conservative measures, such as weight loss and avoiding tight belts or clothing. A, The needle (arrows) reaches the nerve (arrowhead). In conclusion, we believe that ultrasound‐guided perineural injection of the lateral femoral cutaneous nerve is quick, simple, economical, and effective. NLM Complications. If you do not receive an email within 10 minutes, your email address may not be registered, Although it seems like a random type of pain to experience, it is actually a result of a pinched nerve in the pelvic region. Materials Needed This site needs JavaScript to work properly. A common therapy is injection with corticosteroids. The goal of this study was to analyze the effect of injection with methylprednisolone/lidocaine versus placebo. Pain Physician. Preliminary data from this article were presented as a scientific communication at the 96th Scientific Assembly and Annual Meeting of the Radiological Society of North America; November 30, 2010; Chicago, Illinois. J Korean Neurosurg Soc. Meralgia paresthetica is a pain or burning sensation felt over the anterolateral a ... Ultrasound guidance for steroid injection is better than blind injection. Moreover, the needle had to be inserted at an angle that normally is not supported by commercially available devices. The lateral femoral cutaneous nerve is purely sensory; it arises from the L2 and L3 spinal nerve roots, travels downward lateral to the psoas muscle, and then crosses the iliacus muscle. Working off-campus? History, physical exam, and diagnostic work-up were consistent with meralgia paresthetica. B, Confirmatory long‐axis sonogram over the lateral femoral cutaneous nerve at the level of the anterior superior iliac spine showing the nerve as a tiny structure (arrows). Meralgia paresthetica can also be the result of trauma to the thigh or a disease, such as diabetes. Pain Med. All of the patients were followed weekly for the first 3 months by their referring physicians (neurologists and neurosurgeons). Ultimately, a spinal cord stimulator was implanted after a successful temporary percutaneous trial. The injection can include a steroid (to reduce inflammation) and/or lidocaine or marcaine (to reduce pain). Moreover, local anesthetics may also be used to treat lateral femoral cutaneous neuropathy.2–4 Blockade of the lateral femoral cutaneous nerve has been classically described using anatomic landmarks, but the anatomic variability of the nerve may be responsible for failure rates as high as 60%.5. ... Dispersion of the injection fluid is continuously monitored by means of ultrasound, so that dispersion around the nerve can be observed. The mean visual analog scale quality of life decreased from 6.9 ± 3.2 to 2.3 ± 2.5 (t = 5.3; P < .002). Another limitation was that the study evaluated only the effects of 1 or 2 injections. Five patients felt slight sharp pain in the anterolateral thigh during needle insertion; the pain disappeared immediately after needle repositioning. [Meralgia paresthetica. Eur Radiol. 2020 Nov 8:pnaa326. Randomized placebo‐controlled trials of this treatment should be considered in the future. 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