All about Meralgia Paresthetica .pptx

all about meralgia paresthetica ....

1. Meralgia Paresthetica By Aya Reyad Rheumatology Residant at Aswan University Hospital

2. Contents 01 Overview 02 Symptoms 03 Diagnosis 04 Treatment 05 Prevention

3. Overview

4. A painful mononeuropathy of the lateral femoral cutaneous nerve (LFCN), meralgia paresthetica is commonly due to focal entrapment of this nerve as it passes through the inguinal ligament. LFCN is responsible for the sensation of the anterolateral thigh. It is a purely sensory nerve and has no motor component. most common during middle age . It typically occurs in isolation. The paresthesias typically resolve slowly over time Definition

5. The LFCN originates directly from the lumbar plexus and has root innervation from L2-3 . The nerve runs through the pelvis along the lateral border of the psoas muscle to the lateral part of the inguinal ligament. Here , it passes to the thigh through a tunnel formed by the lateral attachment of the inguinal ligament and the ASIS The crossover into the thigh is the most common site of entrapment. The crossover typically occurs 1 cm medial to the ASIS

6. Nerve compression is the main cause ... and more common in diabetics . although RARE impingement of the LFCN by masses (eg, neoplasms, contained iliopsoas hemorrhages) in the retroperitoneal space before it reaches the inguinal ligament can cause the same symptoms. other risc factors > Obesity . > Tight clothing . > pregnancy. Injury . Trauma affecting the nerve Causes

7. Symptoms

8. paresthesias and numbness of the upper lateral thigh area are the presenting symptoms. The paresthesias may be quite painful (burning sensation), patients are hyperesthetic in this area. Walking or standing may aggravate the symptoms; sitting tends to relieve them. Symptoms are typically unilateral . However, they may be bilateral in up to 20% of cases. Pain and Numbness

9. Diagnosis

10. Sensory testing Examination reveals numbness of the anterolateral thigh in all or part of the area involved with the paresthesias Tinel's sign Tap over the nerve to elicit tingling sensation Deep Palpation below the anterior superior iliac spine (pelvic compression testing) reproduces the symptoms Physical Examination

11. Imaging MRI or ultrasound to visualize nerve compression N CS and EMG if no risk factors are identified, if a mass lesion in the retroperitoneal space is suspected, or if back pain also is present. The EMG should be normal in LFCN lesions, but the test is helpful in ruling out upper lumbar radiculopathy. Blood Tests Rule out other potential causes of symptoms Diagnostic Tests NO NEED

12. Treatment

13. Weight Management Maintaining a healthy weight to reduce pressure. Lifestyle Modifications Avoiding tight clothing and prolonged standing. Physical Therapy Strengthening and stretching exercises. TENS. Medication Pain relief with over-the-counter drugs or neurogenic pain medication as carbamazepine and gabapentin Conservative Measures

14. patients with meralgia paresthetica who were treated with neurectomy , neurolysis , or injection found the incidence of complete pain relief to be 85%, 63%, and 22%, respectively 1. Injection A focal nerve block can be done at the inguinal ligament with a combination of lidocaine and corticosteroids 2. Neurolysis Nerve decompression surgery 3. Neurectomy Nerve removal as a last resort 4. Liposuction Fat removal to relieve nerve pressure Surgical Options

15. Prevention

16. Regular exercise Maintain healthy weight and reduce pressure on nerves Healthy diet Reduce inflammation and improve overall health Avoid tight clothing Prevent compression of the nerve Posture correction Maintain proper alignment to reduce nerve pressure Lifestyle Changes

17. THANK YOU