Meralgia paraesthetica G57.1

Tunnel syndrome; dysesthesia, pruritus, alopecia; 

Bernhardt, 1878; Roth, 1895

Meralgia paresthetica (MP) (meralgia, from the Greek mēros = thigh and álgos = pain) is a neuropathic dysesthesia in the anterolateral thigh, usually caused by compression or injury to the lateral femoral cutaneous nerve (LFCN). See also Cheiralgia paraesthetica. Occasionally, pemphigoid, eczema-like, or scleroderma-like changes are found in this area. Alopecia may also occur as a manifestation of the trophic disturbance. See also Notalgia paraesthetica; Cheiralgia paraesthetica; .

Meralgia paraesthetica is considered the third most common bottleneck syndrome and therefore a possible cause of persistent pain in the outer and anterior thigh area (the lateral cutaneous femoral nerve, a purely cutaneous nerve, is affected). Meralgia is particularly common in the 30 to 40 age group and is often associated with diabetes, pregnancy and obesity. The pain usually arises spontaneously.

The causes of the development of compression syndrome can be mechanical or metabolic: mechanical reasons are considered too tight clothes, rapid weight gain and increased pressure in the abdomen. Metabolic causes are mainly due to diabetes and alcohol. Another, rarer cause can be an iatrogenic injury, i.e. caused by a surgical procedure (e.g. osteotomies).

Characteristic symptoms include paresthesias—that is, superficial, stabbing, burning, or tingling pain (often described as “pins and needles”) on the outer front of the thigh, in the area between the hip and the knee. Affected individuals are usually able to pinpoint the location of the paresthetic pain. This allows the diagnosis to be either confirmed or suspected clinically. Another indicator is an increase in pain when pressure is applied to the inguinal ligament and, often, when the leg is extended backward or while sitting.

Furthermore: 

• Paresthesia (tingling, pins and needles)
• Hypoesthesia or numbness
• Neuropathic itching (pruritus neuropathicus)
• Occasionally, allodynia and dysesthesia

Since the lateral femoral cutaneous nerve is exclusively sensory, no motor deficits occur.

Neurosurgical or conservative (avoidance of mechanical triggers).

However, surgical intervention is only necessary in the fewest cases. 85 to 90 percent of patients with meralgia paraesthetica can be successfully treated with conservative measures after correct diagnosis. The exact cause of the pain is always decisive in planning the therapy, which is why mechanical problems (e.g. pressure on the nerve due to too tight clothing, overweight) must also be taken into account as a first step.

The following therapies are used:

• Ultrasound-targeted local infiltration (e.g. with cortisone)
• Physical medicine (e.g. physiotherapy, massage etc.)
• Medicinal pain therapy
• Surgical intervention (neurolysis or neurectomy) is the last treatment option (in 10% of cases). Neurectomy effectively terminates pain conduction in 70-80%. Because the lateral cutaneal femoral nerve is a purely sensory nerve supplying skin and subcutaneous tissue, numbness remains on the lateral thigh. However, the neurectomy has no effect on motor function (Schuh A et al. 2017).

1. Abd-Elsayed A et al. (2025) Radiofrequency Ablation of the Lateral Femoral Cutaneous Nerve for Meralgia Paresthetica: A Description of a Novel Technique. Adv Ther 42:5845-5853.
2. Bernhardt M (1878) Neuropathological Observations. Dtsch Archiv klin Med (Leipzig) 22: 362–393
3. Bernhardt M (1895) On isolated paresthesias occurring in the region of the external femoral cutaneous nerve. Neurol Zentralbl (Berlin) 14: 242–244
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6. Roth WK (1895) Meralgia paresthetica. Karger, Berlin
7. Scholz C et al. (2023) Meralgia Paresthetica: Relevance, Diagnosis, and Treatment. Dtsch Arztebl Int 120:655–661.
   
8. Schuh A et al. (2017) Meralgia paresthetica (Bernhardt-Roth syndrome). MMW Fortschr Med 159:66–68.