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Meralgia Paresthetica - numb thigh

Mike HedmanMike Hedman
in General Training Discussions

Here's my tale of woe... For the past year or so I've had some numbness in my outer upper thigh, and I've seen a couple of orthopedic folks and haven't gotten very far.  I'm 99% sure what I have is Meralgia Paresthetica - a nerve getting compressed in the hip.  While it's been more annoying than painful (thus the year of just living with it), in the past month my hip has been getting pretty sore.  Today I had an x-ray that showed I have the beginnings of arthritis in my hip, and the Physicians Assistant basically told me that this is causing inflammation, which is pushing on the nerve, which is causing the problem.  She then proceeded to inform me that the "intelligent" move would be to not be "stubborn" and quit running so much (I'm an ironman triathlete and ultramarathoner).

So I'm looking for treatment options.  General health websites that list Meralgia paresthetica indicate that surgery is an option (like to re-route the nerve around the problem area).  Perhaps there's some mechanical problem that a Physical Terrorist (I mean Therapist ) can fix?  And yes, maybe I'm grinding my bones into a messand need to knock off the long runs image

Any experiences?  Suggestions?

Thanks,

Mike

Comments

  • Michael JohnsonMichael Johnson

    Unlikely Meralgia Paresthetica is from Hip arthritis.

    It's from irratiation of the lateral femoral cutaneous nerve as it courses over the brim of the pelvis.

    Often from external compression....not tight belts, fuel belts etc.

    Might try PT (intophoresis with dexamethasone) to the tender area (can you elicit the symptoms by tapping on the nerve.) or have the doc. try a cortisone injection.

    Not sure what the PA is talking about....It's one of those things where there are 2 things but unrelated...."true-true and unrelated"

    I have no experience with surgery for this.

    Hope this helps

  • Mike HedmanMike Hedman

    Thanks for the info.



    I don't seem to be able to elicit the symptoms by tapping on the nerve - though I haven't really given it a concerted effort. 



    I think you're right about the "true-true and unrelated" part.  Yes I'm starting to develop some arthritis, yes it's in the hip area.  But she kept saying "so you'll get referred pain..." and I kept replying.."I'm not feeling pain, I'm feeling numb."  After a couple rounds of that I asked how the arthritis pain is causing numbness - "oh, it's inflammation" she replied.  I got the feeling that she had 5 cards in her hand, played them all, and that was that.  I brought up the tendon that crosses over the nerve and she dismissed it.  Right there I knew that I wasn't going to have a productive interaction with her.  I suppose the thing to do these days is to just print out the mayoClinic.com write-up so you can just hand it to them.  It ticks me off knowing that: "the lateral femoral cutaneous nerve becomes trapped — often under the inguinal ligament, which runs along your groin from your abdomen to your upper thigh", saying that I think that's a probable cause, and getting a blank stare followed by a "No".



    I have a sports oriented local PT that I've had good success with before.  I'll print out your suggestions and get in to see them.

    Thanks again,

    Mike

  • Kevin WalterKevin Walter

    Mike,

    Usually meralgia paresthetica (at least classically) is quite painful. Like you say, it is caused by compression of the lateral femoral cutaneous nerve (a pure sensory nerve so no motor weakness), most commonly as it exits the pelvis. We can usually spot the diagnosis when the patient comes in the office as they are either dressed in extremely loose fitting clothes, shorts, or have cut a window in their pants so that nothing touches the affected area, which is usually incredibly sensitive to any light touch. Usually we can make a diagnosis by doing a nerve block to see if it relieves the pain and then the surgery is relatively straightforward to decompress the nerve. Unfortunately, with numbness as your main problem surgery tends to be less effective (in the sense that the numbness doesn't always improve after a nerve is decompressed whereas pain usually gets better pretty quickly.) I would recommend seeing a neurologist or neurosurgeon as they will be more familiar with this diagnosis than will an orthopod.

    I am skeptical that engaging in endurance sports markedly changes our propensity to develop osteoarthritic problems. If I look at my patients who end up needing spine surgery, the proportion of patients who are couch potatoes far outweigh any who engage in strenuous sports. These people have never stressed their backs (or knees, hips for that matter) yet invariably require the most reconstruction, replacements, etc. A fair amount of data indicates that frequent exercise helps maintain mobility into old age. Also, in my experience all x-rays show some degree of osteoarthric change as part of the natural aging process. Over reacting by calling an aging body, "diseased" is one of the problems endemic in medical practice today.

    Kevin Walter, MD --Neurosurgery

  • Mike HedmanMike Hedman

    Kevin, Thank you SO much for the info!

    I started off by asking around for a neurologist, and people told me "neurologists don't do that". 

    I have had some pain in the hip area, but nothing sharp, and some soreness in the groin.  I hear you on the numbness not necessarily being fixed straight away.  In my case, I've noticed that it'll fade over time.  For example, I hadn't had any problems, but then a few days after my 50 run my thigh went numb.  It took maybe a month for it to start moving back towards normal - which is also when the soreness settled in.

    I'll revitalize my search for a sports-aware neurologist.

    Guess what, I just got my year's worth of EN dues worth of information from this thread.

    Gawd I love this place.

    Mike

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