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Meralgia paraesthetica is a mononeuropathy of the lateral femoral cutaneous nerve (LFCN), characterized by symptoms such as burning pain, paresthesia und occasionally impaired sudomotor function of the anterolateral thigh. This condition is often caused by compression or traction injuries due to the anatomically exposed location beneath the inguinal ligament. The primary differential diagnosis is lumbar radiculopathy of the L2 and L3 nerve roots. There are numerous variable anatomical courses, which can complicate ultrasound imaging of the nerve. The sonographic visualization of the LFCN is achieved distal to the inguinal ligament in a space filled with adipose tissue between the sartorius muscle and tensor fasciae latae muscle. As technical requirement, a high-frequency linear probe should be available. The diagnosis is primarily based on clinical presentation. Imaging studies, electrophysiological examinations, or diagnostic nerve blocks may be adjuncts. Meralgia paraesthetica is often self-limiting but can lead to chronic pain conditions in some cases, resulting in significant limitations in daily activities and a high degree of suffering. Therapeutic measures include medications, perineural local anesthetic infiltrations, topical therapy, and physiotherapy as part of a multimodal approach. Surgical procedures are available in cases where conservative therapy fails. [ABSTRACT FROM AUTHOR]

Background: Together with an increased interest in minimally invasive lateral transpsoas approach to the lumbar spine goes a demand for detailed anatomical descriptions of the lumbar plexus. Although definitions of safe zones and essential descriptions of topographical anatomy have been presented in several studies, the existing literature expects standard appearance of the neural structures. Therefore, the aim of this study was to investigate the variability of the extrapsoas portion of the lumbar plexus in regard to the lateral transpsoas approach. Methods: A total of 260 lumbar regions from embalmed cadavers were utilized in this study. The specimens were dissected as per protocol and all nerves from the lumbar plexus were morphologically evaluated. Results: The most common variation of the iliohypogastric and ilioinguinal nerves was fusion of these two nerves (9.6%). Nearly in the half of the cases (48.1%) the genitofemoral nerve left the psoas major muscle already divided into the femoral and genital branches. The lateral femoral cutaneous nerve was the least variable one as it resembled its normal morphology in 95.0% of cases. Regarding the variant origins of the femoral nerve, there was a low formation outside the psoas major muscle in 3.8% of cases. The obturator nerve was not variable at its emergence point but frequently branched (40.4%) before entering the obturator canal. In addition to the proper femoral and obturator nerves, accessory nerves were present in 12.3% and 9.2% of cases, respectively. Conclusion: Nerves of the lumbar plexus frequently show atypical anatomy outside the psoas major muscle. The presented study provides a compendious information source of the possibly encountered neural variations during retroperitoneal access to different segments of the lumbar spine. [ABSTRACT FROM AUTHOR]

The incidence of hip fractures has continued to increase as life expectancy increases. Hip fracture is one of the leading causes of increased morbidity and mortality in the geriatric population. Early surgical treatment (<48 h) is often recommended to reduce morbidity/mortality. In addition, adequate pain management is crucial to optimize functional recovery and early mobilization. Pain management often consists of multimodal therapy which includes non-opioids, opioids, and regional anesthesia techniques. In this review, we describe the anatomical innervation of the hip joint and summarize the commonly used peripheral nerve blocks to provide pain relief for hip fractures. We also outline literature evidence that shows each block's efficacy in providing adequate pain relief. The recent discovery of a nerve block that may provide adequate sensory blockade of the posterior capsule of the hip is also described. Finally, we report a surgeon's perspective on nerve blocks for hip fractures. [ABSTRACT FROM AUTHOR]

Background: Postoperative pain often remains troublesome for the patients, if not adequately managed. Various modalities have been tried to keep the patient pain free. Regional nerve blocks under ultrasound guidance have recently gained much popularity. We aimed to compare the pain relief outcomes after hip replacement surgery by continuous Pericapsular Nerve Group Block (PENG Block) in combination with lateral femoral cutaneous nerve (LFCN) block under the guidance of ultrasound versus patient-controlled intravenous analgesia (PCA). Methodology: Sixty patients, who underwent hip surgery at E University Hospital, Hanoi, Vietnam, from August 2021 to August 2022, were randomly allocated to one of the two groups: group of patients with pain relief with PENG block in combination with LFCN block (PENG group) and the group of patients with patient-controlled intravenous analgesia (PCA group). Outcomes regarding clinical parameters and pain scores on Visual Analogue Scale (VAS), from the initiation of the blocks or the PCA (H0) to 72 h (H72) were recorded and compared. Results: Sixty patients were included in this study. The average VAS scores at rest in both groups was at low pain level (VAS < 4). The average VAS score in both of the groups at most of the time of the study did not have a statistically significant difference. The VAS on movement at the time points H18, H21, H24, H30, H36, H48, H72 of the PENG group was lower than that of the PCA group and the difference was statistically significant between the two groups (P < 0.05). The rate of vomiting/nausea of patients in the PCA group was significantly higher than in the PENG group (P = 0.006). Conclusion: Pericapsular nerve block combined with lateral femoral cutaneous nerve block offers prolonged pain relief when compared with traditional patient-controlled intravenous analgesia in postoperative pain relief after hip replacement, and is associated with lower frequency of vomiting/nausea. [ABSTRACT FROM AUTHOR]

Meralgia paresthetica (MP) is a disorder of lateral femoral cutaneous nerve mononeuropathy caused by entrapment or compression of the nerve. It is characterized by numbing, tingling, and burning pain in the lateral aspect of the thigh. The current treatments for MP include conventional medical management, peripheral nerve blocks, and surgical interventions. Some patients who suffer from MP can experience intractable pain and medical management of MP is often inadequate to provide satisfactory pain control. Although regional anesthesia provides excellent pain relief, the analgesic effects of peripheral nerve block are shortlived. Emerging evidence suggests that cryoneurolysis has a low-risk safety profile and can provide prolonged pain relief of superficial nerves when administered appropriately. We present a successful case of a patient with intractable neuropathic pain resulting from MP treated with cryoneurolysis therapy. The patient demonstrated immediate pain relief by 100% after the procedure followed by 80% and 60% pain reduction at 1-month and 3-months follow-up, respectively. Cryoneurolysis may be an alternative modality for patients who fail at conventional medical treatments of neuropathic pain. [ABSTRACT FROM AUTHOR]

Objectives: The study aims to explore morphological variations of the lateral femoral cutaneous nerve (LFCN) as well as its connections within the lumbar plexus, offering insights for clinical assessments and surgical considerations in lumbar spine approaches. The goal is to enhance understanding of LFCN anatomy, particularly its origin and intra-abdominal course, in diverse anatomical configurations. Methods: The study employed detailed stratigraphic dissection techniques on 80 cadavers to investigate the morphological variations of the LFCN and its connections within the lumbar plexus. Cadaveric specimens were dissected to assess the origin of LFCN at different levels and potential differences in its course, providing valuable insights for clinical and surgical implications. Results: The study revealed significant anatomical variability in the lateral femoral cutaneous nerve (LFCN) across specimens. The origin of LFCN, typically from L2-L3 lumbar roots, exhibited diverse patterns, with variations observed in 48.3% of cases. Notably, the L2 root dominated in 81.25% of instances, and origin solely from L2 root constituted 11.5% of specimens, higher than previously reported rates. Unusual patterns included LFCN starting from femoral nerve in 7.5 % of specimens, highlighting the intricate nature of lumbar plexus anatomy. These findings contribute to a nuanced understanding of LFCN variations and their clinical implications. Conclusion: The study underscores the substantial morphological alterations of the lateral femoral cutaneous nerve, emphasizing the need for clinicians to be cognizant of diverse patterns in lumbar plexus anatomy. These findings have important implications for surgical interventions and neurologic assessments involving the lateral femoral cutaneous nerve. [ABSTRACT FROM AUTHOR]

Abstract Objective The INFIX technique is becoming one of the most commonly performed surgical procedures for anterior pelvic ring instability injuries. The purpose of this article is to compare the clinical outcomes of modified anterior subcutaneous internal fixation (M-INFIX) with conventional anterior subcutaneous internal fixation (C-INFIX) for anterior pelvic ring instability injuries. Patients and methods A retrospective analysis of 36 cases of unstable pelvic injuries treated operatively at our institution, 20 of which were treated with C-INFIX and 16 with M-INFIX. Data collected included age, gender, ISS score, fracture typing, operative time, operative bleeding, postoperative complications, fracture healing time, Matta score, Majeed score, and follow-up time. Statistical sub-folding of each variable between the two groups was performed. Results There was no statistical difference between the C-INFIX and M-INFIX groups in terms of age, gender, ISS (Injury Severity Score), follow-up time, fracture typing, fracture healing time, and Majeed score (P > 0.05). the M-INFIX had a significantly lower incidence of postoperative complications than the C-INFIX group, especially in the incidence of Lateral femoral cutaneous nerve (LFCN) injury (P

The prevalence of meralgia paresthetica (MP), which is caused by compression of the lateral femoral cutaneous nerve (LFCN), has been increasing over recent decades. Since guidelines and large-scale studies are lacking, there are substantial regional differences in diagnostics and management in MP care. Our study aims to report on current diagnostic and therapeutic strategies as well as time trends in clinical MP management in Germany. Patients hospitalized in Germany between January 1, 2005, and December 31, 2018, with MP as their primary diagnosis were identified using the International Classification of Disease (ICD-10) code G57.1 and standardized operations and procedures codes (OPS). A total of 5828 patients with MP were included. The rate of imaging studies increased from 44% in 2005 to 79% in 2018 (p < 0.001) and that of non-imaging diagnostic studies from 70 to 93% (p < 0.001). Among non-imaging diagnostics, the rates of evoked potentials and neurography increased from 20%/16% in 2005 to 36%/23% in 2018 (p < 0.001, respectively). Rates of surgical procedures for MP decreased from 53 to 37% (p < 0.001), while rates of non-surgical procedures increased from 23 to 30% (p < 0.001). The most frequent surgical interventions were decompressive procedures at a mean annual rate of 29% (± 5) throughout the study period, compared to a mean annual rate of 5% (± 2) for nerve transection procedures. Between 2005 and 2018, in-hospital MP care in Germany underwent significant changes. The rates of imaging, evoked potentials, neurography, and non-surgical management increased. The decompression of the LFCN was substantially more frequent than that of the LFCN transection, yet both types of intervention showed a substantial decrease in in-hospital prevalence over time. [ABSTRACT FROM AUTHOR]

The direct anterior approach (DAA) has its origins in the first and oldest approach for hip replacement in the literature, but at the same time it would not be fanciful to suggest its increasing popularity as the latest approach for hip replacement procedures, especially among younger surgeons. However, in a geographical context, the DAA is not considered the major approach in most countries. Moreover, the term DAA encompasses numerous variations in terms of technique. In this narrative review, we describe our recent experience of advances in the DAA in terms of improved techniques and devices, along with some of its disadvantages. Also, we express our perspective on its future application. The DAA is established as one of exemplary approaches to THA. The use of fluoroscopy, the traction table, and appropriate soft tissue management has become essential in the DAA for a safe and trouble-free procedure with adequate patient comfort. With the combination of recent technologies such as robotics, three-dimensional preoperative planning, and artificial intelligence (AI)-based surgeon assist systems, we can look forward to the DAA being performed more efficiently in the future. [ABSTRACT FROM AUTHOR]

Objective: The INFIX technique is becoming one of the most commonly performed surgical procedures for anterior pelvic ring instability injuries. The purpose of this article is to compare the clinical outcomes of modified anterior subcutaneous internal fixation (M-INFIX) with conventional anterior subcutaneous internal fixation (C-INFIX) for anterior pelvic ring instability injuries. Patients and methods: A retrospective analysis of 36 cases of unstable pelvic injuries treated operatively at our institution, 20 of which were treated with C-INFIX and 16 with M-INFIX. Data collected included age, gender, ISS score, fracture typing, operative time, operative bleeding, postoperative complications, fracture healing time, Matta score, Majeed score, and follow-up time. Statistical sub-folding of each variable between the two groups was performed. Results: There was no statistical difference between the C-INFIX and M-INFIX groups in terms of age, gender, ISS (Injury Severity Score), follow-up time, fracture typing, fracture healing time, and Majeed score (P > 0.05). the M-INFIX had a significantly lower incidence of postoperative complications than the C-INFIX group, especially in the incidence of Lateral femoral cutaneous nerve (LFCN) injury (P < 0.05). In contrast, the M-INFIX group had statistically higher operative time, intraoperative bleeding, and Matta score than the C-INFIX group (P < 0.05). Conclusion: This study was based on a modified application of the surgical experience with C-INFIX and showed better clinical outcomes in terms of complication rates and quality of repositioning than the conventional surgical approach. These findings indicate that further analytical studies of this study would be valuable. [ABSTRACT FROM AUTHOR]

Introduction: Typically, the lateral femoral cutaneous nerve, also known as the lateral cutaneous nerve of the thigh (LCNT), runs under the inguinal ligament near the anterior superior iliac spine, runs anterior to the sartorius muscle and then divides into two terminal branches, i.e., anterior and posterior, which provide sensory innervation to the anterior and lateral thigh. This report describes an unusual anatomic variant in which terminal branches of the LCNT pierced the sartorius muscle. Case description: Dissection involved formalin-fixed right isolated lower limb. The procedure revealed anatomical variation of the LCNT. The nerve's division level into anterior and posterior branches was at the level of the inguinal ligament under the sartorius muscle. The posterior branch of the LCNT was directly adjacent to the anterior superior iliac spine. After a short course, this branch emerged from under the sartorius muscle lateral border 39 mm distally (in a straight line) to the inguinal ligament. The nerve's anterior branch pierced the sartorius muscle. It exited on the anterior surface of the muscle, 72 mm (in a straight line) from the inguinal ligament. The innervation territory of both branches was typical. We found no other anatomical variations of lumbar plexus branches. Conclusions: The LCNT terminal branches may show anatomic variations, which clinicians should consider during neurological assessments of nerve lesions. Deviations from the typical course of nerves should also be kept in mind when conducting surgical interventions.

Introduction: Anatomical variations of the nerves derived from the lumbar plexus are common and clinically valid. Therefore, this report aims to present the coexisting anatomical variations of the lateral femoral cutaneous and genitofemoral nerves. Case description: During routine dissection of an isolated male left lower limb (fixed in 10 % formalin solution), atypical arrangements of the lateral femoral cutaneous and genitofemoral nerves were found. The lateral femoral cutaneous nerve division level into anterior and posterior branches was high, above the inguinal ligament. Both branches passed beneath the inguinal ligament at the midpoint of the distance between the anterior superior iliac spine and the femoral artery. The anterior branch of the lateral femoral cutaneous nerve was better developed and had a greater diameter than the posterior branch. The femoral branch of the genitofemoral nerve was absent and partially replaced by the most medial branch derived from the anterior division of the lateral femoral cutaneous nerve. Conclusions: The lateral femoral cutaneous and genitofemoral nerves can show anatomic variability, which should be remembered during clinical assessments of nerve lesions and while performing surgical interventions.

The incidence of hip fractures has continued to increase as life expectancy increases. Hip fracture is one of the leading causes of increased morbidity and mortality in the geriatric population. Early surgical treatment (

Objective: A recent spurt in incidence of meralgia paresthetica to 0.1- 81% due to minimally invasive anterior approach to hip joint has resulted in reinterest in anatomy of lateral femoral cutaneous nerve (LFCN). Familiarity with variations in the course of LFCN will reduce the morbidity associated with orthopedic procedures around the anterior superior iliac spine (ASIS) and inguinal ligament (IL). Methods: Twenty five adult human formalin embalmed cadavers were dissected. Course and relations of nerve to ASIS, IL and sartorius muscle was noted, distance of nerve from ASIS at IL was measured and statistically analyzed. Results: Mean distance of LFCN from ASIS at IL was 1.73±1.15 cm. Differences between two sides and sexes was statistically not significant (p=0.51 and p=0.96 respectively). Inferomedial to ASIS, 94% of LFCNs crossed IL with 92% of them present within 4 cm medial to ASIS. Majority of LFCNs (90%) exited pelvis and entered thigh posterior to IL. Out of these nerves 48% were single trunks on entry into thigh, then bifurcated into anterior and posterior branches. Remaining LFCNs bifurcated proximal to IL or at level of IL. Trifurcations were seen in 6% while a rare case of pentafication was observed. In 66% main trunk/branches were present in intermuscular cleft between sartorius muscle and tensor fascia lata. Conclusions: Care should be exercised by surgeons while dissecting around IL as more than half of nerves are liable to be injured during operative procedures. This would help in better anticipation of problem, acceptance and reducing litigation. [ABSTRACT FROM AUTHOR]

Although anterior subcutaneous pelvic internal fixation is a valuable tool for the reduction and fixation of unstable pelvic ring injuries, lateral femoral cutaneous nerve irritation by the implant is the most common complication. This study aimed to investigate the association between the nerve-to-implant distance and the postoperative lateral femoral cutaneous nerve symptom. Patients who underwent anterior subcutaneous pelvic internal fixation between 2016 and 2019 were retrospectively analyzed. Lateral femoral cutaneous nerve status was defined as follows: not identified, nerve-to-implant distance <13 mm, and =13 mm. The proportion of patients who experienced postoperative nerve disorders was compared using the nerve status. Nerve-to-implant distances were compared using the presence or absence of postoperative lateral femoral cutaneous nerve disorders. The predictive value of a nerve-to-implant distance of 13 mm for postoperative nerve disorders was assessed. Overall, 26 lateral femoral cutaneous nerves were included. Ten patients had postoperative nerve disorders, of which seven had an nerve-to-implant distance <13 mm, while the other three occurred in patients whose nerves were not identified. A nerve-to-implant distance =13 mm was significantly associated with a decreased risk of postoperative nerve disorder compared to a nerve -to-implant distance <13 mm (p = 0.017). A nerve-to-implant distance =13 mm had a perfect sensitivity (100%) and modest specificity (58.3%). Nerve-to-implant distance was =13 mm. Nerve disorders were frequently observed when the nerve-to-implant distance was <13 mm or the nerve was not identified intraoperatively. Efforts to identify the lateral femoral cutaneous nerve may be useful to avoid internal fixation-related nerve disorders. [ABSTRACT FROM AUTHOR]

Background: Blockade of the lateral femoral cutaneous nerve (LFCN) with local anesthetic (LA) has therapeutic role as well as diagnostic value for meralgia paresthetica (MP). The aim of this study was to compare the effectiveness of ultrasound-guided LA and LA + CS injections in the treatment of MP. Methods: This was a prospective, double-blinded, randomized controlled study. Thirty-two patients were evaluated clinically, and electrophysiologically and diagnosed as MP by diagnostic block. They were randomly assigned to two groups and all patients completed the study. The first group (n = 17) received 2 mL of lidocaine 2%+1 mL of betamethasone, while the second group (n = 15) received 2 mL of lidocaine 2% + 1 mL saline solution. Results: No statistically significant difference was detected between the groups in numeric rating scale (NRS) values. In both groups, NRS values were significantly decreased after the injection that confirms the diagnosis of MP. The improvement continued on the following weeks in both groups. At the 4th week, the NRS value reached to 2.47 in the CS group and reached to 3.13 in the LA group. Conclusions: Both CS and LA injections for the treatment of MP were found to be clinically effective and both may be therapeutic options. In intractable cases, once the nerve block is applied with or without CS, well-being can be achieved by keeping the patient away from the triggering factors. To provide effective and isolated injection of LFCN, that may have frequent anatomical variations, ultrasonography guidance could be suggested.

BACKGROUND: The effectiveness of the muscle energy technique (MET) on postpartum meralgia paresthetica (MP) affecting the lateral femoral cutaneous nerve is unknown. OBJECTIVE: To investigate the effectiveness of the MET on postpartum MP affecting the lateral femoral cutaneous nerve. METHODS: In this randomized controlled trial, 30 patients with postpartum MP were randomly allocated to study and control groups. The study group received the MET with conventional therapeutic exercises and the control group received the conventional exercises alone for four weeks (thrice a week, for 30–40 minutes duration). Lateral femoral cutaneous nerve distal latency, pain intensity, response to the prone knee bend (PKB) test and pelvic compression test were assessed. RESULTS: Patients allocated to the MET group had improvements compared to the controls in pain intensity (MD: - 1.66, 95%CI - 2.39 to - 0.94), distal latency (MD: - 0.66, 95%CI - 0.94 to - 0.36), and knee range of motion in the PKB test (MD: 19.5 ∘ , 95%CI 13 to 26.1) with high treatment effects, Cohen's d –ES = 1.71, 1.86 and 2.24 respectively. However, there was no between-group difference for the pelvic compression test (p = 0.41). CONCLUSION: The MET can reduce pain, distal latency, and increase the prone knee range of motion in women with MP affecting the lateral femoral cutaneous nerve. [ABSTRACT FROM AUTHOR]

Meralgia paresthetica is a common condition that is usually diagnosed by its classical clinical presentation and by exclusion of a spinal origin of pain, sensory loss, and/or paresthesias in the anterolateral thigh. Treatment modalities include conservative management, local injections, and surgical therapy. To date, no level 1 evidence exists about treatment options for idiopathic meralgia paresthetica. This review article aims to give a structured overview of epidemiology, history, anatomy, diagnostics, and treatment. It focuses on the existing literature and current developments in clinical management. A literature search on PubMed/MEDLINE was performed on 20 December 2021, yielding 1412 results. Abstracts were screened and classified in terms of epidemiology, anatomy, diagnostics, and treatment. High-quality observational data that was included in recent meta-analyses showed satisfactory results for conservative management, injections, and surgical decompression or neurectomy, but there is some major methodological criticism. For idiopathic meralgia paresthetica, the results of surgical decompression have never been compared to those of neurectomy in a randomized setup. The only study protocol published so far does not consider any extended decompression techniques (dynamic, circumferent, proximal, and distal to the inguinal ligament). A multicenter, prospective design has never been proposed. Reliable high-quality evidence on the treatment of idiopathic meralgia paresthetica is lacking at the current state, and challenges in clinical decision-making remain. [ABSTRACT FROM AUTHOR]

Abstract Background An incision for total hip arthroplasty (THA) via the direct anterior approach (DAA) is generally made outside of the space between the sartorius and tensor fasciae latae muscles to prevent lateral femoral cutaneous nerve (LFCN) injury. Anatomical studies have revealed that the LFCN courses between the sartorius and tensor fasciae latae muscles. When the LFCN branches radially while distributing in the transverse direction from the sartorius muscle to the tensor fasciae latae muscle, it is called the fan type. Studies suggest that damage to the fan type LFCN is unavoidable during conventional fasciotomy. We previously demonstrated that injury to non-fan variation LFCN occurred in 28.6% of patients who underwent THA by fasciotomy performed 2 cm away from the intermuscular space. This suggests that the conventional approach also poses a risk of LFCN injury to non-fan variation LFCN. LFCN injury is rarely reported in the anterolateral approach, which involves incision of fascia further away than the DAA. The purpose of this study is to investigate how the position of fasciotomy in DAA affects the risk of LFCN injury. Methods We will conduct a prospective, randomized, controlled study. All patients will be divided into a fan variation and a non-fan variation group using ultrasonography before surgery. Patients with non-fan variation LFCN will receive conventional fasciotomy and lateral fasciotomy in the order specified in the allocation table created in advance by our clinical trial center. The primary endpoint will be the presence of LFCN injury during an outpatient visit using a patient-based questionnaire. The secondary endpoints will be assessed based on patient-reported outcomes at 3 months after surgery in an outpatient setting using the Western Ontario and McMaster Universities Osteoarthritis Index, the Japanese Orthopaedic Association Hip-disease Evaluation Questionnaire, and the Forgotten-Joint Score-12. Discussion We hypothesize that the incidence of LFCN injury due to DAA-THA is reduced by making the incision further away from where it is typically made in conventional fasciotomy. If our hypothesis is confirmed, it will reduce the disadvantages of DAA and improve patient satisfaction. Trial registration UMIN Clinical Trials Registry, UMIN000035945 . Registered on 20 February, 2019.

Background: Blockade of the lateral femoral cutaneous nerve (LFCN) with local anesthetic (LA) has therapeutic role as well as diagnostic value for meralgia paresthetica (MP). The aim of this study was to compare the effectiveness of ultrasound-guided LA and LA + CS injections in the treatment of MP. Methods: This was a prospective, double-blinded, randomized controlled study. Thirty-two patients were evaluated clinically, and electrophysiologically and diagnosed as MP by diagnostic block. They were randomly assigned to two groups and all patients completed the study. The first group (n = 17) received 2 mL of lidocaine 2%+1 mL of betamethasone, while the second group (n = 15) received 2 mL of lidocaine 2% + 1 mL saline solution. Results: No statistically significant difference was detected between the groups in numeric rating scale (NRS) values. In both groups, NRS values were significantly decreased after the injection that confirms the diagnosis of MP. The improvement continued on the following weeks in both groups. At the 4th week, the NRS value reached to 2.47 in the CS group and reached to 3.13 in the LA group. Conclusions: Both CS and LA injections for the treatment of MP were found to be clinically effective and both may be therapeutic options. In intractable cases, once the nerve block is applied with or without CS, well-being can be achieved by keeping the patient away from the triggering factors. To provide effective and isolated injection of LFCN, that may have frequent anatomical variations, ultrasonography guidance could be suggested. [ABSTRACT FROM AUTHOR]

Purpose of Review Meralgia paresthetica (MP) is a condition characterized by paresthesias, neuropathic pain, and alterations in sensorium of the anterolateral thigh secondary to impingement of the lateral femoral cutaneous nerve (LFCN). MP is generally diagnosed by clinical history and is often a diagnosis of exclusion. When diagnosis remains a challenge, diagnostic modalities such as ultrasound, MRI, electromyography, and nerve conduction studies have been utilized as an adjunct. This review summarizes the most recent medical literature regarding MP, its pathophysiology, presentation, and current treatment options. Recent Findings Treatment options for patients with MP range from lifestyle modifications and conservative management to surgical procedures. Initial management is often conservative with symptoms managed with medications. When conservative management fails, the next step is regional blocks followed by surgical management. The conflicting data for treatment options for MP highlight how the evidence available does not point to a single approach that's universally effective for treating all patients with MP. Summary Despite the apparent success at treating MP with regional blocks and surgical interventions, much remains to be known about the dosing, frequency, and optimal interventions due to the inconclusive results of current studies. Further research including randomized controlled trials are needed to better understand the most optimal treatment options for MP including studies with a larger number of participants. [ABSTRACT FROM AUTHOR]

Abstract Background Meralgia paresthetica is an entrapment neuropathy. Neuropathic pain was reported to be improved by using neural prolotherapy. Aim of the research was to assess and evaluate the short-term efficacy of neural prolotherapy on relieving pain, paresthesia and improving function and quality of life of patients with meralgia paresthetica. The study included 19 lower limbs with idiopathic meralgia paresthetica obtained from 15 patients. Subcutaneous perineural injection of dextrose (5%) in sterile water was given once. All patients were evaluated for outcome measures twice, at baseline visit and at follow-up visit four weeks after the injection which included: patient assessment of overall symptoms of meralgia paresthetica, patient assessment of meralgia paresthetica pain, patient assessment of meralgia paresthetica paresthesia and patient assessment of meralgia paresthetica effect on function and quality of life using visual analogue scale. Results There was a statistically significant improvement in the visual analogue scale of patient assessment of overall meralgia paresthetica symptoms, patient assessment of meralgia paresthetica pain, patient assessment of meralgia paresthetica paresthesia and patient assessment of meralgia paresthetica effect on function and quality of life when the findings at the postinjection visit were compared to the preinjection assessment among all patients. All the patients tolerated the injection procedure-induced pain. All the patients experienced immediate postinjection relieve of the meralgia paresthetica pain. At the postinjection assessment visit, all patients were satisfied with the procedure. There were 12 lower limbs (63.2%) from 10 patients (66.6%) that showed improvement and recovery. Two patients of them had bilateral meralgia paresthetica. There was no patient withdrawal, and no patients were lost to follow-up. There was one lower limb (5.3%) from one patient (6.7%) who had bruises at the injection sites that resolved within few days after the procedure. Conclusions Neural prolotherapy is easy, safe, tolerable, effective and successful in treatment of meralgia paresthetica. It is effective in relieving pain, paresthesia and improving function and quality of life of patients with meralgia paresthetica. Neural prolotherapy injection should be included in the conservative treatment armamentarium of meralgia paresthetica. Trial registration : NCT04499911 . Registered 5 August 2020—retrospectively registered.

Meralgia paraesthetica (MP) is the consequence of an entrapment or stretch injury of the lateral femoral cutaneous nerve at the crossing region with the inguinal ligament where the nerve exits the pelvis. It results in temporary or permanent sensory loss, paraesthesia and pain in the anterolateral region of the thigh. Idiopathic forms are known for example as seat belt syndrome or jeans syndrome. An MP can also occur as a complication of surgical or intensive care patient positioning. In focus are the lithotomy position, prone position and beach chair position. We analyzed 21 complaints about MP occurring for the first time postoperatively, which had been submitted to the expert committee for medical treatment errors at the North Rhine Medical Association over the past 10 years. Among these, six cases could be identified as positioning damage after a lithotomy position. In three cases MP occurred after supine positioning but the etiology could not be clarified with certainty. In 12 cases MP was recognized as a direct surgical complication. The pathophysiology, incidence and course as well as legal implications of position-related MP are discussed. Pressure damage to the nerve at its intersection with the inguinal ligament is assumed to be the main pathomechanism. Although all the cases presented here occurred after lithotomy positioning, the complication also appears to occur with other types of positioning according to the literature data, the most common being prone positioning. This also explains the increasingly published case reports of MP after prone positioning in COVID-19 patients for respiratory treatment. Safe avoidance of the positioning-related complication does not appear to be possible due to the anatomical variability of the course of the nerve and the unclear pathomechanisms. [ABSTRACT FROM AUTHOR]

Abstract Background Lateral femoral cutaneous nerve (LFCN) injury after total hip arthroplasty causes patient dissatisfaction. This cadaveric study aimed to assess the risk for LFCN injury after the direct anterior approach (DAA) and anterolateral supine approach (ALS) with a focus on the anatomical variations of the LFCN. Methods Thirty-seven hemipelves from 20 formalin-preserved cadavers (10 males and 10 females) were dissected to identify the LFCN, evaluate variations, and measure the distance from the LFCN to each approach. The LFCN was classified as classical, late, multi trunk, or primary femoral. Results There were no significant variations in the LFCN between the sexes. The distance from the LFCN to DAA incision (10 [0–17.8] mm) was significantly less than that from the LFCN to ALS incision (27 [0–40] mm); moreover, 64.9% of DAA incisions crossed the LFCN. The classical type LFCN was closest to the DAA incision. The DAA incision most frequently crossed the LFCN at the proximal third, and the frequency of intersection of the LFCN and DAA incisions decreased by 25% by a 10-mm shortening of the DAA proximal incision. In contrast, 27% of ALS incisions crossed the LFCN. Multi trunk type LFCN was closest to the ALS incision. There were no significant differences between each approach and LFCN variations, and the frequency of intersection of the LFCN and ALS incisions decreased by 20% by a 10-mm shortening of the ALS proximal incision. Conclusions The intersection rates between the LFCN and the DAA and between the LFCN and the ALS were approximately 65 and 30%, respectively. Approximately 20–25% of these injuries may be avoidable by a 10-mm shortening of the proximal incision.

Abstract Background The postoperative complaints of hypoesthesia or a burning sensation due to lateral femoral cutaneous nerve (LFCN) injury in patients are not yet solved. The present study aimed to identify the three-dimensional (3D) distribution of LFCN using preoperative ultrasound and evaluate the rate of injury in direct anterior approach for total hip arthroplasty. Methods A total of 59 patients (28 males and 31 females, age 69.0 ± 4.6 years, BMI 24.7 ± 3.0 kg/m2) were randomly allocated to the ultrasound group and 58 patients (28 males and 30 females, age 68.5 ± 4.5 years, BMI 24.8 ± 2.8 kg/m2) were in the control group. Surgeons received the data of 3D distribution of LFCN only in the ultrasound group before surgery with respect to the direction, the depth on the skin, and the length to tensor fasciae latae (TFL). The anatomical characteristics of LFCN in the surgical region were summarized. At 1 and 3 months of post surgery, the rate of LFCN injury and abnormal sensitive area was evaluated in both groups. Results There was a significant consistency in gender, age and BMI of these two groups (P > 0.05). Based on the data from the ultrasound group, over 90% of patients had one or two branches of LFCN. LFCN always courses in the fascia layer, the depth ranged from 6.8 ± 2.6 (3.0–12.0) mm to 11.1 ± 3.4 (4.0–17.0) mm and depended on the thickness of the subcutaneous fat, and length was 3.3 ± 4.6 (− 5.0–10.0) mm at proximal part and − 2.7 ± 4.7 (− 10.0–8.0) at distal end to the medial edge of TFL. Both the rate of LFCN injury and abnormal sensory area in the ultrasound group was significantly lower than those in the control group (3.4% vs. 25.9%, P = 0.001, at 1 month; 3.4% vs. 22.4%, P = 0.005, at 3 months). Conclusions LFCN mostly courses along the medial border of TFL in the fascia layer. The 3D distribution of LFCN using preoperative ultrasound mapping could help the surgeons to evaluate the risk of injury preoperatively and decrease the rate of injury during the operation. However, some branch injuries, especially for the fan type LFCN, could not be avoided.

Background: An incision for total hip arthroplasty (THA) via the direct anterior approach (DAA) is generally made outside of the space between the sartorius and tensor fasciae latae muscles to prevent lateral femoral cutaneous nerve (LFCN) injury. Anatomical studies have revealed that the LFCN courses between the sartorius and tensor fasciae latae muscles. When the LFCN branches radially while distributing in the transverse direction from the sartorius muscle to the tensor fasciae latae muscle, it is called the fan type. Studies suggest that damage to the fan type LFCN is unavoidable during conventional fasciotomy. We previously demonstrated that injury to non-fan variation LFCN occurred in 28.6% of patients who underwent THA by fasciotomy performed 2 cm away from the intermuscular space. This suggests that the conventional approach also poses a risk of LFCN injury to non-fan variation LFCN. LFCN injury is rarely reported in the anterolateral approach, which involves incision of fascia further away than the DAA. The purpose of this study is to investigate how the position of fasciotomy in DAA affects the risk of LFCN injury.Methods: We will conduct a prospective, randomized, controlled study. All patients will be divided into a fan variation and a non-fan variation group using ultrasonography before surgery. Patients with non-fan variation LFCN will receive conventional fasciotomy and lateral fasciotomy in the order specified in the allocation table created in advance by our clinical trial center. The primary endpoint will be the presence of LFCN injury during an outpatient visit using a patient-based questionnaire. The secondary endpoints will be assessed based on patient-reported outcomes at 3 months after surgery in an outpatient setting using the Western Ontario and McMaster Universities Osteoarthritis Index, the Japanese Orthopaedic Association Hip-disease Evaluation Questionnaire, and the Forgotten-Joint Score-12.Discussion: We hypothesize that the incidence of LFCN injury due to DAA-THA is reduced by making the incision further away from where it is typically made in conventional fasciotomy. If our hypothesis is confirmed, it will reduce the disadvantages of DAA and improve patient satisfaction.Trial Registration: UMIN Clinical Trials Registry, UMIN000035945 . Registered on 20 February, 2019. [ABSTRACT FROM AUTHOR]

• Lateral femoral cutaneous nerve decompression can present pitfalls for trainees. • Surgical anatomy of the thigh and groin is not routine for neurosurgeons. • Understanding landmarks and tissue layers is key to identification of the nerve. • Step-by-step intraoperative photographs and schematic diagrams provide an aid. Meralgia paraesthetica is an entrapment neuropathy of the lateral femoral cutaneous nerve, usually due to compression at the inguinal ligament as the nerve passes from the pelvis into the thigh. Surgical decompression of the lateral femoral cutaneous nerve is a simple and effective treatment option, but the surgical anatomy of the area is not always familiar to neurosurgeons and neurosurgical trainees alike. This paper is a simple review of the relevant surgical anatomy and the surgical steps of lateral femoral cutaneous nerve decompression, with the aim of providing the busy surgeon and trainee a quick and easy reference guide to the procedure. [ABSTRACT FROM AUTHOR]

Purpose Of Review: This review article summaries the epidemiology, etiology, clinical presentations, and latest treatment modalities of meralgia paresthetica, including the latest data about peripheral and spinal cord stimulation therapy. Meralgia paresthetica (MP) causes burning, stinging, or numbness in the anterolateral part of the thigh, usually due to compression of the lateral femoral cutaneous nerve (LFCN).Recent Findings: There are emerging data regarding the benefit of interventional pain procedures, including steroid injection and radiofrequency ablation, and other interventions including spinal cord and peripheral nerve stimulation reserved for refractory cases. The strength of evidence for treatment choices in meralgia paraesthetica is weak. Some observational studies are comparing local injection of corticosteroid versus surgical interventions. However, more extensive studies are needed regarding the long-term benefit of peripheral and spinal cord stimulation therapy. [ABSTRACT FROM AUTHOR]

Background: Meralgia paresthetica is an entrapment neuropathy. Neuropathic pain was reported to be improved by using neural prolotherapy. Aim of the research was to assess and evaluate the short-term efficacy of neural prolotherapy on relieving pain, paresthesia and improving function and quality of life of patients with meralgia paresthetica. The study included 19 lower limbs with idiopathic meralgia paresthetica obtained from 15 patients. Subcutaneous perineural injection of dextrose (5%) in sterile water was given once. All patients were evaluated for outcome measures twice, at baseline visit and at follow-up visit four weeks after the injection which included: patient assessment of overall symptoms of meralgia paresthetica, patient assessment of meralgia paresthetica pain, patient assessment of meralgia paresthetica paresthesia and patient assessment of meralgia paresthetica effect on function and quality of life using visual analogue scale. Results: There was a statistically significant improvement in the visual analogue scale of patient assessment of overall meralgia paresthetica symptoms, patient assessment of meralgia paresthetica pain, patient assessment of meralgia paresthetica paresthesia and patient assessment of meralgia paresthetica effect on function and quality of life when the findings at the postinjection visit were compared to the preinjection assessment among all patients. All the patients tolerated the injection procedure-induced pain. All the patients experienced immediate postinjection relieve of the meralgia paresthetica pain. At the postinjection assessment visit, all patients were satisfied with the procedure. There were 12 lower limbs (63.2%) from 10 patients (66.6%) that showed improvement and recovery. Two patients of them had bilateral meralgia paresthetica. There was no patient withdrawal, and no patients were lost to follow-up. There was one lower limb (5.3%) from one patient (6.7%) who had bruises at the injection sites that resolved within few days after the procedure. Conclusions: Neural prolotherapy is easy, safe, tolerable, effective and successful in treatment of meralgia paresthetica. It is effective in relieving pain, paresthesia and improving function and quality of life of patients with meralgia paresthetica. Neural prolotherapy injection should be included in the conservative treatment armamentarium of meralgia paresthetica. Trial registration : NCT04499911. Registered 5 August 2020—retrospectively registered. [ABSTRACT FROM AUTHOR]

We review the ultrasound (US) findings in patients who present with meralgia paresthetica (MP). The anatomy of the lateral femoral cutaneous nerve at the level where the nerve exits the pelvis and potential entrapment sites that can lead to MP are discussed. A wide range of pathological cases are presented to help in recognizing the US patterns of MP. Finally, our experience with US‐guided treatment is discussed. [ABSTRACT FROM AUTHOR]

Meralgia paresthetica (MP), also known as Bernhardt–Roth syndrome, is a peripheral neuropathy of the primary sensory lateral femoral cutaneous nerve (LFCN). Its diagnosis is challenging, because it can mimic other clinical conditions particularly associated with upper lumbar spine or pelvis. Patients present with pain and paresthesia over the anterolateral thigh. Diagnosis is usually based on clinical examination and is supported by sensory nerve conduction (SNC) studies. The initial treatment is always conservative. In limited number of patients who are refractory to conservative managements, surgical treatment via decompression/neurolysis or neurectomy is concerned. There is still no consensus on which surgical technique is the best and the first choice. We retrospectively analyzed the surgical outcomes of 12 nonobese patients who underwent decompression/neurolysis between the years 2013 and 2018. Bilateral SNC studies were performed in all cases which supported the diagnosis. We applied conservative treatments for 3 months in addition to the treatments previously applied in other centers. Surgery was recommended for the patients who were refractory to these treatments. Preoperative and postoperative pain levels during follow-up visits were evaluated with visual analogue scale (VAS). A retrospective analysis was performed on preoperative and postoperative 6th month VAS scores. The mean preoperative VAS value was 8.75 ± 0.62 and the postoperative VAS value at the sixth month was 1.17 ± 0.72. A significant reduction in the pain was shown (p < 0.05). Our surgical results showed that decompression/neurolysis of the LFCN should be concerned as the primary surgical approach to avoid negative outcomes of resection surgeries.