Meralgia Paraesthetica Explained

Meralgia paraesthetica is a condition that causes burning pain in the outer and front parts of the thigh. It is caused by trapping the lateral femoral cutaneous nerve as it passes over the outer part of the pelvic bone. What is meralgia paraesthetica, and how do you treat it?

Causes of burning pain in front of thigh

Meralgia paraesthetica is caused by pressure on the lateral femoral cutaneous nerve that supplies sensation to the outer part of the thigh. The nerve originates from branches of the lower spine and forms in the large iliopsoas muscle in the pelvis. It enters the thigh by piercing the fascia on the inside of the pelvic bone and travels down the outside of the thigh. It only supplies sensation to the thigh and doesn’t affect your ability to use your leg muscles. 

Pressure on the lateral femoral cutaneous nerve can be due to several factors. These can include:

• Pregnancy 

• Medical conditions such as obesity and diabetes 

• Wearing tight belts or clothing around your waist 

• Direct trauma to the front of your pelvis 

• Surgery to your hip, including a bone graft 

Diagnosis of burning pain in front of thigh

Meralgia paraesthetica more commonly occurs in men between the ages of 30 and 40, although all ages can be affected. 

Common symptoms of meralgia paraesthetica include:

• Burning pain, pins and needles, and numbness outside the thigh. Sometimes, people describe numb pain in the thigh.

• Sensitivity to light touch on the outside of the thigh

• Worsening symptoms when wearing tight clothes or a tight belt

• A recent increase in weight

Often, examination demonstrates tenderness near the pelvic brim, where the nerve becomes trapped. Your doctor should examine your spine, hip and legs to ensure other causes of burning pain are excluded. 

Generally, we find reduced sensation when touching the outside of your thigh, but leg muscle testing and reflexes are normal. The femoral nerve stretch test is painful, and repeatedly tapping the nerve will reproduce pain. 

Usually, we use investigations to confirm a diagnosis of trapping of the nerve and rule out other causes. For example, an ultrasound of the front of the pelvis shows thickening of the lateral femoral cutaneous nerve on the inside of the pelvic brim. We often order an MRI scan to rule out other causes, such as trapping the nerves in the pelvis or lower back. Other tests, such as nerve studies, may be used if we think you have another cause. 

Other causes of burning pain in front of the thigh

There are many other causes of numbness and burning pain in the thigh. Examples include a pinched nerve from the lower spine (also called sciatica), spinal stenosis, quadriceps tendonitis, and iliotibial band friction syndrome.

Treatment of Meralgia Paraesthetica 

In general, we start with simple treatments. Losing weight will be effective if weight gain or pregnancy is a factor. Also, loosening tight-fitting belts or clothes will help. Other simple treatments include ice packs on the outer pelvis.

If simple treatments don’t help, medications or a cortisone injection might help.

Amitriptyline or Duloxetine tablets have been shown to reduce pain and numbness in the thigh from nerve compression. Sometimes, we combine these treatments with oral NSAIDs such as ibuprofen. 

In addition, a cortisone injection targeting the site of compression of the lateral femoral cutaneous nerve is often effective. This injection can be diagnostic and therapeutic. Generally, it is essential to inject under ultrasound guidance to improve accuracy and effectiveness. Overall, injections are effective in treating severe numbness and burning in the thigh, which does not respond to time and medication.

Finally, surgery to reduce nerve pressure may be required in cases that fail simple treatments and injections. However, surgery is unpredictable and is not always effective at reducing pain. 

Other frequently asked questions about burning in front of the thigh

Can meralgia paraesthetica go away? 

Yes. Approximately 85% of cases will settle with simple treatments such as weight loss and wearing loose-fitting clothing. 

What other conditions cause burning pain in front of the thigh? 

Burning pain outside the thigh can be caused by other pathologies, such as pinched nerves from the lumbar spine, trapping of different nerves in the groin, and inflammatory neurological conditions causing nerve swelling. In these conditions, pain and numbness are not just confined to the outside of the thigh but are also felt in other areas of the thigh or below the knee. Inner thigh pain and numbness are generally not due to meralgia paraesthetica. 

Is meralgia paraesthetica dangerous? 

No. Meralgia paraesthetica is not dangerous. However, your doctor needs to ensure the exclusion of other causes of thigh pain and numbness, which may be more serious. 

Burning thigh pain after surgery: how common is it? 

It’s more common than we think. Cases have been reported after hip replacement surgery with a front approach and spinal surgery. Treatment is similar to other causes. 

Hip and groin pain map

Click on your pain site to identify possible causes. Then, click on specific causes to find out more about each condition:

Final word from Sportdoctorlondon about burning pain in front of thigh 

Burning sensation on the outside of the thigh could be due to pressure on a nerve outside the hip. You should see an experienced sports medicine doctor who can get the correct diagnosis and treat you correctly.

Related topics:

• Pinched nerve: what does it mean? 
• Groin nerve pain
• Amitriptyline for pain: FAQs
• Duloxetine for pain: FAQs
• How long does it take for a cortisone shot to work: FAQs