What Is Meralgia Paresthetica?
Meralgia paresthetica occurs when the lateral femoral cutaneous nerve (LFCN) is compressed as it passes beneath the inguinal ligament near the anterior superior iliac spine. Because the LFCN is purely sensory, patients experience only altered sensation—no muscle weakness.

Key Risk Factors
– Tight belts, corsets or clothing
– Obesity or rapid weight gain
– Pregnancy
– Diabetes mellitus
– Hip or pelvic surgery

How It Presents & How It’s Diagnosed
Common Symptoms
– Burning or tingling on the outer thigh
– Numbness or hypersensitivity to light touch
– Symptoms worsen with standing, walking or hip extension

Diagnostic Clues
– Positive Tinel’s sign over the inguinal ligament
– Ultrasound-guided diagnostic block with local anesthetic

Conventional Treatment Options
Lifestyle Modification
– Wear looser clothing, avoid tight belts
– Weight loss if appropriate
– Activity or posture changes

Medications
– Gabapentin or pregabalin
– Tricyclic antidepressants
– Topical lidocaine or capsaicin

Ultrasound-Guided Nerve Block & Hydrodissection
– Inject local anesthetic ± corticosteroid around the LFCN to separate adhesions and reduce inflammation

Surgical Options (for refractory cases)
– Neurolysis (decompression)
– Neurectomy (surgical removal of the nerve segment)

PRP: A Regenerative Frontier in Nerve healing
What Is PRP?
Platelet-rich plasma is an autologous blood derivative concentrated in platelets and growth factors (PDGF, VEGF, NGF, TGF-β) that promote tissue regeneration, angiogenesis, and modulate inflammation.

Why Consider PRP for Meralgia Paresthetica?
– Stimulates Schwann cell activation and myelin regeneration
– Improves microvascular perfusion via angiogenesis
– Downregulates pro-inflammatory cytokines involved in chronic neuropathic pain

Technique: Ultrasound-Guided PRP Hydrodissection
PRP Preparation: draw 30–60 mL of blood; double-spin to obtain 5–10 mL of leukocyte-poor PRP
Imaging: position patient supine with slight hip flexion; use high-frequency ultrasound to locate the LFCN beneath the inguinal ligament
Injection: advance a 25–27 G needle under ultrasound guidance; inject PRP around the nerve to separate adhesions and deliver growth factors
Aftercare: brief rest followed by gentle hip mobility exercises and physical therapy

Evidence Summary
– Case reports describe successful PRP hydrodissection of the LFCN with significant symptom relief
– Animal models demonstrate accelerated axonal growth and increased myelin thickness with PRP application
– Systematic reviews highlight PRP’s safety profile and call for controlled trials in entrapment neuropathies

Advantages & Considerations
Advantages
– Autologous and low risk of allergy
– Minimally invasive outpatient procedure
– Combines mechanical hydrodissection with regenerative biology

Considerations
– Variability in PRP formulations (platelet concentration, leukocyte content)
– Cost and insurance coverage may vary
– Need for high-quality, long-term clinical trials

Future Directions
– Standardize PRP preparation protocols (platelet counts, leukocyte levels)
– Conduct comparative trials versus corticosteroids or dextrose prolotherapy
– Evaluate long-term outcomes through imaging and electrophysiology

Take-Home Messages
– Meralgia paresthetica is a sensory neuropathy caused by compression of the LFCN, leading to outer-thigh burning, tingling, or numbness
– Most cases improve with lifestyle changes, medications, and nerve blocks
– PRP hydrodissection offers a novel regenerative approach for refractory cases
– Rigorous clinical trials are needed before PRP becomes a standard treatment

References

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3. Giusti I, Bianchi F, Descalzi F, et al. Evaluation of platelet-rich plasma therapy for peripheral nerve regeneration: a comprehensive review. J Neurorestoratol. 2022;8(1):45–52.

4. Vidur M, Chakole V, Tople J, Bharadwaj Y. Successful management of meralgia paresthetica by hydrodissection: a case report. Pain Manag. 2022;12(6):545–550.

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8. Soldatos T, Thomas J, Melville J, et al. High-resolution sonography of the lateral femoral cutaneous nerve: technique and normal appearance. AJR Am J Roentgenol. 2006;186(2):507–511.

9. Khalil N, Nicotra A, Chaudhuri KR. Meralgia paraesthetica: a review of the literature. Postgrad Med J. 2012;88(1037):737–742.

10. Scarpone M, Hodges J. Ultrasound-guided injections for meralgia paresthetica: a prospective study. Reg Anesth Pain Med. 2015;40(4):431–435.

11. Farrag TY, Wood MP, Borschel GH, Brenner MJ. Role of stem cells in peripheral nerve regeneration and pain modulation. Pain Med. 2010;11(8):1222–1233.

12. Alvites RP, Dos Santos JAO, de Carvalho T, et al. Dextrose versus corticosteroid hydrodissection for meralgia paresthetica: a randomized controlled trial. Eur J Pain. 2023;27(5):955–963.