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Age / Sex : 33 / F
Chief complaint: right anterolateral thigh pain & numbness 1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case.
(Quiz는 quiz일 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.) Courtesy: 류혜진(Yoo Hye Jin), 서울대병원(Seoul National University Hospital)
Diagnosis: Meralgia paresthetica
Discussion
Findings:
Transverse
ultra-sonographic images show a hypoechoic linear structure passing through the
inguinla ligament at ASIS level. Right sided hypoechoic structure
is thickened compared to contralateral lesion
Diagnosis:
Meralgia paresthetica
Discussion:
Meralgia
paresthetica is numbness or pain in the outer thigh not caused by injury to the
thigh, but by injury to a nerve that extends from the thigh to the spinal
column.
This chronic
neurological disorder involves a single nerve—the lateral cutaneous nerve of
thigh (also called the lateral femoral cutaneous nerve or lateral femoral
cutaneous neuropathy.) The term meralgia paraesthetica combines four Greek
roots to mean thigh pain with anomalous perception.
The lateral femoral cutaneous nerve
most often becomes injured by entrapment or compression where it passes between
the upper front hip bone (ilium) and the inguinal ligament near the attachment
at the anterior superior iliac spine (the upper point of the hip bone). Less
commonly, the nerve may be entrapped by other anatomical or abnormal
structures, or damaged by diabetic or other neuropathy or trauma such as from
seat belt injury in an accident.
The nerve may become painful over a
period of time as weight gain makes underwear, belting or the waistband of
pants gradually exert higher levels of pressure. Pain may be acute and radiate
into the rib cage, and into the groin, thigh, and knee. Alternately, weight
loss or aging may remove protective fat layers under the skin, so the nerve can
compress against underwear, outer clothing, and—most commonly— by belting. Long
periods of standing or leg exercise that increases tension on the inguinal
ligament may also cause pressure.
Diagnosis is
largely based on patient description and relevant details about recent
surgeries, hip injuries, or repetitive activities that could irritate the
nerve. Examination checks for sensory differences between the affected leg and
the other leg.
Treatment varies. In most cases, the
best treatment is to remove the cause of compression by modifying patient
behavior, in combination with medical treatment to relieve inflammation and
pain.
References:
1. Ann Surg
2000; 232(2):281-286
2. Radiographics
2010; 30: 983-1000
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