Lateral Femoral Cutaneous Nerve Entrapment

  • Lisa Rochelle WitkinEmail author
  • Amitabh Gulati
  • Tiffany Zhang
  • Helen W. Karl


The lateral femoral cutaneous nerve (LFCN) is a sensory nerve innervating the anterolateral thigh. It is susceptible to entrapment along its course, usually at its exit from the pelvis under the inguinal ligament. The typical presentation of LFCN neuropathy is pain, paresthesia or dysesthesia, and numbness over the anterolateral thigh. Meralgia paresthetica is the name of this clinical syndrome. However, due to the great variation of LFCN distribution, the clinical presentation may be atypical; other causes such as lumbar radiculopathy need to be ruled out. The management of LFCN neuropathy includes treating underlying conditions and providing symptomatic relief with steroid nerve blocks.


Lateral femoral cutaneous nerve (LFCN) LFCN entrapment Meralgia paresthetica Anterior superior iliac spine (ASIS) Inguinal ligament 

Supplementary material

Video 61.1

Physical exam of the lateral femoral cutaneous nerve (MOV 29000 kb)

Video 61.2

Landmark-guided injection of the lateral femoral cutaneous nerve (MOV 34295 kb)


  1. 1.
    Hager W. Neualgia femoria. Resection des nervous cutaneous femoris anterior externus. Heilung Disch Med Wochenschr. 1885;11:218.CrossRefGoogle Scholar
  2. 2.
    Parisi TJ, Mandrekar J, Dyck PJ, Klein CJ. Meralgia paresthetica: relation to obesity, advanced age, and diabetes mellitus. Neurology. 2011;77(16):1538–42.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    van Slobbe AM, Bohnen AM, Bernsen RM, Koes BW, Bierma-Zeinstra SM. Incidence rates and determinants in meralgia paresthetica in general practice. J Neurol. 2004;251(3):294–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Kitchen C, Simpson J. Meralgia paresthetica. A review of 67 patients. Acta Neurol Scand. 1972;48(5):547–55.CrossRefPubMedGoogle Scholar
  5. 5.
    Reichert FL. Meralgia paresthetica; a form of causalgia relieved by interruption of the sympathetic fibers. Surg Clin N Am. 1933;13:1443.Google Scholar
  6. 6.
    Van Diver T, Camann W. Meralgia paresthetica in the parturient. Int J Obstet Anesth. 1995;4(2):109–12.CrossRefPubMedGoogle Scholar
  7. 7.
    Deal CL, Canoso JJ. Meralgia paresthetica and large abdomens. Ann Intern Med. 1982;96(6 Pt 1):787–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Park JW, Kim DH, Hwang M, Bun HR. Meralgia paresthetica caused by hip-huggers in a patient with aberrant course of the lateral femoral cutaneous nerve. Muscle Nerve. 2007;35(5):678–80.CrossRefPubMedGoogle Scholar
  9. 9.
    Kopell HP, Thompson WAL. Peripheral entrapment neuropathies. 2nd ed. Malabar, FL: R. E. Krieger Pub. Co; 1976.Google Scholar
  10. 10.
    Litwiller JP, Wells Jr RE, Halliwill JR, Carmichael SW, Warner MA. Effect of lithotomy positions on strain of the obturator and lateral femoral cutaneous nerves. Clin Anat. 2004;17(1):45–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Trummer M, Flaschka G, Unger F, Eustacchio S. Lumbar disc herniation mimicking meralgia paresthetica: case report. Surg Neurol. 2000;54(1):80–1.CrossRefPubMedGoogle Scholar
  12. 12.
    Amoiridis G, Wohrle J, Grunwald I, Przuntek H. Malignant tumour of the psoas: another cause of meralgia paraesthetica. Electromyogr Clin Neurophysiol. 1993;33(2):109–12.PubMedGoogle Scholar
  13. 13.
    Yamout B, Tayyim A, Farhat W. Meralgia paresthetica as a complication of laparoscopic cholecystectomy. Clin Neurol Neurosurg. 1994;96(2):143–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Dibenedetto LM, Lei Q, Gilroy AM, Hermey DC, Marks Jr SC, Page DW. Variations in the inferior pelvic pathway of the lateral femoral cutaneous nerve: implications for laparoscopic hernia repair. Clin Anat. 1996;9(4):232–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Broin EO, Horner C, Mealy K, Kerin MJ, Gillen P, O’Brien M, et al. Meralgia paraesthetica following laparoscopic inguinal hernia repair. An anatomical analysis. Surg Endosc. 1995;9(1):76–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Mirovsky Y, Neuwirth M. Injuries to the lateral femoral cutaneous nerve during spine surgery. Spine (Phila Pa 1976). 2000;25(10):1266–9.CrossRefGoogle Scholar
  17. 17.
    Massey EW. Meralgia paresthetica secondary to trauma of bone graft. J Trauma. 1980;20(4):342–3.PubMedGoogle Scholar
  18. 18.
    Yamamoto T, Nagira K, Kurosaka M. Meralgia paresthetica occurring 40 years after iliac bone graft harvesting: case report. Neurosurgery. 2001;49(6):1455–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Feigl GC, Dreu M, Ulz H, Breschan C, Maier C, Likar R. Susceptibility of the genitofemoral and lateral femoral cutaneous nerves to complications from lumbar sympathetic blocks: is there a morphological reason? Br J Anaesth. 2014;112(6):1098–104.CrossRefPubMedGoogle Scholar
  20. 20.
    Butler R, Webster MW. Meralgia paresthetica: an unusual complication of cardiac catheterization via the femoral artery. Cathet Cardiovasc Interv Off J Soc Card Angiography Interv. 2002;56(1):69–71.CrossRefGoogle Scholar
  21. 21.
    Dellon AL, Mont M, Ducic I. Involvement of the lateral femoral cutaneous nerve as source of persistent pain after total hip arthroplasty. J Arthroplasty. 2008;23(3):480–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Hospodar PP, Ashman ES, Traub JA. Anatomic study of the lateral femoral cutaneous nerve with respect to the ilioinguinal surgical dissection. J Orthop Trauma. 1999;13(1):17–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Ghavanini MR, Ghavanini AA. Meralgia paresthetica as the presenting feature of chronic appendicitis. Am J Phys Med Rehabil. 2001;80(9):703–5.CrossRefPubMedGoogle Scholar
  24. 24.
    Kho KH, Blijham PJ, Zwarts MJ. Meralgia paresthetica after strenuous exercise. Muscle Nerve. 2005;31(6):761–3.CrossRefPubMedGoogle Scholar
  25. 25.
    Williams PH, Trzil KP. Management of meralgia paresthetica. J Neurosurg. 1991;74(1):76–80.CrossRefPubMedGoogle Scholar
  26. 26.
    Ivins GK. Meralgia paresthetica, the elusive diagnosis: clinical experience with 14 adult patients. Ann Surg. 2000;232(2):281–6.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Dias Filho LC, Valença MM, Guimarães Filho FA, Medeiros RC, Silva RA, Morais MG, et al. Lateral femoral cutaneous neuralgia: an anatomical insight. Clin Anat. 2003;16(4):309–16.CrossRefPubMedGoogle Scholar
  28. 28.
    Aszmann OC, Dellon ES, Dellon AL. Anatomical course of the lateral femoral cutaneous nerve and its susceptibility to compression and injury. Plast Reconstr Surg. 1997;100(3):600–4.CrossRefPubMedGoogle Scholar
  29. 29.
    Keegan JJ, Holyoke EA. Meralgia paresthetica. An anatomical and surgical study. J Neurosurg. 1962;19:341–5.CrossRefPubMedGoogle Scholar
  30. 30.
    Majkrzak A, Johnston J, Kacey D, Zeller J. Variability of the lateral femoral cutaneous nerve: an anatomic basis for planning safe surgical approaches. Clin Anat. 2010;23(3):304–11.PubMedGoogle Scholar
  31. 31.
    Grothaus MC, Holt M, Mekhail AO, Ebraheim NA, Yeasting RA. Lateral femoral cutaneous nerve: an anatomic study. Clin Orthop Relat Res. 2005;437:164–8.CrossRefGoogle Scholar
  32. 32.
    Carai A, Fenu G, Sechi E, Crotti FM, Montella A. Anatomical variability of the lateral femoral cutaneous nerve: findings from a surgical series. Clin Anat. 2009;22(3):365–70.CrossRefPubMedGoogle Scholar
  33. 33.
    Hopkins PM, Ellis FR, Halsall PJ. Evaluation of local anaesthetic blockade of the lateral femoral cutaneous nerve. Anaesthesia. 1991;46(2):95–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Enneking FK, Chan V, Greger J, Hadzic A, Lang SA, Horlocker TT. Lower-extremity peripheral nerve blockade: essentials of our current understanding. Reg Anesth Pain Med. 2005;30(1):4–35.PubMedGoogle Scholar
  35. 35.
    Ghent WR. Further studies on meralgia paresthetica. Can Med Assoc J. 1961;85:871–5.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Ghent WR. Meralgia paraesthetica. Can Med Assoc J. 1959;81:631–3.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Edelson JG, Nathan H. Meralgia paresthetica. An anatomical interpretation. Clin Orthop Relat Res. 1977;122:255–62.Google Scholar
  38. 38.
    Nathan H. Gangliform enlargement on the lateral cutaneous nerve of the thigh. Its significance in the understanding of the etiology of meralgia paresthetica. J Neurosurg. 1960;17:843–50.CrossRefPubMedGoogle Scholar
  39. 39.
    Jefferson D, Eames RA. Subclinical entrapment of the lateral femoral cutaneous nerve: an autopsy study. Muscle Nerve. 1979;2(2):145–54.CrossRefPubMedGoogle Scholar
  40. 40.
    Vinik A, Mehrabyan A, Colen L, Boulton A. Focal entrapment neuropathies in diabetes. Diabetes Care. 2004;27(7):1783–8.CrossRefPubMedGoogle Scholar
  41. 41.
    Suber DA, Massey EW. Pelvic mass presenting as meralgia paresthetica. Obstet Gynecol. 1979;53(2):257–8.PubMedGoogle Scholar
  42. 42.
    Yamamoto T, Kurosaka M, Marui T, Mizuno K. Hemangiomatosis presenting as meralgia paresthetica. J Pediatr Surg. 2001;36(3):518–20.CrossRefPubMedGoogle Scholar
  43. 43.
    Jones RK. Meralgia paresthetica as a cause of leg discomfort. Can Med Assoc J. 1974;111(6):541–2.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Kim S, Choi JY, Huh YM, Song HT, Lee SA, Kim SM, et al. Role of magnetic resonance imaging in entrapment and compressive neuropathy – what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: part 1. Overview and lower extremity. Eur Radiol. 2007;17(1):139–49.CrossRefPubMedGoogle Scholar
  45. 45.
    Petchprapa CN, Rosenberg ZS, Sconfienza LM, Cavalcanti CFA, Vieira RLR, Zember JS. MR imaging of entrapment neuropathies of the lower extremity. RadioGraphics. 2010;30(4):983–1000.CrossRefPubMedGoogle Scholar
  46. 46.
    Chhabra A, Del Grande F, Soldatos T, Chalian M, Belzberg AJ, Williams EH, et al. Meralgia paresthetica: 3-Tesla magnetic resonance neurography. Skelet Radiol. 2013;42(6):803–8.CrossRefGoogle Scholar
  47. 47.
    Seror P, Seror R. Meralgia paresthetica: clinical and electrophysiological diagnosis in 120 cases. Muscle Nerve. 2006;33(5):650–4.CrossRefPubMedGoogle Scholar
  48. 48.
    Shin YB, Park JH, Kwon DR, Park BK. Variability in conduction of the lateral femoral cutaneous nerve. Muscle Nerve. 2006;33(5):645–9.CrossRefPubMedGoogle Scholar
  49. 49.
    Deimel GW, Hurst RW, Sorenson EJ, Boon AJ. Utility of ultrasound-guided near-nerve needle recording for lateral femoral cutaneous sensory nerve conduction study: does it increase reliability compared with surface recording? Muscle Nerve. 2013;47(2):274–6.CrossRefPubMedGoogle Scholar
  50. 50.
    Boon AJ, Bailey PW, Smith J, Sorenson EJ, Harper CM, Hurdle MF. Utility of ultrasound-guided surface electrode placement in lateral femoral cutaneous nerve conduction studies. Muscle Nerve. 2011;44(4):525–30.CrossRefPubMedGoogle Scholar
  51. 51.
    Coert JH, Dellon AL. Documenting neuropathy of the lateral femoral cutaneous nerve using the pressure-specified sensory testing device. Ann Plast Surg. 2003;50(4):373–7.CrossRefPubMedGoogle Scholar
  52. 52.
    Nahabedian MY, Dellon AL. Meralgia paresthetica: etiology, diagnosis, and outcome of surgical decompression. Ann Plast Surg. 1995;35(6):590–4.CrossRefPubMedGoogle Scholar
  53. 53.
    van Eerten PV, Polder TW, Broere CA. Operative treatment of meralgia paresthetica: transection versus neurolysis. Neurosurgery. 1995;37(1):63–5.CrossRefPubMedGoogle Scholar
  54. 54.
    Harney D, Patijn J. Meralgia paresthetica: diagnosis and management strategies. Pain Med. 2007;8(8):669–77.CrossRefPubMedGoogle Scholar
  55. 55.
    Pennekamp W, Krumova EK, Feigl GP, Frombach E, Nicolas V, Schwarzer A, et al. Permanent lesion of the lateral femoral cutaneous nerve after low-volume ethanol 96% application on the lumbar sympathetic chain. Pain Physician. 2013;16(4):391–7.PubMedGoogle Scholar
  56. 56.
    Dureja GP, Gulaya V, Jayalakshmi TS, Mandal P. Management of meralgia paresthetica: a multimodality regimen. Anesth Analg. 1995;80(5):1060–1.PubMedGoogle Scholar
  57. 57.
    Grossman MG, Ducey SA, Nadler SS, Levy AS. Meralgia paresthetica: diagnosis and treatment. J Am Acad Orthop Surg. 2001;9(5):336–44.CrossRefPubMedGoogle Scholar
  58. 58.
    Sharrock NE. Inadvertent “3-in-1 block” following injection of the lateral cutaneous nerve of the thigh. Anesth Analg. 1980;59(11):887–8.CrossRefPubMedGoogle Scholar
  59. 59.
    Capdevila X, Biboulet P, Bouregba M, Barthelet Y, Rubenovitch J, d’Athis F. Comparison of the three-in-one and fascia iliaca compartment blocks in adults: clinical and radiographic analysis. Anesth Analg. 1998;86(5):1039–44.CrossRefPubMedGoogle Scholar
  60. 60.
    Shannon J, Lang SA, Yip RW, Gerard M. Lateral femoral cutaneous nerve block revisited. A nerve stimulator technique. Reg Anesth. 1995;20(2):100–4.PubMedGoogle Scholar
  61. 61.
    Choi HJ, Choi SK, Kim TS, Lim YJ. Pulsed radiofrequency neuromodulation treatment on the lateral femoral cutaneous nerve for the treatment of meralgia paresthetica. J Korean Neurosurg Soc. 2011;50(2):151–3.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Philip CN, Candido KD, Joseph NJ, Crystal GJ. Successful treatment of meralgia paresthetica with pulsed radiofrequency of the lateral femoral cutaneous nerve. Pain Physician. 2009;12(5):881–5.PubMedGoogle Scholar
  63. 63.
    Hurdle MF, Weingarten TN, Crisostomo RA, Psimos C, Smith J. Ultrasound-guided blockade of the lateral femoral cutaneous nerve: technical description and review of 10 cases. Arch Phys Med Rehabil. 2007;88(10):1362–4.CrossRefPubMedGoogle Scholar
  64. 64.
    Tagliafico A, Serafini G, Lacelli F, Perrone N, Valsania V, Martinoli C. Ultrasound-guided treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy): technical description and results of treatment in 20 consecutive patients. J Ultrasound Med. 2011;30(10):1341–6.CrossRefPubMedGoogle Scholar
  65. 65.
    Soneji N, Peng PW. Ultrasound-guided pain interventions – a review of techniques for peripheral nerves. Korean J Pain. 2013;26(2):111–24.CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Ng I, Vaghadia H, Choi PT, Helmy N. Ultrasound imaging accurately identifies the lateral femoral cutaneous nerve. Anesth Analg. 2008;107(3):1070–4.CrossRefPubMedGoogle Scholar
  67. 67.
    Kim JE, Lee SG, Kim EJ, Min BW, Ban JS, Lee JH. Ultrasound-guided lateral femoral cutaneous nerve block in meralgia paresthetica. Korean J Pain. 2011;24(2):115–8.CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    Tagliafico A, Bodner G, Rosenberg I, Palmieri F, Garello I, Altafini L, et al. Peripheral nerves: ultrasound-guided interventional procedures. Semin Musculoskelet Radiol. 2010;14(5):559–66.CrossRefPubMedGoogle Scholar
  69. 69.
    Khalil N, Nicotra A, Rakowicz W. Treatment for meralgia paraesthetica. Cochrane Database Syst Rev. 2012;12:Cd004159.PubMedGoogle Scholar
  70. 70.
    Trescot AM. Cryoanalgesia in interventional pain management. Pain Physician. 2003;6(3):345–60.PubMedGoogle Scholar
  71. 71.
    del Rey ML, Canuel JF, Skouvakis D. Successful treatment of bilateral meralgia paresthetica using pulsed radiofrequency. NYNJSIPP annual meeting; Jersey City; 2014.Google Scholar
  72. 72.
    Wu H, Groner J. Pulsed radiofrequency treatment of articular branches of the obturator and femoral nerves for management of hip joint pain. Pain Pract. 2007;7(4):341–4.CrossRefPubMedGoogle Scholar
  73. 73.
    Abejon D, Garcia-del-Valle S, Fuentes ML, Gomez-Arnau JI, Reig E, van Zundert J. Pulsed radiofrequency in lumbar radicular pain: clinical effects in various etiological groups. Pain Pract. 2007;7(1):21–6.CrossRefPubMedGoogle Scholar
  74. 74.
    Balogh SE. Transcutaneous application of pulsed radiofrequency: four case reports. Pain Pract. 2004;4(4):310–3.CrossRefPubMedGoogle Scholar
  75. 75.
    Van Zundert J, Brabant S, Van de Kelft E, Vercruyssen A, Van Buyten JP. Pulsed radiofrequency treatment of the Gasserian ganglion in patients with idiopathic trigeminal neuralgia. Pain. 2003;104(3):449–52.CrossRefPubMedGoogle Scholar
  76. 76.
    Kim YH, Lee CJ, Lee SC, Huh J, Nahm FS, Kim HZ, et al. Effect of pulsed radiofrequency for postherpetic neuralgia. Acta Anaesthesiol Scand. 2008;52(8):1140–3.CrossRefPubMedGoogle Scholar
  77. 77.
    Wilkes D, Ganceres N, Solanki D, Hayes M. Pulsed radiofrequency treatment of lower extremity phantom limb pain. Clin J Pain. 2008;24(8):736–9.CrossRefPubMedGoogle Scholar
  78. 78.
    Cohen SP, Sireci A, Wu CL, Larkin TM, Williams KA, Hurley RW. Pulsed radiofrequency of the dorsal root ganglia is superior to pharmacotherapy or pulsed radiofrequency of the intercostal nerves in the treatment of chronic postsurgical thoracic pain. Pain Physician. 2006;9(3):227–35.PubMedGoogle Scholar
  79. 79.
    Barna SA, Hu MM, Buxo C, Trella J, Cosgrove GR. Spinal cord stimulation for treatment of meralgia paresthetica. Pain Physician. 2005;8(3):315–8.PubMedGoogle Scholar
  80. 80.
    Slavin KV. Peripheral nerve stimulation. Lunsford LD, editor. Pittsburgh: Karger; 2011.Google Scholar
  81. 81.
    de Ruiter GC, Wurzer JA, Kloet A. Decision making in the surgical treatment of meralgia paresthetica: neurolysis versus neurectomy. Acta Neurochir (Wien). 2012;154(10):1765–72.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Lisa Rochelle Witkin
    • 1
    Email author
  • Amitabh Gulati
    • 2
  • Tiffany Zhang
    • 3
  • Helen W. Karl
    • 4
  1. 1.Division of Pain Medicine, Department of AnesthesiologyNew York-Presbyterian/Weill Cornell Medical CenterNew YorkUSA
  2. 2.Anesthesiology and Critical CareMemorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.Department of Anesthesiology and Pain MedicineUniversity of Washington Medical CenterSeattleUSA
  4. 4.Department of Anesthesiology and Pain MedicineUniversity of Washington, Seattle Children’s HospitalSeattleUSA

Personalised recommendations