Ultrasound-Guided Percutaneous Neuroplasty of the Lateral Femoral Cutaneous Nerve for the Treatment of Meralgia Paresthetica

Abstract

The lateral femoral cutaneous nerve (LFCN) can be visualized with ultrasound imaging using a high frequency linear transducer. The entrapment of the LFCN, often near the lateral aspect of the inguinal ligament, is accepted as an etiology of meralgia paresthetica (MP). This case report describes an ultrasound-guided, percutaneous technique that utilizes injected fluid to facilitate blunt dissection (or hydrodissection) to perform an external neuroplasty of the LFCN. This procedure resulted in immediate, long-term relief of pain associated with severe, chronic MP. This procedure may potentially represent an alternate treatment for patients with contraindications or partial contraindications to surgical neurolysis, nerve transection (usually described as being performed under general anesthesia), or corticosteroid injection, or in patients not responding to conservative treatment measures.

Meralgia paraesthetica: Ultrasound-guided injection at multiple levels with 12-month follow-up

“…The long arrow shows the echogenic needle tip (out-plane) just adjacent to the nerve coming from lateral aspect in order to spread the medication around and to loosen the perineural tissue by gently advancing the needle more distally. (Sart) sartorius muscle Interestingly in a previously published case report, Mulvaney [19] showed immediate and long-term relief of pain associated with chronic MP using only percutaneous fluid injection around the nerve. He attributed this result to the blunt dissection (hydrodissection) that might be caused by the injected fluid, which might also result in improvement of the perineural circulation.…”

Ultrasound-Guided Nerve Hydrodissection

“…Similar results were obtained in a case study of a 45-year-old man with chronic meralgia paresthetica. Using a similar in-plane injection, the patient remained symptom free at an 18-month follow-up (13).…”

Ultrasound‐Guided Perineural Injection for Pronator Syndrome Caused by Median Nerve Entrapment

“…Our small sample size and the relatively short follow‐up time of 6 months limited our ability to evaluate long‐term improvement. Finally, most perineural injection evaluations discussed in the literature were performed with a steroid but without hydrodissection; only a few case reports of perineural hydrodissections without a steroid were identified . Future studies comparing the outcomes of perineural hydrodissections of nerve entrapments with and without the use of a steroid in the injectate would be helpful to determine the optimal treatment protocol for these patients.…”