A 35-year-old woman comes to the physician complaining of right thigh numbness. She states that her symptoms started a few weeks prior to delivering her first child. She describes numbness and paresthesias along the anterolateral aspect of her right thigh. She denies any weakness, difficulty walking, back pain, recent trauma, or bowel/bladder difficulty. Her symptoms have improved somewhat after the delivery of her child a few days ago. Her past medical history is significant for asthma, rheumatoid arthritis, and Lyme disease treated with 2 weeks of oral doxycycline therapy. Her current medications include albuterol and sulfasalazine.
Her blood pressure is 110/60 mm Hg, pulse is 72/min, and respirations are 12/min. Her BMI is 34 kg/m². On neurological examination, she has a reduction in pain and temperature perception along the anterolateral aspect of her right thigh. The remainder of the neurological examination is normal.
Which of the following is the most appropriate next step in management?

Question

Quizplus · Accepted Answer

11ec193a_987c_40f7_853d_ffebd311f0b1_MD0002_00 This patient's clinical presentation is consistent with meralgia paresthetica, a pure sensory syndrome due to lateral femoral cutaneous nerve (LFCN) compression. This condition is usually seen in patients who are pregnant, obese, diabetic, or who wear tight pants or belts. Patients typically present with sensory symptoms in the distribution of the LFCN (anterolateral thigh), which originates in the upper lumbosacral plexus (L2-L3) and runs underneath the inguinal ligament where it can frequently be compressed. meralgia paresthetica The LFCN is a pure sensory nerve, and therefore patients will not present with any symptoms of weakness. Diagnosis is made clinically, but MRI of the lumbar spine or EMG/NCS may be needed in equivocal cases to rule out other causes. Since meralgia paresthetica is a benign and self-limited condition, conservative treatment (e.g., avoiding tight garments, weight loss) improves symptoms in > 90% of patients. Patients with persistent symptoms for > 2 months may respond to anticonvulsants (e.g., gabapentin) or local nerve block. (Choice A) Lyme disease may present with radiculopathy in the later stages, but it is unlikely in this patient since she received adequate treatment with doxycycline. (Choice B) MRI of the spine is preferred for diagnosing radiculopathy, spinal stenosis, or spondylolisthesis. However, these patients tend to present with weakness and sensory loss in the distribution of the affected spinal root nerves. (Choice C) Physical therapy is useful to treat chronic musculoskeletal pain, but it is not beneficial for meralgia paresthetica. (Choice D) Plain x-rays can evaluate for conditions such as stress fractures or lytic lesions, but these typically present with point tenderness or joint pain. Educational objective: Meralgia paresthetica is due to lateral femoral cutaneous nerve (LFCN) compression and presents with pure sensory symptoms (e.g., numbness, paresthesias, and dysesthesias) in the anterolateral thigh. Risk factors include wearing tight pants or belts, pregnancy, obesity, and diabetes. The diagnosis is made clinically. Patients should be reassured that this is not a serious condition, and they usually respond to conservative treatment. __________ References: Meralgia Paresthetica (http://www.ncbi.nlm.nih.gov/pubmed/21435164)

A 35-Year-Old Woman Comes to the Physician Complaining of Right