A 34-year-old, obese, Caucasian male presents to your office with an abnormal sensation over his right thigh. He says, "It gets numb, and sometimes I feel burning over my thigh." He denies any back pain, muscle weakness, or abnormal sensation below the knee. His past medical history is insignificant. He smokes two packs of cigarettes and consumes 1-2 bottles of beer daily. He is a construction worker. He frequently works in a squatting position. Physical examination reveals an area of decreased sensation over the right anterolateral thigh. There is no muscle weakness. Deep tendon reflexes are symmetrical.
Which of the following is the most appropriate next step in the management of this patient?

Question

A 34-year-old, obese, Caucasian male presents to your office with an abnormal sensation over his right thigh. He says, "It gets numb, and sometimes I feel burning over my thigh."  He denies any back pain, muscle weakness, or abnormal sensation below the knee.  His past medical history is insignificant.  He smokes two packs of cigarettes and consumes 1-2 bottles of beer daily.  He is a construction worker.  He frequently works in a squatting position.  Physical examination reveals an area of decreased sensation over the right anterolateral thigh.  There is no muscle weakness.  Deep tendon reflexes are symmetrical.
Which of the following is the most appropriate next step in the management of this patient?

Quizplus · Accepted Answer

Explanation: Meralgia paresthetica is a clinical diagnosis (diagnosed based on the history and physical findings). The classic patient will present with complaints of typical pain in the characteristic location, sensory abnormalities, and absent neurologic abnormalities of the lower leg on examination. Some of the common causes are obesity and the use of tight garments around the waist. Management includes reassurance of the patient (that this is not a serious condition) and conservative measures such as weight loss (in obese patients) and avoidance of tight-fitting garments to reduce the pressure on the nerve entrapment area. (Choices A and B)Plain x-rays of the hip and pelvis, electromyography (EMG), and nerve conduction studies (NCS) are not necessary in a patient with the characteristic history and physical findings. (Choice C)Physical therapy has no role in the management of meralgia paresthetica. (Choice D)Local corticosteroid injection and the use of anticonvulsants (i.e., carbamazepine, phenytoin, or gabapentin) are reserved for patients with persistent symptoms that are refractory to conservative measures. Educational Objective: Meralgia paresthetica is a clinical diagnosis. It is a benign condition, and treatment includes reassurance, weight loss, and the avoidance of tight-fitting garments.

A 34-Year-Old, Obese, Caucasian Male Presents to Your Office with an Abnormal