Sonographic evaluation of the lateral femoral cutaneous nerve in meralgia paresthetica

Identify sonographic features of the lateral femoral cutaneous nerve (LFCN) in meralgia paresthetica (MP) and report therapeutic outcomes in sonographically confirmed cases.

Retrospective review of 50 patients with clinically suspected MP and 20 controls. Ultrasounds were reviewed for characteristics of the LFCN and compared between groups. When available, MRIs were reviewed. In cases of sonographically pathologic LFCN, subsequent therapeutic interventions were recorded.

Thirty-five of the suspected MP cases (70%) had ultrasound findings suggestive of MP, 10 (20%) were negative, and in 5 (10%) the LFCN was not seen. Sonographic findings in positive cases included nerve enlargement in all cases (mean cross-sectional area 9 mm² (standard deviation (SD) ± 5.59) versus 4 mm² (SD ± 2.31) and 3 mm² (SD ± 2.31) in negative cases and normal controls, respectively; p < 0.01), nerve hypoechogenicity (30 of 35 cases, 86%), and focal lesion (7 of 35 cases, 20%). Sixteen ultrasounds positive for MP had MRIs with only 4 (25%) reporting a concordant LFCN abnormality (enlargement or T2 hyperintensity). Twenty-five of the 35 (71%) patients with positive sonographic findings for MP had a US-guided LFCN block (local anesthetic ± corticosteroid), with 24 of 25 (96%) patients reporting immediate symptomatic improvement. Eighteen of 35 (51%) underwent LFCN neurectomy or neurolysis, all of whom experienced symptomatic improvement.

Ultrasound is a useful modality for LFCN assessment in clinically suspected MP and is more sensitive for abnormalities than MRI. Nearly all patients who received perineural analgesia and/or neurectomy or neurolysis had symptomatic improvement.