Leg o-n Fire: Lateral Femoral Cutaneous Neuropathy

At the age of 32 Sigmund Freud developed a brand new issue. Pricking and other unpleasant sensations had over-taken skin on the outer part of his right thigh. Walking created his symptoms worse. The affected skin was exquisitely painful and sensitive to touch and also the regular rubbing of his underclothes irritated the area.

Seven decades later in 1895, when Freud wrote up his self-observations to get a German medical journal, the abnormal feelings were still current, but had moved. Initially, the area of disturbance was more obvious near the top of the leg, but gradually the abnormal sounds moved downward to your area a hands breadth above the part of his leg.

When Freud packed a fold of skin in this region, it hurt more than it did in his left thigh. Although h-e may feel a pinprick as such, it also burned. Even so, individual locations inside the area of excessive skin were insensitive to ordinarily painful maneuvers. He also noticed that temperature sense was reduced. Hot objects placed from the affected skin felt colder than in unaffected areas. And although the initial pricking sensations increased over time, his outer leg had become generally less sensitive and painful to common stimulations.

Freuds medical practitioner, Josef Breuer, found that the affected skin was within the place of the lateral femoral cutaneous nerve, a nerve that concerns it-self with sensation only and does not have any physical associations. Dr. Breuer concluded that Freuds symptoms were brought on by injury to this nerve. Dr. Breuer also suspected that the nerve could be especially susceptible to injury in the groin close to the front of the hip where it passes between strands of a tendon. Consequently, he thought that wearing tight clothing may worsen the situation.

Our knowledge of this disorder has altered little in the 110 years since Freud wrote his report for Berlins Neurologisches Centralblatt, or in the 20 years since Francis Schiller, M.D., translated it into English for the American journal Neurology. Browse here at the link reducible hernia symptoms to discover the meaning behind this hypothesis.

Freud and Breuer were not the first to ever understand this disorder, to set the record straight. Max Bernhardt of Germany first wrote about this in 1878 and in 1895 Vladimir Roth of Moscow called the condition meralgia paresthetica, an expression still being used. This name is the amount of its three parts. Meros is Greek for thigh, algos is Greek for pain and paresthetica suggests unprovoked sensations. This entrapment neuropathy (pinched nerve situation) was one of the first to be recognized as such.

The lateral femoral cutaneous nerve is formed in the lower back from branches of the 2nd and third lumbar spinal nerves which combine to form an individual nerve (o-n each side) soon after emerging from the spinal column. The nerve passes through the interior of the pelvis and leaves the pelvis near the outer border of the inguinal (groin) tendon before making a downward turn to run beneath the skin of the outer leg.

The course of the nerve can differ from person to person and also from side to side in the same person. In about 25% of people the nerve splits into branches before attaining the inguinal ligament, and there might be as much as 5 branches. This variability will make some people more at risk of nerve-injury than others. For one more viewpoint, consider having a look at: preventing a hernia.

Pres-sure within the pelvis, as from pregnancy, obesity and (rarely) tumors, can hurt the portion of the nerve within the pelvis. And as Freud"s medical practitioner surmised, the nerve is particularly susceptible to damage from external pressure at the inguinal ligament, as from corsets, wide belts and tight pants. However, a reason for meralgia paresthetica is not usually found, as was obviously the case when Freud had it.

The nerve can be injured during a large number of surgery, including orthopedic, vascular, gynecological, abdominal, hernia and also stomach-stapling procedures. In a recent collection of spinal surgery circumstances in Taiwan, 60 out of 252 patients experienced meralgia paresthetica like a complication of the surgery. Fortuitously, in most cases it fixed within two months.

Diagnosis of this condition is usually created from the physical examination and the history, with the important features being unpleasant and numbness feelings on the side of the leg. Other conditions can mimic meralgia paresthetica, as an example, a pinched spinal nerve in the back, or disability in the regional femoral nerve that also emerges from the pelvis at the inguinal ligament. Exams of nerve and muscle electricity--electromyography and nerve conduction studies--can help solve unclear cases.

Therapy of meralgia paresthetica has not been studied by the gold-standard method of randomized, controlled trials involving a comparison group of untreated patients. Therefore in choosing appropriate treatment all we have to go on are collections of cases revealed in medical journals. Conventional methods are tried first, because many cases turn out well without drastic treatments. Browse here at herniabeltbvd"s Profile | Armor Games to read where to provide for this hypothesis. Fat loss, conclusion of pregnancy, elimination of tight clothes and basic watchful waiting may all-be successful.

While awaiting a favorable out-come, symptoms could be maintained with skin-patches containing a certain epilepsy, anti-inflammatory drugs, local anesthetic drug and antidepressant drugs known to relieve nerve-pain, and local treatments with ste-roids. Surgery to alleviate the pinch is generally reserved as a last-resort.

(C) 2005 by Gary Cordingley.

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