Ultrasound Imaging and Guidance in Meralgia Paresthetica: Finding/Treating the Incognito

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Dear Editor, A 61-year-old woman was admitted to our department with a 2-week history of burning pain, tenderness, paresthesia, and sensory loss on the anterolateral side of the right thigh. She also had a history of laparoscopic cholecystectomy 3 weeks previously. The medical history was unremarkable except for hypertension and previous carpal tunnel surgery. She was obese, with a body mass index of 35.5 kg/m2. Physical examination revealed tenderness to touch on the right anterior superior iliac spine (ASIS) and partial sensory loss in the upper part of the right anterolateral thigh. Tinel’s sign was positive on the right side, i.e., with reproduction of tenderness, moderate pain, and burning symptoms. Ultrasound (US) imaging for the lateral femoral cutaneous nerve (LFCN) uncovered a spur formation on the right ASIS compressing the nerve (Figure 1). US-guided hydrodissection of the right LFCN with 1 mL methylprednisolone (40 mg) and 2 mL 2% prilocaine was performed with the in-plane technique (from medial to lateral side), and it yielded immediate relief from tenderness. As there was partial relief (about 50%) from the complaints of burning pain and partial sensory loss after 1-month follow-up, pregabalin 150 mg/d was started, and the patient became symptom free after 1 month.