Meralgia Paresthetica in Children: Case Series and Surgical Technique

Background: Meralgia paresthetica is a painful compressive neuropathy of the lateral femoral cutaneous nerve, with minimal literature existing about the disorder in children. Easily overlooked, a misdiagnosis can lead to unnecessary imaging or surgical intervention. The purpose of this study was to increase provider awareness and compare patient-reported outcomes between surgical and nonsurgical management. Methods: We retrospectively reviewed records of pediatric patients treated for meralgia paresthetica by a single provider. Patients were initially treated with physical therapy, anti-inflammatories, and local injection to confirm the diagnosis. Individuals with persistent symptoms were offered surgical decompression. Patient-reported outcomes were assessed using the International Hip Outcome Tool 33 (iHOT-33) survey. Results: Twenty-four patients were treated. The mean age was 12.7 years (range: 9 to 17 y). Ninety-two percent were female, 63% had bilateral involvement, and 38% were referred with an alternate diagnosis. The average BMI was 20.96. Local injection provided immediate relief for all patients and lasted an average of 11 days. Seventy-one percent (17/24) had persistent symptoms in follow-up and underwent surgical decompression. All patients improved following initial decompression, but 4/17 (24%) had recurrence of symptoms requiring a second surgery. All recurrences had accessory nerves missed during the first surgery. Seventy-nine percent of patients (19/24) completed the iHOT-33 survey at an average of 33 months after intervention (injection or surgery). The average iHOT-33 score was higher in the operative group but was not statistically significant (7.88 vs. 6.72, P =0.250). Conclusions: Meralgia paresthetica can be readily diagnosed using physical examination and confirmed with a local injection, without the need for advanced imaging. In our cohort, it predominantly affected thin, adolescent females. Steroid injection provided definitive treatment for 29% of our patients. Persistent symptoms can be improved with surgical decompression, and we found a high rate of aberrant anatomy and accessory nerves in this population. Outcomes were not significantly different between local injection only and surgical management. More studies are needed to determine the role of ligation versus decompression. Level of Evidence: Level IV—case series.