The lateral femoral cutaneous nerve is a pure sensory nerve with contributions from the second and third nerves of the lumbar plexus (L2-L3). Compression usually occurs where the nerve passes underneath the inguinal ligament near its attachment to the anterior superior iliac spine of the pelvis. Patients complain of burning pain on the upper, outer aspect of the thigh, occasionally extending from the hip to the knee. Obesity and diabetes are associated with this condition. It has been nicknamed the “skinny pants syndrome” dueto compression by tight clothing or belts. Prolonged standing or running may also cause nerve irritation, and long distance runners may be predisposed. Diagnosis isclinical.
Conservative management provides relief in over 90% of cases. This includes rest, clothing modification, ice application, NSAID use, lidoderm patch, and weight loss in obese patients. Surgical options include nerve decompression, decompression and transposition, and neurectomy. Decompression has a higher failure and recurrence rate compared with neurectomy, butneurectomy has the adverse effects ofdenervation pain and numbness in the nerve distribution.
References Greenberg M. Handbook of Neurosurgery. 6th ed. New York: Thieme Medical Publishers, 2005.