Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

8. Groin Pain Etiology: Hip- Referred Groin Pain
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injured. Direct trauma to the nerve, such as a shear injury from a seat
belt, is another possible cause of meralgia paresthetica.
Physical Exam Examination of the hip for any prior scars or
operations is advisable. Tapping of the inguinal ligament laterally, 1 cm
medial to the ASIS where the nerve crosses, elicits a Tinel’s sign, with
stinging or burning into the anterolateral thigh [ 21 ]. Hypesthesia and/or
allodynia of a patch of skin along the upper lateral thigh is consistent
with the dermatomal findings for this neuralgia. Extension of the thigh
may also aggravate symptoms as it places the nerve on stretch.
Diagnostic Exams The diagnosis of meralgia paresthetica is clinical
and does not require imaging. X-rays will be unrevealing. MRI may
reveal edema and swelling of the nerve in extreme cases, best seen on T2
images proximal and laterally along the inguinal ligament; this is subtle
and not universally present. Ultrasound may show swelling of the nerve
between the inguinal ligament and deep circumflex iliac artery, with
flattening of the nerve as it courses under the inguinal ligament. Sensory
nerve conduction velocities may be ordered to confirm the diagnosis if
questions exist [ 21 ].
Differential It is important to rule out lumbar disk herniation as a
cause of symptoms. Any focal weakness or other symptoms in the L2
distribution should prompt evaluation for this. Additionally, intrapelvic
masses have been known to compress this nerve along its course and
should be considered in the differential.
Appropriate Treatment/Referral Referral to a pain specialist for
corticosteroid injections should be considered in patients in whom
meralgia paresthetica is suspected. Typically, this is undertaken with the
use of ultrasound guidance. These can be both confirmatory of the
diagnosis and therapeutic. Small series have shown good results and
high rates of resolution over the course of 1–2 months [ 22 ]. If there is no
long-term improvement, neurectomy may be considered .
Physiological Problems
Gluteus Medius Tendonitis
Presentation Tears and tendonitis of the gluteus medius tendon have
only recently become recognized as causes of hip pain. They can also
present with primary complaint of groin pain. Likened to the “rotator