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History of meralgia paresthetica and Freud’s thigh

In this site we found a nice crisp historical note on meralgia paresthetica: https://shebayer.com/clothing/lateral-femoral-cutaneous-neuropathy-information/

Freud and meralgia paresthetica 

At the age of 32 Sigmund Freud developed a new problem. Stitches and other unpleasant feelings had surpassed the skin on the outside of his right thigh. Walking aggravates the symptoms. The affected skin is extremely sensitive to touch and even the touch of his usual clothes rash.

Seven years later, in 1895, when Freud wrote to his self-observation of a German medical journal, abnormal sensations were still present, but had emigrated. Initially, the area of disturbance was greater in the upper thigh, but gradually moved abnormal sensations reduced to an area the size of the palm of a span above the knee.

When Freud pressed a fold of skin in this area, it hurts more than it did in his left thigh. Although I could feel a sting as such, were also burnt. Despite this, the different points in the area of anomalous skin was impervious to normally painful maneuvers. He also noted that the sense of temperature has been changed. hot objects placed against the affected skin feel cooler than in unaffected areas. And if the sensations of the original puncture improved over time, your thigh was now less sensitive to normal stimuli.

doctor Freud, Josef Breuer, said the skin was affected in the territory of the lateral cutaneous femoral nerve, a nerve that deals with the unique sensation and has no muscular connections. Mr. Breuer has concluded that the symptoms of Freud have been caused by damage to this nerve. Mr. Breuer also suspect that the nerve may be particularly vulnerable to injury in the groin in front of the hip where it passes between the strands of a ligament. Consequently, he believes that wearing tight clothing can aggravate the condition.

Our understanding of this disorder has changed little during the 110 years since Freud wrote his report to Berlin Neurologische Centralblatt, or during the 20 years since Francis Schiller MD, translated into English for the American journal Neurology.

To make things clear, Freud and Breuer are not the first to recognize this condition. Max Bernhardt of Germany to first wrote about it in 1878 and 1895 in Moscow Vladimir Roth called “meralgia paresthetica condition,” a term still in use. This name is the sum of its three parts. “Meros” is Greek and thigh, ” somethings “is Greek for pain and” paresthesia “means unprovoked sensations. This entrapment neuropathy (pinched nerve condition) was the first to be recognized as such.

femoral cutaneous nerve is formed in the lower back branches of lumbar nerves, second and third are combined to form a single nerve (per side) shortly after leaving the spine. The nerve passes through the interior of the basin and release Basin near the border of the inguinal (groin) ligament before taking a downward trend to run under the skin of the thigh.

The course of the nerve can vary person to person and even from side to side in the same person. Approximately 25% of the nerve divides into branches before reaching the inguinal ligament and can be extended to five branches. This variability may make some people more vulnerable to nerve damage than others.

The pressure in the basin of the pregnancy, obesity and (rarely) tumors, can damage the nerve in the pelvis. And as Freud doctor guessed, the nerve is particularly vulnerable to injury by external pressure on the inguinal ligament, corsets, wide belts and tight pants. However, a cause of meralgia paresthetica is not always as it seems to be the case that Freud had.

The nerve may be injured in a variety of surgical procedures, including orthopedic, vascular, gynecological, abdominal hernia, and even stomach stapling operations. In a recent series of cases of spinal surgery in Taiwan, 60 252 patients in meralgia paresthetica experienced as a complication of surgery. Fortunately, in all cases be resolved within two months. 
< , br /> The diagnosis of this condition is usually the history and physical examination, key elements include numbness and discomfort in the lateral thigh. Other conditions can mimic meralgia paresthetica, for example, spine pinched nerve in lower back or near the femoral nerve damage that emerges as the basin of the inguinal ligament. Evidence of muscles and nerves of electricity – electromyography and nerve conduction studies – can help resolve ambiguous cases.

The treatment of meralgia paresthetica was not studied by the method of the gold standard of randomized controlled trials that included a control group of patients untreated. Thus, in choosing appropriate treatment all we need to go to collections of cases published in medical journals. Because many cases go well, without drastic treatments, conservative approaches are tried first. The weight loss, removal of tight clothing, abortion and simple Careful monitoring can be effective.

Pending a successful outcome, the symptoms can be managed with skin patches containing a local anesthetic, anti-inflammatory drugs, certain antidepressants and epilepsy are known to relieve nerve pain, and local steroid injections. The surgery to relieve the pinching is usually reserved as a last resort.