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A 49-year-old truck driver presents with reports of slight burning in the front of his left thigh corresponding to an area covering his front left pants pocket. The patient can recall no history of trauma to the area, has no problems with bowel or bladder, and his past medical and surgical history is unremarkable. The patient saw his PCP who ruled out a hernia or anything systemic and diagnosed the condition as a muscle strain.

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Given the subjective reports, what is your best working hypothesis at this stage?

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This is a classic history for a patient with meralgia paresthetica. However, further testing would be needed to confirm the diagnosis.

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Does this patient warrant a lower quarter screen?

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A lower quarter screening examination would certainly be warranted with this patient.

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What special tests do you plan to use in the physical examination?

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In addition to the lower quarter screening examination and assessing all of the anterior thigh muscles, the prone knee bend should be used to stress the femoral nerve.

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The physical examination revealed the following:

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  • No postural deviation or gait abnormalities.
  • Active range of motion throughout the trunk and lower extremities was within normal limits and pain free.
  • Strength testing is graded as 5/5 throughout trunk and bilateral lower extremities.
  • Decreased sensation to light touch and pinprick over the anterolateral skin of left thigh.
  • Decreased sensation to light touch and pinprick over the anterolateral skin of left thigh.
  • Negative straight and crossed leg raising.
  • Positive inverse Lasegue (prone straight leg raise into hip extension) test. Prone knee bend test also positive.

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Following the physical examination, was your working hypothesis confirmed?

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The physical examination should have confirmed provisional diagnosis of meralgia paresthetica.

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What is the etiology of meralgia paresthetica?

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Describe the cutaneous distribution of the lateral femoral cutaneous nerve of the thigh.

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What is the recommended course of treatment for this condition?

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What medical/surgical options are available for this condition?

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