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Dear Dr. Roach: I'm a 71-year-old female who's in fairly good health. I only take a statin for high cholesterol and have been diagnosed with spinal stenosis. In April, I began experiencing a burning pain that circles my upper left leg. The pain is constant and never wavers. I had blood tests and a hip X-ray done, which didn't show a reason for the pain.
A neurologist suggested an ultrasound with an injection of antibiotics into the lateral femoral cutaneous nerve. Do you agree that this might stop the pain, or might it do more harm? I can live with the pain but would rather not. -- B.M.
Answer: Pain from compression of the lateral femoral cutaneous nerve is called meralgia paresthetica. It's common, and there are several risk factors, especially certain conditions that predispose people to local compression of the nerve: obesity, pregnancy, tight belts and waistbands, compression from a wallet, and a recent surgery in the area.
The typical symptoms are pain and numbness in the area of the nerve (the upper outer thigh). The pain is often described as burning or stinging, sometimes with the "pins and needles" sensation of a limb falling asleep after remaining still for a prolonged period.
If you mean that the pain makes a complete circle around your thigh, this would be very atypical for meralgia paresthetica. Spinal stenosis can cause similar symptoms, and the exact distribution of the pain and numbness is critical for making a determination of the likely cause. Sometimes a nerve conduction study can be performed to be sure that this isn't nerve compression from spinal stenosis.
If there's an underlying condition (such as wearing a thick wallet in one's front pocket) that can be reversed, this may stop the symptoms, which are temporary for many people in many cases. Since yours has been going on for months, an injection into the nerve can be performed by an anesthesiologist.
However, I think you must've misunderstood the treatment. It's not antibiotics that are injected, it's an anti-inflammatory drug (a steroid) or a combination of the drug with a local anesthetic agent. It's effective at relieving symptoms with this condition, often for the long-term future.