Hiphuggers' tingly thighs

Pressure on a sensory nerve can cause pain and paresthesia in the nerve's area of distribution. Entrapment of the median nerve in the carpal tunnel is the commonest example of this problem, but other nerves can be affected. The lateral femoral cutaneous nerve can be compressed as it passes under the inguinal ligament, which results in pain and paresthesia in the lateral aspect of the thigh, a condition commonly known as meralgia paresthetica.1

I recently saw 3 mildly obese young women between the ages of 22 and 35, who had worn tight “low-rise” trousers (also called hiphuggers) over the previous 6 to 8 months. All presented with symptoms of tingling or a burning sensation on the lateral aspect of the thigh (bilateral in one case). The results of a physical examination were unremarkable, except for mild local tenderness at the anterior superior iliac spine in 2 patients. These 2 patients also had Tinel's sign, whereby a reproducible tingling sensation was elicited when the lateral femoral cutaneous nerve was stimulated by finger-tapping close to the anterior superior iliac spine. One of the women was concerned about multiple sclerosis and requested MRI but was reassured by my explanation of the origin of her symptoms. In all 3 patients, the symptoms resolved after 4 to 6 weeks of avoiding hiphuggers and wearing loose-fitting dresses.

Meralgia paresthetica has been described in association with various garments and accessories (such as wallets2 and tight jeans3) causing compression of the lateral femoral cutaneous nerve. Now that hiphuggers are back in fashion, physicians can expect to see more patients with tingly thighs. Simple observation of the patient's mode of dress may give a clue to the diagnosis and prevent unnecessary investigations.