Dr. Roach: Tight pants and packed pockets may cause tingling, numbness
Dear Dr. Roach: I have had meralgia paresthetica for two and a half years. I have all the classic symptoms: tingling, pins and needles, some numbness and stinging in the top and side of my left thigh. I have tried numerous exercises and been treated by a physical therapist and an acupuncturist. Nothing has helped. My doctor has suggested the possibility of medication and/or an injection.
I am 70 years old, do not smoke, am not overweight and am extremely active. This condition has made it difficult to get a good night's sleep. What are your thoughts?
Dear K.B.: Meralgia paresthetica is caused by pressure on the lateral femoral cutaneous nerve. This causes the symptoms you mention, usually on the front and outside of the upper thigh. I often see it in people who have recently gained weight -- and occasionally in those who have recently lost weight. I have never had a patient with symptoms that have lasted as long as yours.
Fortunately, 90% of the time, the symptoms will go away by themselves. Patients should avoid excessively tight clothing and belts, and consider weight loss, if appropriate.
Only once have I sent a patient to an anesthesiologist for a nerve block, which was successful. If the nerve block were unsuccessful at providing adequate long-term relief, a person could consider referral to a surgeon to decompress the nerve. As a last resort, the nerve can be cut, but that would leave permanent numbness on the thigh.
Dear Dr. Roach: I am an 88-year-old man losing my balance. Can you explain what might be causing this?
Dear S.C.: Although the primary organs of balance are the semicircular canals in the middle ear, many systems have to work properly in order to keep one's balance. The eyes need to tell us where we are in space -- balancing with eyes closed is much harder. Proprioception is the sensation of where your body parts are. Without that, balance is a great challenge. Motor control and coordination require strength and smooth movement. Many parts of the central nervous system, peripheral nerves and even muscle and joint diseases can keep us from making the small adjustments we need for that smooth movement and even for staying in place.
Medications are an under-recognized source of balance problems. A long, careful look at medication lists can sometimes reveal medications that are more likely to cause harm than good.
Solving balance problems involves finding the part that's not working properly, but more often balance problems represent several systems not working properly -- especially for those in their 80s and older. Treatment starts with strengthening and balance exercises. A thorough evaluation by your regular doctor, sometimes with the help of experts including neurologists, and joint and eye specialists, is the place to begin. Because loss of balance can lead to falls, and because falls often lead to disability, searching for causes of balance problems and treating them promptly can prevent catastrophe.
Tai chi has been proven a useful way of improving muscle coordination, balance and strength.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.