best surgeon based on physical examination recommendations

[ntrenchard]

Hello forum,

I just wanted to see if there is any way we can make recommendations of surgeons based on where one hurts along the pudendal nerve upon physical examination. I don't know if there's any credence to this idea, but I think it's worth a shot for those of us who don't have the luxury of getting a 3 T MRI. So for example, I had a rectal exam by a PN specialist who pressed along my pudendal nerve. I hurt (and was also given blocks) in these locations:

1. ST and SS ligaments on my right side
2. both Alcock's canals (more towards the anterior part, i think its the harder to reach opening).
3. inferior rectal branch
4. no penile/genital pain

I know there's been a debate over Dr. Hibner vs. the Houston team, but maybe we can make the decision clearer based upon the physical examination alone. If its clear that a patient is only hurting at the ligaments, maybe the traditional TG is best for them and they don't have to wait as long to get a Hibner consult. But if your symptoms include the anterior Alcock's canal (which I think only Dr. Hibner tries to decompress) then its better going with the altered TG approach. And so on with other surgeons and other conditions.

Like a forum is supposed to, I'd like to hear from what worked and what hasn't.

ntrench

[HerMajesty]

Was this Dr. Weiss in San Fran? Just wondering because that is how he does his exam. It is a subjective vs. an objective tool and does not work on everybody who has pudendal neuralgia. I personally have atypical symptoms: all my neuropathy is numbness and neuropathic itch. The neuropathic itch looks the same as pain on EMG ( runs down same nerve fibers), but someplace along the line it is processed differently. I also have delayed symptoms, that is I can do a 5 hour drive in relative comfort and then be very symptomatic shortly after arriving at my destination. Needless to say, Dr. Weiss palpated along my pudendal nerve without illiciting any pain at all, and I still have pudendal neuralgia, although he seemed a little confused about that because of his methodology.
I work with a physical therapist who does manual therapy (joint manipulation), and one thing I have noted is that two people can have exactly the same objective findings and yet entirely different subjective symptoms. I had a complex pattern of pelvic joint dysfunction but experienced pudendal neuralgia and bladder issues (interstitial cystitis, neurogenic bladder), with ZERO musculoskeletal pain. Most people with even a piece of the kind of joint dysfunction I have, experience severe pain in back, hips, legs, abdomen, sacrum, coccyx, etc.
My point is, I think any subjective tool is of limited use in discerning pathology, and I think trying to elicit pain with nerve palpation is such a subjective tool although it might prove to be useful in some patients.