New Pain Location in Upper Back Thighs and Inner Thighs

[shawnmellis]

Hi everoyone,
For about 1 year I mainly just had pain in my upper perineum and some in lower perineum that I noticed when sitting. 2 months ago, I reinjured myself doing gardening and I have had a new burning pain in a different location which is both thighs in the upper back (posterior) part of them and also in the inner thigh area for both thighs. I first injured myself standing up from a squatting position 1 year ago and I felt a pull and pain in my left adductor muscle (thigh muscle) which connects to the lower and middle part of pelvis. When I reinjured myself 2 months ago, I also felt a pull and pain in this area of my left thigh muscle. My MRI showed that I have tendinosis on both of my upper thigh muscles. Tendinosis means chronic degeneration or tendon injury, so that is most likely somehow related to the cause of my pudendal neuralgia. My MRI showed varices (enlarged veins) on both sides of my pelvis in the dorsal branch of the pudendal nerve all the way to just outside the alcocks canal, which sometimes indicates entrapment in the location of varices. Dr. Dellon, said that adductor muscles can entrap your pubic ramus tunnel (dorsal branch of pudendal nerve) and there is another nerve close to there also called the perineal nerve which branches out to the femoral nerve (thigh nerve), so anybody with similar problems like mine could have compression of both your dorsal nerve and your perineal branch of the nerve (which is outside the distal part of alcock's canal closer to dorsal branch of pudendal nerve and not at the entrance to the alcocks canal) which branches to the femoral nerve which goes to the back of your thigh (posterior femoral nerve) and also inner thighs. It could also possibly be your obturator nerve or another sciatic nerve. As far as the sciatic nerve goes though, you should probably have pain that goes all the way down your legs to your feet from that and not just in your buttocks, back thigh and inner thigh. As far as obturator, you usally have more just buttock pain and not as much thigh pain My pain is in my perineum, addductor muscles, back thigh, inner thigh, some of buttocks and sometimes front, which can be the perineal nerve radiating to the femoral nerve branch or it could just be the femoral nerve itself compressed separately or obturator nerve. This is what I am trying to rule out and figure out now, but I am pretty sure it is the perineal nerve which is in the lower perineum area by your pubic ramus bone area, which branches to the femoral nerve of your thigh. Any thoughts? You guys can email me at shawnmellis@gmail.com if you want any time and feel free to join me also at a facebook group for pudendal neuralgia called Pudendal Neuralgia Support at http://www.facebook.com/groups/10383831 ... 838315764/ to also chat online with me. Take care and hope to hear from you soon
Shawn

[Faith]

I have recently started having pain around the ishcial tuberosities (mostly medial) and along the inferior ischial ramus I think. Sometimes it feels like I might have a pain below the ischial tuberosities, but my hamstrings are really tight too so it could be coming from that. I have always had some pain around my left ischial tuberosity but I could almost pinpoint it as coming from alcock's canal. I too have been researching a lot about the PBPFCN and also the inferior cluneal nerve. Are they the same thing? I find it very confusing and hard to find literature. I posted a couple of sites though on a thread called "inferior cluneal nerve". If you look at diagrams though the inferior cluneal nerve and PN run within a few cm of each other so who knows is it separate nerve injuries or "nerve cross talk"?

[shawnmellis]

Hi, What is PBPFCN? Some of these nerves overlap, are close to each other or radiate pain to other branchces of nearby nerves. Cluneal nerves are a possible cause of pain related to pain more in your ischial tuberosity (back sitting bone of pelvis). The front part of your pelvis (pubis ramus) bone can also be near your source of nerve pain, because it is close to the perineal nerve at the area outside the Alcocks canal, the part closer to the dorsal branch and not the entrance to the alcocks canal. Also, pain from the perineal branch can cause pain to radiate to your femoral (thigh) nerves which not too many talk about or discuss, but I have learned this from my own symptoms and research, and talking with doctors. This should be considered, in my opinion with anybody who has thigh nerve pain and perineum and sitting pain, especially if you have any pain in your adductor thigh muscles which connect to your lower front pelvis bone (pubis ramus). Anybody else have any thoughts to add or similar problems?

Shawn

Shawn

[Faith]

PBPFCN is perineal branch of the posterior femoral cutaneous nerve. I think it might be used interchangably with inferior cluneal nerve. can anyone add to this? Shawn I know you have seen Dr. Dellon can you tell me how he diagnoses which nerves are causing what pain? And can he do one surgery to address mulitple nerve entrapements such as PFCN and PN?

[carolynm]

I wonder if a trip to your neighborhood neurologist would fit here. Are they good at diagnosing such nerves by your symptoms? When I went to one in my early stages of Pn, they just confirmed what I already knew.

cm

[shawnmellis]

Faith, I am also a little confused on the cluneal nerve and the posterior perineal femoral nerve. I think I found somewhere that the deep perineal nerve branch(which innervates the bulbospongious muscle) of the pudendal nerve branches to the posterior femoral nerve, which would make sense in my case since i have pain in both of those areas, I think the cluneal is more where the back sitting bone is at the ischial tuberosity and the femoral and perineal are more towards the front pubis ramus part of the pelvis where you sit, near the lower part of perineum. Any thoughts?
Shawn

[Faith]

This picture shows all the nerves we are talking about, inferior cluneal (ICN), perineal branch of the posterior femoral cutaneous nerve (PBPFCN), perineal nerve, and pudendal http://www.pudendalhope.org/sites/defau ... lNerve.jpg I think I understand that the ICN and PBPFCN come off the PFCN, but the ICN goes down and around the ischial tuberosities whereas the PBPFCN goes up along the labia majora (sorry I didn't look at the male anatomy) and therefore can have symptoms similar to PN. I am a little confused about the perineal nerve though...is it not just a branch of the Pudenal nerve?

It sure seems like entrapment of the ICN is likely as it lies basically directly underneath the sit bones. I am a very thin person so maybe my ICN is just irritated (from the botox I had several weeks ago) or there is "cross talk" between the nerves or is it central sensitization (which I have a real problem with) because why would I all of a sudden develop a ICN entrapment after 3 years of having PN pain? I think the cross-talk is very likely...look how close the ICN is to the PN...it looks like they are only a few centimeters apart. Some people do not believe in nerve "cross talk", but nerve singals go up and down the spinal cord (not just one way) so I would think anything that comes off S2,3,4 could have pain sensations as well. This would also explain why the pain with PN can change almost daily it seems as it comes off 3 sacral nerve roots which affects many different areas of the pelvis. I love this picturehttp://en.wikipedia.org/wiki/File:Gray828.png that shows all the sacral nerve roots and what they affect sensation wise.

I have a real hard time telling where my pain is coming from extactly because after burning so long I start to just feel a "cool" almost numbing sensation (not in a marcaine kind of way) all along my posterior perineum and around the ischial tuberosity. I just personally disagree with Dellon when he says you won't have ischial pain if you have PNE. The PN runs right along the medial portion of the ischial tuberosity with only the obturator internus muscle between the nerve and the bone

[shawnmellis]

Good Anatomy Picture showing all of these nerves! 'Does anybody have any thoughts? My opinion is that you can have a compression of any one of these nerves or more than one of these at the same time or that you can get referred pain from one nerve to another branch of the nerve, such as maybe from the Posterior Fermoral Nerve to the Cluneal Nerve or the Cluneal Nerve to the Posterior Femoral Nerve, since they are so close. It is confusing and I need a nerve and anatomy expert to explain better some of this to me to help. Not sure if just any neurologist could explain this or not. My orthopedic doctor can't

Shawn

[shawnmellis]

Hi, Dr. Dellon diagnoses you mostly with a physical exam. He can take care of certain nerves all at once, such as the dorsal branch and the perineal nerve exiting the alcocks canal, but not sure about if he can also do the cluneal nerve at the same time as the other two. For dorsal and perineal all at once, he cuts along the crease of the inner thigh to access both of these nerves. It may be worth seeing him prior to your surgery with Hibner.
Shawn

[shawnmellis]

Hi, Faith, I think I may have found something useful. I got this from my Peripheral Nervous System Book I read. This is what is says:
"The POSTERIOR FEMORAL CUTANEOUS NERVE" is formed by ventral rami branches from the S1, S2, and S3 spinal segments. This POSTERIOR FEMORAL CUTANEOUS NERVE is the ORIGIN OF THE INFERIOR CLUNEAL NERVES, which are cutaneous nerves supplying skin of the inferior buttock. The POSTERIOR FEMORAL CUTANEOUS NERVE continues DISTALLY and gives MULTIPLE BRANCHES that supply skin of the POSTERIOR EXTERNAL GENITALIA AND POSTERIOR THIGH."

Based on this it looks like the POSTERIOR FEMORAL CUTANEOUS NERVE can be compressed OR the INFERIOR CLUNEAL NERVE can be compressed causing similar symptoms of thigh and buttocks pain since the POSTERIOR FEMORAL CUTANEOUS NERVE is the origin of the INFERIOR CLUNEAL NERVES that supply skin to the inferior buttock. Also, based on this if your POSTERIOR FEMORAL CUTANEOUS NERVE is compressed you can also have pain in your skin of the POSTERIOR EXTERNAL GENITALIA INCLUDING THE PERINEUM, BULBOSPONGIOUS MUSCLE AND THE POSTERIOR THIGH.

So, this is a very possible explanation to me of other areas other than the traditonal rectal, Alcock's canal, and the part of the pudendal nerve between the Sacrospinous and Sacrotuberous Ligaments that can also cause pain in the perineum and pain in the thigh. I also read on Wikipedia (and saw in anatomy diagrams) that the Perineal branch of the Pudendal Nerve goes to the Bulbospongious muscle which is the superficial (area close to skin) muscle that goes all the way vertically and centrally from just above the rectum to right below the genitals, which is where I have a lot of pain. You can go to wikipedia at http://en.wikipedia.org/wiki/Deep_branc ... neal_nerve to see where it says this. I also read somewhere that this perineal branch of the pudendal nerve branches to the POSTERIOR FEMORAL NERVE. I think that anyone with pain in the thighs or pain in the perineum should print this out and show it to the PNE specialist they see. I got this from a Book called "A Comprehensive Introduction to The Peripheral Nervous System" by Charles A. Henderson M.D. on page 440. It is the latest edition of the book that I purchased from Amazon.com Anybody have any thoughts?

Shawn