Nerve entrapment location

[REV800X]

Hello - I've tried to read as much as I can lately, and am not quite understanding this concept. (I'm in the mechanical engineering field - not in med field, but the body and engineering are similar...)

As an example, my pain is only in the perineum, so wouldn't the nerve be entraped at the bottom of the Alcock canal just before it reaches the perineum? Which is also a location that I understand it not easy to reach with surgery. I also do not have any pain in the buttocks sitting, so would the standard PNE surgery even be effective if the entrapment is lower or closer to the end of the nerve? How is the entrapment location determined? Only by 3D scans?

[carolynm]

Entrapment is only confirmed at surgery, but the 3T MRI is indicative of the location. For example, I am entrapped at the SS ligament by scar tissue. I have had all of the symptoms distal to that point, i.e. rectal pain, perineum pain, and clitoral pain. So it is most of the time not possible to match your symptoms with your location.

cari

[REV800X]

Entrapment is only confirmed at surgery, but the 3T MRI is indicative of the location. For example, I am entrapped at the SS ligament by scar tissue. I have had all of the symptoms distal to that point, i.e. rectal pain, perineum pain, and clitoral pain. So it is most of the time not possible to match your symptoms with your location.

cari

Hi Cari,

I thnk I understand what you are saying, and I think "distal" means "after"... So what I was getting at is if I only have severe perineum pain, the entrapment must be close to that area as it isn't impacting the other nerve branches? That is what I meant by the entrapment after or in the Alcock canal. But I do understand that the 3T MRI is potentially the only way to determine location short of surgery. With that, if my thought process is correct, my Dr. would not even be able to get to the location of my entrapment if it is at the end of the Alcock canal, as he would be operating and looking at the nerves to high up or closer to the spine than what I'm guessing is the entrapped location.... But, then I am a person who tends to overthink and want to understand things.....

Dave

[carolynm]

It is possible to be entrapped "higher up" meaning closer to the sacral root origin of the pudendal nerve--and still only have 1 or all of the branches causing your symptoms. For example, you could have entrapment at the SS/ST ligaments but only have the perineum pain. Or, you could be entraped at Alcock's and have perineum pain. I think it is good to overthink in this case, because the medical community won't always have the correct answers for you, since PN is so rare.

cari

[Violet M]

Dave, theorectically what you are saying sounds right but one PNE physician explained to me once that your symptoms depend on which nerve fibers are affected as well as which branches. I was entrapped at the ligamental grip (ST/SS ligaments) and alcock's canal including the falciform process but I've had mostly perineal symptoms and very few rectal symptoms. Keep in mind that each person's anatomy varies and branches of the nerve may come off at different places in different people.

[helenlegs 11]

Hi Dave,
I can understand your problem, you have thought this through well. It's not an easy thing to determine however, as the posts above show. I had heard the Dr Hibner is doing separate diagnostic blocks of the branched nerves to see if they any can be eliminated. I think that Dr Dellon and Azzaman (or similar) do surgery if it is a lower dorsal branch problem but things do seem to change and more dr's may be added to the list now and others seem to be able to access a little lower that alcocks(I'm not 100% sure but Dr H Martin in Oklahoma may be able to? some one will correct me if I'm wrong )
Good luck
Helen

[REV800X]

Thanks to everyone for their replies. This information really helps. Overall it sounds like it is very hard to determine the exact location...