Hi everyone
I logged in about 5 months ago and have since been going through the various hoops such as urology and gynae to reach a diagnosis. Meanwhile I was sent to a wonderful physio lady via the NHS. She diagnosed the pudendal nerve plus my sacriollic joint as being my problem and she`s emailed different collegues to see if any of them are able to help give me the correct physio.
I`ve also been given an appointment to the pain clinic to discuss a possible steroid injection- which I believe is the nerve block that`s often discussed on here?
Today I phoned for the result of a recent MRI of my pelvis and was told they found osteoarthritis in the sacriollic joint!
Well this has `thrown` me as I`d thought of all possibilties as to why I`m in pain in my back and down through my pelvis - with all PN symptoms - and never considered arthritis in my sacriollic joint.
My question to any of you who may know is could this arthritis be causing the PN?
I saw an xray when my hubby had arthritis in his hand and saw a spur of arthritis growing from his thumb, which he had successful surgery to remove.
Could such a spur be aggravating my pudendal nerve do you think?
Sorry in advance for any spelling mistakes and thanks in advance for any enlightenment.
I`m to see my GP next Tuesday and it would be really helpful to go armed with information - because as you all know GP`s aren`t clued up about these things.
Try and keep pain free all.
Joy
osteoarthritis
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helenlegs 11
- Posts: 1779
- Joined: Fri Sep 17, 2010 9:39 am
- Location: North East England
Re: osteoarthritis
Hi Joy,
You would have to ask the radiologist what he had seen to get a better idea of where exactly the osteoarthritis was affecting and how much could be seen.
The pudendal nerve roots come from S2 S3 and S4 in the sacrum which is slightly to the inside of the SI joints. But it's just too difficult to speculate I would say.
You could take a look at the home page (in red to the left above) and go to ANATOMY. There is a really clever interactive Atlas of the female pelvis to look at right at the bottom of that page. Click on sacroiliac joint and it shows up on the diagram, then click on pudendal nerve and again it will show that nerves position, although the actual nerve roots don't show up.
I know so little about arthritis, sorry.
The only other thing to mention is that the nerves will not be visible on the scan so the radiologist would not be able to see any direct correlation diagnostically between the two, as the nerves can not be seen at all.
Was this in one side or both?
A sacroiliac joint problem can have a knock on effect of course. It is quite likely that it could effect the piriformis muscle as this does run just under that joint and the pudendal nerve runs very near that. That Atlas will put the piriformis in too.
You may already know all of this (sorry) but it does give you the opportunity to see how things do interact anatomically. Some of the other diagrams show the pudendal nerve more completely too.
As the sacroiliac joint is a main stabiliser in the pelvis and helps support the trunk above I would think that may well explain your back pain and it may be indirectly (not sure if it could be directly) responsible for pudendal nerve pain.
Take care,
Helen
You would have to ask the radiologist what he had seen to get a better idea of where exactly the osteoarthritis was affecting and how much could be seen.
The pudendal nerve roots come from S2 S3 and S4 in the sacrum which is slightly to the inside of the SI joints. But it's just too difficult to speculate I would say.
You could take a look at the home page (in red to the left above) and go to ANATOMY. There is a really clever interactive Atlas of the female pelvis to look at right at the bottom of that page. Click on sacroiliac joint and it shows up on the diagram, then click on pudendal nerve and again it will show that nerves position, although the actual nerve roots don't show up.
I know so little about arthritis, sorry.
The only other thing to mention is that the nerves will not be visible on the scan so the radiologist would not be able to see any direct correlation diagnostically between the two, as the nerves can not be seen at all.
Was this in one side or both?
A sacroiliac joint problem can have a knock on effect of course. It is quite likely that it could effect the piriformis muscle as this does run just under that joint and the pudendal nerve runs very near that. That Atlas will put the piriformis in too.
You may already know all of this (sorry) but it does give you the opportunity to see how things do interact anatomically. Some of the other diagrams show the pudendal nerve more completely too.
As the sacroiliac joint is a main stabiliser in the pelvis and helps support the trunk above I would think that may well explain your back pain and it may be indirectly (not sure if it could be directly) responsible for pudendal nerve pain.
Take care,
Helen
Fall 2008. Misdiagnosed with lumber spine problem. MRN June 2010 indicated pudendal entrapment at Alcocks canal. Diagnosed with complex variant piriformis syndrome with sciatic, pudendal and gluteal entrapment's by Dr Filler 2010.Guided piriformis botox injection 2011 Bristol. 2013, Nerve conduction test positive; new spinal MRI scan negative, so diagnosed for the 4th time with pelvic nerve entrapment, now recognised as Sciatic, pudendal, PFCN and cluneal nerves at piriformis level.
Re: osteoarthritis
Thank you Helen
Hmmm where to go next? After jumping through all the hoops and seeing urology, gynae etc, I was ready to ask my GP for a referral to Dr Greenslade but now am wondering whether to chase my back problem instead?
I`ve an appointment with my GP on Tuesday and I`ll see if he can tell me more, or perhaps he can find out. The arthritis is definitely in the sacriollic joint - but knowing exactly where and how much,would help to know if it`s this that`s contributing to the pudendal pain.
My back pain`s left sided - my Sl joint`s tender to touch on that side and my pudendal pain`s left sided, and I`m now getting buttock pain which I`ve discovered is typical of sacriollic disfunction.
At least after all the run around to different doctors, my physio came to the diagnosis of PN, although she`s believed for a few weeks that it`s stemming from my back. She`s been busy emailing collegues to find one of them who`re able to give me the correct PT. Bless her heart!!
I`m to see her this Friday, she`s been waiting for the results of the MRI as has my GP.
I`m to see the pain clinic on the 28th to discuss a nerve block - so as you can see I`ve been busy since we last `talked`.
I`ve looked at the interactive map before but I shall go back for another look, now that you`ve explained about the piriformis muscle.
I realise that the arthritis could be coincidental but it`s `interesting` that the pain from this and the pudendal pain are all left-sided, even so I don`t want to assume that my back is the cause and waste time before asking for a referral to see Dr G.
Thanks again for your help - I hope that you`re moving in the right direction to get pain free too.
warm regards
Joy
Hmmm where to go next? After jumping through all the hoops and seeing urology, gynae etc, I was ready to ask my GP for a referral to Dr Greenslade but now am wondering whether to chase my back problem instead?
I`ve an appointment with my GP on Tuesday and I`ll see if he can tell me more, or perhaps he can find out. The arthritis is definitely in the sacriollic joint - but knowing exactly where and how much,would help to know if it`s this that`s contributing to the pudendal pain.
My back pain`s left sided - my Sl joint`s tender to touch on that side and my pudendal pain`s left sided, and I`m now getting buttock pain which I`ve discovered is typical of sacriollic disfunction.
At least after all the run around to different doctors, my physio came to the diagnosis of PN, although she`s believed for a few weeks that it`s stemming from my back. She`s been busy emailing collegues to find one of them who`re able to give me the correct PT. Bless her heart!!
I`m to see her this Friday, she`s been waiting for the results of the MRI as has my GP.
I`m to see the pain clinic on the 28th to discuss a nerve block - so as you can see I`ve been busy since we last `talked`.
I`ve looked at the interactive map before but I shall go back for another look, now that you`ve explained about the piriformis muscle.
I realise that the arthritis could be coincidental but it`s `interesting` that the pain from this and the pudendal pain are all left-sided, even so I don`t want to assume that my back is the cause and waste time before asking for a referral to see Dr G.
Thanks again for your help - I hope that you`re moving in the right direction to get pain free too.
warm regards
Joy
-
helenlegs 11
- Posts: 1779
- Joined: Fri Sep 17, 2010 9:39 am
- Location: North East England
Re: osteoarthritis
Seeing Dr Greenslade isn't a bad idea at all, especially as your GP is accepting pelvic issues could be part of your problems.
I have seen him and he is very good at working things out in this complicated area. I really would advise you to see someone pelvic related first or at least along side if that is possible. I can NOT say this strongly enough!!!
If you see a neurosurgeon they will automatically give you a spinal, say S1/L5 diagnosis (which doesn't have much primary influence on the pudendal nerve??) and you could be stuck forever with that, whether it is right or wrong. There is nothing to say that both lower spine and some degree of pelvic problem is combining to give you the symptoms you have too of course.
However because PN is so under recognised I would try and establish if that diagnosis is correct before a spinal one. once you have an answer that the medical profession are happy with (and who is going to challenge a neurosurgeon) you will find it very difficult to go in any other direction.
Even if nothing shows nerve impingement wise on MRI at S1/L5 they are too fond of then saying yes there is a problem with your lower back but it isn't that bad, so you must have central sensitisation and stop looking for any other pathology.
I have some signs of early onset of arthritis in my hip (obviously not much) but they have taken no interest in that what so ever (that was 3 years ago) The degree of your SIJ problem may be more noticeable, it will be intersting to see what your GP feedback on that is.
And YES! I am very jaded about this whole back v pelvis thing, as this has been exactly my experience
take care
Helen
I have seen him and he is very good at working things out in this complicated area. I really would advise you to see someone pelvic related first or at least along side if that is possible. I can NOT say this strongly enough!!!
If you see a neurosurgeon they will automatically give you a spinal, say S1/L5 diagnosis (which doesn't have much primary influence on the pudendal nerve??) and you could be stuck forever with that, whether it is right or wrong. There is nothing to say that both lower spine and some degree of pelvic problem is combining to give you the symptoms you have too of course.
However because PN is so under recognised I would try and establish if that diagnosis is correct before a spinal one. once you have an answer that the medical profession are happy with (and who is going to challenge a neurosurgeon) you will find it very difficult to go in any other direction.
Even if nothing shows nerve impingement wise on MRI at S1/L5 they are too fond of then saying yes there is a problem with your lower back but it isn't that bad, so you must have central sensitisation and stop looking for any other pathology.
I have some signs of early onset of arthritis in my hip (obviously not much) but they have taken no interest in that what so ever (that was 3 years ago) The degree of your SIJ problem may be more noticeable, it will be intersting to see what your GP feedback on that is.
And YES! I am very jaded about this whole back v pelvis thing, as this has been exactly my experience
take care
Helen
Fall 2008. Misdiagnosed with lumber spine problem. MRN June 2010 indicated pudendal entrapment at Alcocks canal. Diagnosed with complex variant piriformis syndrome with sciatic, pudendal and gluteal entrapment's by Dr Filler 2010.Guided piriformis botox injection 2011 Bristol. 2013, Nerve conduction test positive; new spinal MRI scan negative, so diagnosed for the 4th time with pelvic nerve entrapment, now recognised as Sciatic, pudendal, PFCN and cluneal nerves at piriformis level.
Re: osteoarthritis
Hi Helen
and thanks again so much for your help and advice.
After mulling it over, I`m taking your advice and continue chasing the pudendal nerve diagnosis rather than let the docs decide it`s my back - and as you say getting stuck with that diagnosis.
After all it`s no good my coming on here and asking advice if I`m not going to follow through with it, so thank you again for your time and effort in helping me see the situation better.
I can cope with a bit of arthritis..... ESPECIALLY after having pudendal nerve pain and all that goes with it. It`s just that I wondered if it maybe connected but after looking at the anatomy page, I could see the sacrioliac joint appears higher or more to one side than the pudendal nerve.
At the moment I`ve a few irons in the fire, I`m to see my physio lady tomorrow and hopefully she`s found someone who can give me the correct PT - even so she made the diagnosis that the pudendal nerve is what`s causing my trouble and I haven`t shared this with my GP yet.
So with the physio`s diagnosis on board I`m asking the GP on Tuesday for a referral to doctor G.
I was going to try the doctor in London as we`re in Norfolk, but a friend who lives near Bristol has kindly agreed to put us up whenever we need it, and hearing such good reports of Dr G on here was the decider.
I`m a wimp over things like asking for referrals, so my husband`s coming with me for support and to hopefully keep the doc on the track of PN and not arthritis.
I`ve also got an appointment with the pain clinic later this month to discuss a nerve block.
So at last things are moving in the right direction - I`ll let you know how it goes with my GP on Tuesday.
take care too
Joy
and thanks again so much for your help and advice.
After mulling it over, I`m taking your advice and continue chasing the pudendal nerve diagnosis rather than let the docs decide it`s my back - and as you say getting stuck with that diagnosis.
After all it`s no good my coming on here and asking advice if I`m not going to follow through with it, so thank you again for your time and effort in helping me see the situation better.
I can cope with a bit of arthritis..... ESPECIALLY after having pudendal nerve pain and all that goes with it. It`s just that I wondered if it maybe connected but after looking at the anatomy page, I could see the sacrioliac joint appears higher or more to one side than the pudendal nerve.
At the moment I`ve a few irons in the fire, I`m to see my physio lady tomorrow and hopefully she`s found someone who can give me the correct PT - even so she made the diagnosis that the pudendal nerve is what`s causing my trouble and I haven`t shared this with my GP yet.
So with the physio`s diagnosis on board I`m asking the GP on Tuesday for a referral to doctor G.
I was going to try the doctor in London as we`re in Norfolk, but a friend who lives near Bristol has kindly agreed to put us up whenever we need it, and hearing such good reports of Dr G on here was the decider.
I`m a wimp over things like asking for referrals, so my husband`s coming with me for support and to hopefully keep the doc on the track of PN and not arthritis.
I`ve also got an appointment with the pain clinic later this month to discuss a nerve block.
So at last things are moving in the right direction - I`ll let you know how it goes with my GP on Tuesday.
take care too
Joy
Re: osteoarthritis
Hi Joy,
Sunil originally posted this article and I've re-posted it in other areas. It may help to explain the relationship between SIJD/Osteoarthritis and PNE.
http://www.ijav.org/2011/ijav_2011_123-127.pdf
Kind regards,
Karyn
Sunil originally posted this article and I've re-posted it in other areas. It may help to explain the relationship between SIJD/Osteoarthritis and PNE.
http://www.ijav.org/2011/ijav_2011_123-127.pdf
Kind regards,
Karyn
Ultra Sound in 03/08 showed severely retroverted, detaching uterus with mulitple fibroids and ovarian cysts.
Pressure and pain in lower abdomen and groin area was unspeakable and devastating.
Total lap hysterectomy in 06/08, but damage was already done.
EMG testing in NH in 04/10 - bilateral PN and Ilioinguals
3T MRI at HSS, NY in 09/10
Bilateral TG surgery with Dr. Conway on 03/29/11. Bilat ilioinguinal & iliohypogastric neurectomy 03/12. TCD surgery 04/14.
Pressure and pain in lower abdomen and groin area was unspeakable and devastating.
Total lap hysterectomy in 06/08, but damage was already done.
EMG testing in NH in 04/10 - bilateral PN and Ilioinguals
3T MRI at HSS, NY in 09/10
Bilateral TG surgery with Dr. Conway on 03/29/11. Bilat ilioinguinal & iliohypogastric neurectomy 03/12. TCD surgery 04/14.
Re: osteoarthritis
Thank you Karyn
even more to think about in that article.
take care
Joy
even more to think about in that article.
take care
Joy
Re: osteoarthritis
A link (that shouldn't expire) to the article that Sunil posted: http://tinyurl.com/am7y8gj
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
Re: osteoarthritis
Thank you Violet.
I went to my physio yesterday, she had another look at my back and found that around the T12 area I was rock solid ( her words). I`m learning a little bit of knowledge but isn`t that the Maigne`s area?
Considering my initial pain mimiced renal colic where I was admitted to hospital with the belief that I had kidney stones, I`m wondering if I`ve got Maigne`s and not PN?
I`m totally confused as I also have PN symptoms, especially BM pain.
Anyway, I`m still going to ask my GP on Tuesday for a referral to Doctor Greenslade. By all account`s he seems the best man to see.
Meanwhile the physio said that she`s going to phone the GP - which I thought was really good of her- and tell him her findings of the pudendal nerve causing me pain.
At last `things` are happening.
take care everyone
Joy
I went to my physio yesterday, she had another look at my back and found that around the T12 area I was rock solid ( her words). I`m learning a little bit of knowledge but isn`t that the Maigne`s area?
Considering my initial pain mimiced renal colic where I was admitted to hospital with the belief that I had kidney stones, I`m wondering if I`ve got Maigne`s and not PN?
I`m totally confused as I also have PN symptoms, especially BM pain.
Anyway, I`m still going to ask my GP on Tuesday for a referral to Doctor Greenslade. By all account`s he seems the best man to see.
Meanwhile the physio said that she`s going to phone the GP - which I thought was really good of her- and tell him her findings of the pudendal nerve causing me pain.
At last `things` are happening.
take care everyone
Joy
Re: osteoarthritis
Thanks for creating the tiny url, Violet! Any chance we can put it in our publications section?
Best wishes to you, Joy! Please let us know how things are coming along for you.
Kind regards,
Karyn
Best wishes to you, Joy! Please let us know how things are coming along for you.
Kind regards,
Karyn
Ultra Sound in 03/08 showed severely retroverted, detaching uterus with mulitple fibroids and ovarian cysts.
Pressure and pain in lower abdomen and groin area was unspeakable and devastating.
Total lap hysterectomy in 06/08, but damage was already done.
EMG testing in NH in 04/10 - bilateral PN and Ilioinguals
3T MRI at HSS, NY in 09/10
Bilateral TG surgery with Dr. Conway on 03/29/11. Bilat ilioinguinal & iliohypogastric neurectomy 03/12. TCD surgery 04/14.
Pressure and pain in lower abdomen and groin area was unspeakable and devastating.
Total lap hysterectomy in 06/08, but damage was already done.
EMG testing in NH in 04/10 - bilateral PN and Ilioinguals
3T MRI at HSS, NY in 09/10
Bilateral TG surgery with Dr. Conway on 03/29/11. Bilat ilioinguinal & iliohypogastric neurectomy 03/12. TCD surgery 04/14.