new and so confused please help have a EMG schduled?

[momof3bigguys]

hello i am new to this board and am glad i stumbled across it in my research!! i am a 38 yr old with a LONG history of pelvic surgeries for endometreosis, in apr. of 2012 i had a issue with my foot where it felt like it exploded on the bottom of the foot,it swelled up and hurt so bad..it left a burning sensation that i still have now..in nov.of 2012 my pelvic area felt like it exploded and the vaginal area burned as well!! after MONTHS of testing and an explortory surgery they still DONT kknow what it is.. i have ALL of the symptoms of pudendal nerve entrapment including burning when sitting,a forgin object stuck in the vagina, feels like my vagina is stuck in a blood pressure cuff..at times the vagina feels like its being pinched? there is a odd discharge that is so irritaing and it burns.my vagina hurts all the time..i am now seeing a neuromuscular dr that says its some kinda nerve issue?? and i am having a EMG and skin biopsy next week? my right foot and vagina feel the same. i had a MRI that showed i have a few bulging discs and one that is a protruding it's minimally affects the
thecal sac without foraminal encroachment?
my question is will the EMG and skin biopsy show pudendal nerve entrapment? i dont want to go thru this test for nothing? what type of dr should i be seeing for this?? will the EMG point them in the right direction? its been 7 1/2 months and i have seen so many drs and dont know where to go at this point?!!!

[Meliora]

Hi Momof3! Welcome to the board. Although, I am sorry you are dealing with pudendal nerve issues/foot pain. I wanted to answer you the best I could, as I have a little experience with the tests you are to have. The feeling of a blood pressure cuff around your vagina/foreign object "could" be from spasms and possibly the pinching feeling as well. The burning could be from nerve irritation, an entrapment, a neuropathy, etc. If you do have pelvic floor spasms, compounded vaginal Baclofen suppositories have been helpful for me. A gynecologist, urogynecologist, pudendal specialist, pain management doctor, even the neurologist could help you find the right medications, that can give you some relief.

The EMG will show the health of your peripheral nervous system, the nerves outside of your central nervous system ( CNS- brain/spinal cord.) Any abnormal responses could indicate there is a nerve disorder and certain responses usually point the doctor to which one. The skin biopsy could be looking for a small fiber neuropathy. A SFN (short for small fiber) can cause a burning feeling of the nerves, etc. It is common in the feet, but can be elsewhere. Since your pudendal nerve (which is a peripheral nerve) and your foot feel the same, checking for SFN is a good idea. I am assuming the EMG test you are mentioning is of the arms/legs? That is the most common areas tested. Most peripheral nerve disorders are treatable, so ruling them out is important.

The EMG and skin biopsy will not directly test the pudendal nerve, but if you have a nervous system problem could possibly explain why you are in pain. "I" would personally go through with the testing, because if there is a problem, I would want treatment to prevent further issues. There is an EMG that can be done on the pudendal nerve, but I was told its only 50% correct in that area (from what the pelvic pain doctor from Harvard told me anyhow - and this doctor does do the test.) The EMG of the pudendal nerve is done by some pudendal nerve specialists, but not by the one I currently see (Dr. Hibner.) I decided not to have a pudendal EMG, just a personal choice.

I would think it a good idea to finish the testing with your neurologist/neuromuscular specialist. If nothing is found on tests, then go to a pudendal nerve specialist/or you can go to one regardless. I hope the doctors can help you sort out why you are in pain. It is a real puzzle sometimes. Hang in there!

[momof3bigguys]

thank you for your response..ok,i will go thru with the test im PRAYING that something shows up that will point me in the right direction!!! this has been the longest 7 and a half months of my life and just NEED some answers!!! i forgot to mention sitting is such a issue feels so much worse as i sit here typing..it BURNS soo bad 24 7 but sitting makes it worse!!

[Violet M]

You might want to have your docs take another look at your MRI and rule out tarlov cysts because they can cause symptoms similar to pudendal neuralgia.

There is a type of EMG that is specific to the pudendal nerve but not many docs do them and you might have to travel to one of the PN specialists. It's not totally accurate either so it's probably not something that needs to be at the top of your list until you have a somewhat more accurate diagnosis from local physicians/physical therapists. A PT might be able to help you with the diagnosis but it would need to be someone who is trained in treating people with pudendal neuralgia.

Violet

[momof3bigguys]

thank you both for your knowlegable information... i am just at a loss right now. i had my EMG and skin biopsy yesterday and the dr said they didnt see any type of issues,although i have to wait 3 weeks for the skin biopsy to come back this news was dishearting!! i have been thru so many tests over these last 7 months i am just fustrated!! i guess i have to wait and see where my dr sends me now..
you mentioned something about having my dr re reading my MRI? should it be the spine specialist who ordered it or the neuromuscular dr?

[Violet M]

Mom, not sure what type of EMG you had. The problem with EMG's is they test motor function rather than sensory fibers so they are not 100% accurate in the diagnosis of pudendal neuralgia.

It seems like the spine specialist should be able to tell you if there are tarlov cysts showing up on the MRI although from what other patients are saying, some docs dismiss them as insignificant even when they might be.

Violet