Femoral Acetabular Impingement (FAI) and Pudendal Nerve

[Patty]

DG the only pain doctor in New England that I would trust to give a pudendal block is Dr Barreveld. She is out of Newton Welkesley. The Clinic I went to was a complete nightmare.....

[DakotaGirl]

Patty,

I remember you- we talked on the phone a while ago. You were a big help to me and I still haven't resolved my problems.
I am going to the deaconess to a uro-gyn today to see if they can shed any light on the urethral pain.

Dr. Barreveld at the Newton? I trust your opinion and will keep this in mind. It could be genitifemoral too? My pain mgmt dr wants me to rule out pelvic issues before he does anymore nerve blocks on my hip or spine.

Thanks for jumping in here. Hope you are Better than when we last spoke.

[DakotaGirl]

Patty
Elkadry was recommended. You didnt have good luck there did you? They said she does Botox to the pelvic floor that's what I have. PFD. Also told to go back to pt with elkadry doing Botox under anesthesia or trigger point injections into pelvic floor.

[Patty]

I just sent you a long pm. Both the trigger points and Botox are not done under anesthesia sorry to say. The trigger points hurt like hell. Like brutal. Never did Botox dud not see the point.

[Schnick86]

Thank you everyone for your replies! I really appreciate everyone's input, and apologize for my late response.

DakotaGirl - I am so sorry to hear about how horrible your pain has been, and what a rough road it has been for you. I will keep you in prayer, and hope that you can get some answers and improvement soon.

Janetm2 - Thank you for the information, and the input, I think that conservative is always the best option too...I just feel like I have hit a brick wall and may need intervention.

Stephanies - I think we are going to go get a second opinion with Dr. Coleman in New York, thanks for the advice.

RJR - I have had both types of pudendal blocks. One through the buttocks (x-ray guided), and 2 others transvaginally. I only had success with the transvaginal approach in getting any relief. Interestingly when I had the block, my hip still hurt, but the pain was localized only to the hip. Where as when the block is not in affect, I have radiating pain from hip to the pudendal nerve and the pudendal nerve to the hip. When I had an intra-articular steroid injection to the hip, everything seemed to feel better, even the pudendal nerve, however I was not pain free, but much improved. This is why they think my hip is contributing to my pain. (See below) However, a month and a half out from the hip injection, the pain is significantly worse again.

In my journey, I have seen several specialists (Physical Medicine and Rehab, Urogynecology, Vulvodynia Specialist (OBGYN), Orthopedic Hip specialist, Psychologist, 2 Pevlic floor Physical therapists and a hip therapist). I have had 4 MRI's (hip, pelvis, siatic plexus, lumbar spine). I have tried Neurotin, diclofinac (NSAID), Transvaginal Nerve blocks with and without injected steroid, Cortisol injection to the hip, and also another cortisol injection to the flexor tendon. I also tried tramadol this past weekend, when I had such a bad pain flair after trying some Hip PT on the elliptical for 8 minutes (Almost had my husband take me to the ER.) Unfortunately, I had a horrible adverse reaction, and developed myoclonus, (uncontrolled twitching of the muscles of the body). Needless to say, no more Tramadol for me! I have tried several months of pelvic floor physical therapy, which I was unable to tolerate due to pain, and I have now transitioned to Hip physical therapy, which I have only had 2 sessions. I did 6 minuets on a recumbent bike today, and a couple exercises on the table of about about 6-8 reps and I could barely walk when I got home, let alone sit without having excruciating pain to my hip and radiating to my right groin. I am just frustrated because my pain has gotten worse over the past several months despite interventions. I would think if it was just the nerve damage, I should be feeling better as it heals with time. So, the thought is that the nerve is just constantly being inflamed by the hip, and especially when I do to much activity. So do you fix the hip, to eventually fix the inflammation on the nerve so it stops the chronic inflammation, and allows the nerve to heal?

My Orthopedist doesn't want to touch me with a ten foot pole right now, because my nerve is so flared. He agrees that there is sufficient data to support that the traction needed during surgery would potentially stretch my nerve even more, and potentially cause more damage. So I feel like I am in a catch 22, don't fix the hip, continue to inflame the nerve, but fix the hip, and potentially damage the nerve even more... I have come to the realization that even if I have surgery to fix the hip the pain won't go away until the nerve heals. But, I want to be able to be active again without having to continue to flare my pain so bad that I am bedridden for 2 days.

In the meantime, I am trying to chase around my 8 month old son who just started to crawl this week... I don't know how to manage my chronic daily pain, while trying to care for him, my husband, and myself...

Thanks for listening. I appreciate any help at this point.

Sincerely,
Schnick86

[Violet M]

Schnick, if there is any chance you have pudendal neuralgia I would be very cautious about using the elliptical or the recumbent bike. I understand your love of exercise because I am a bit of an exercise freak which is what got me in trouble in the first place. The elliptical machine made my symptoms worse. Is the PT you are seeing trained in treating people with pudendal neuralgia? I'm just surprised they would have you doing these types of activities for PT. It's no wonder your symptoms are flared up.

I think it makes sense that you need to allow the nerve to heal and that may take some time. That doesn't mean you won't ever be able to exercise again though, so keep your courage up because with the right treatments you will most likely get better. There was a time I didn't see how I could ever exercise again but I'm doing great now. I'm just saying that it doesn't sound like exercise is the right thing for you right now.

Sounds like your choices right now are to stop the exercise and wait to see if the nerve heals or to go ahead with the hip surgery. Can you get a second opinion from an orthopedist who is more experienced in treating people with PN?

Violet

[Carlie]

Hi, My SI joint is giving my pain doctor fits. He keeps injecting it (thought it was a tear, unhealed) and is frustrated because nothing seems to help. I fell on my "bottom" accidently prior to a spinal surgery, and during the surgery, I developed PNE. Over time, I developed arthritis in the right hip and lower back. Presently, the pain doctor injects the nerve endings (burns the nerve endings off), in effect. I may have pain but I will not feel it. This is done every six months, with me sedated. After a 24 hour downhill ride; I feel better, much, much better in a few days. Bayer is my pain med. I did not know what was wrong and had no idea that I had arthritis to the extent I did. One morning I could not move out of bed - the pain was that bad from my waist down. I found the doctor at a medical school here; he just started here when I finally got into the center. There are three PNE patients there now and he is doing everything he can to alleviate some of this distress. I am in the midst of trying to sell a large home and move cross country; I need to go back to Hibner in Phoenix but I am jammed to no end right now. My front yard drown due to too much rain and I am trying to take care of first things first. There is no time to rest it seems. Monday, the pain doctor injects the SI joint again. It gives me grief along with the PNE, all rolled into one. I cannot complain, things have been worse and I am getting some relief now. The SI joint and the hip seem to bother a lot of PNE patients. This is a new area for me, the hip and SI joint. Interesting. I hope you are feeling better. PNE treatment has come so far. The women's physical therapist at the medical school is really sharp and stretched the ligament that was replaced. She is very good. I highly recommend a medical school women's physical therapist; a lot of private practices do not allow a lot of time for individual hands-on work that PNE requires and the schools do allow the individual work time. She is sharp, really sharp. FAI sounds if it is no fun and games for sure. I hope you feel better. Good medical care helps. Carlie

[winged_cent]

My experience may be helpful for you.

I too have pudendal nerve symptoms couple with (very mild) FAI and a labral tear. My PN symptoms are 95% on the left side, as are the hip issues. A peculiar aspect which I have never been able to fully understand is that the PN symptoms (nerve tingling/burning) are somehow connected to soreness on the left side of my coccyx provoked by sitting, and are partially diminished by sitting on something hard on that side (like a golf ball).

Anyway, I have gone through many rounds of pelvic PT with specialists in New York (including Stacey Futterman, who works with the HSS surgeons). While originally I had actual pelvic floor trigger points, those were resolved without eliminating the symptoms, and my pelvic floor is fine, a "little tight" at worst, as they say. However, the symptoms continued, and they urged me to get my hip looked at. I have also been up to Canada for the treatment with the chiropractor Dr. Kirk Andrew, which did not resolve my symptoms, and gotten two pudendal nerve blocks (they were positive diagnostically, but the cortisone did not provide any lasting relief).

I am pretty sure I don't have some kind of bona fide PNE entrapment; in addition to the symptoms being comparably mild in degree compared with others on the forum, it seems that true entrapment would not vary based on muscle manipulation such as PT, sitting on a golf ball, etc. It must be some kind of muscle dysfunction pressing down on the pudendal nerve - and the mechanism may or may not be related to muscles adapting poorly to the labral tear/FAI.

My actual hip symptoms are very mild - I have virtually no pain walking, using the elliptical, or going up/down the stairs. I do have mild pain with deep hip flexion such as lunges and prolonged running, and I get pain if I try to sleep on my left side.

I would not be going for surgery if not for the PN issues, and no orthopedist or physical therapist can guarantee me that it is actually going to help. However, at this point, I do not know what other treatment to pursue. Therefore, I will be getting hip surgery on June 1. I am young (28/M) and the doctors/PT say that should make recovery speedier.

I am also concerned about the fact that pudendal nerve injuries are possible as a side effect of the surgery itself. It does scare me, but the physical therapists which I have worked with (Stacey Futterman) have said that it hasn't happened to their patients - and while some did not improve from the surgery, nobody got worse (after proper rehab). I also take solace in the fact that both the literature that I have read and my doctor's statements as to the patients they have had (my doctor said it happened 2 or 3 times over a decade of doing such surgeries) are that any PN injury is a time-limited neuropraxia, a one-time event caused by the nerve's stretching. That still sounds awful to somebody who already has this condition, but if the procedure has any possibility of resolving the underlying muscular problem causing the PN, that's a risk I'm willing to take.

I can keep you updated with how it goes!

[wannagetbetter]

Winged_Cent - Did the doctors estimate how much time your PN might possibly be affected by possible stretching of the nerve?

[Violet M]

Wishing you all the best with our surgery. I will be interested to hear how it goes for you.

Violet