Health Organization for Pudendal Education

Hello! First time posting. I wanted to know if anyone has been diagnosed with pudendal nerve entrapment at the obturator internus muscle? I had 3T MRI by Dr. Potter HSS and by Dr. Carrino JH. The pudendal nerve had inflammation at obturator internus. I have not heard of anyone mentioning this area of entrapment before. I have not been successful in locating information in my research. I also had a 1.5T with Dr. Filler, his impression was piriformis syndrome, but the nerve block was negative. I had a pudendal nerve block at the OI and it was positive. I have all the symptoms of PN for 6 years.

Welcome!

Are you able to post the report for us?

My understanding is that the medial fascia of the obturator internus m. is what forms "Alcock's canal", also termed "Pudendal canal" or "Obturator canal". The nerve can get injured, entrapped, whacked, etc at many different locations along its serpentine course, and Alcock's canal is one of the biggies. It's just amazing to me that so few who sit on a traditional bicycle seat (that hard, narrow kind) get any symptoms at all.

All of us are made a little different, and different variations of branching of the nerve and locations/courses it takes/ reasons it gets 'sick' or 'hurt', make this crazy condition so challenging to pinpoint the exact problem, and thus, the best therapeutic option can be offered.

I asked to have my 3T MRI done with contrast to identify if inflammation were present, but Dr Potter and the neuroradiologist she collaborated with for my scan, said she did not need contrast (so it would not provide info on inflammation, just compression or entrapment or scar tissue).

Hope this helps. Someone else may be able to link up the places where the anatomical drawings/pictures are to confirm.

Welcome, Frickla. If you don't mind my asking, what exactly are the symptoms of PNE at the obturator muscle? Does it hurt to walk?

Lernica

Frickla, I had entrapment at the OI muscle. The nerve runs between that muscle and the levator ani in the alcock's canal. Some of the PN docs cut away a small part of that muscle to enlarge the alcock's canal if they think the muscle is impinging on the PN.

I used to get severe burning on the upper/inner thighs before PN surgery and I'm quite certain it was due to the OI muscle being in spasm from the pain of PNE.

Dr. Bautrant recently told me that nerve pain on the inside of thigh would indicate compression or entrapmet at the OI.

Hello, sorry I have not gotten back to this thread earlier. The pain is mostly centered under the buttock extends to the hip, inside and back of the thigh, pubic bone area, tailbone and it hurts to sit. Pain is reduced with laying down, increased by sitting and everyday activities. Affects bladder and rectum. Hurts more going up hills/climbing. Do you think Dr. H in AZ could address this? My understanding is that he performs PNE surgery at the ligaments, but this is not where my issue is. This area was ruled out by Dr. P in NYC. I was diagnosed by Dr. M in OKC. What to do next???

Frickla, there has been some discussion as to whether Dr. Potter's MRI can rule out PNE with 100% accuracy. You may want to get an opinion based on an exam too if you haven't already, before coming to any definite conclusions on what treatment options to pursue.

I have pain on the inside of the thigh. It extends to the knee. Of the French doctors which ones have the most success in the area of the OI muscle? I did have second opinion and positive nerve block. Any information on doctor M. C. working with M.H. as a route to resolution?

I'm assuming by Dr. M. C. you are referring to Dr. Conway? He decided to use the procedure Dr. Antolak uses.

I don't know which French doctor has the best success with the OI muscle. I think Prof. Robert is probably the most experienced and can decompress the OI nerve if necessary,

Hi Frickla,
Sorry to hear that entrapment in the OI muscle causes so many symptoms. I dont know any of French doctors. Have you thought about Dr. Dellon in U.S?
I think he should be able to help you.
Best, M