Inferior Cluneal Nerve Entrapment

[Faith]

After reading Dr. Dellon's new publication on pelvic pain and his belief that PN doesn't cause ishcial tuberosity pain I have been thinking a lot and trying to research the inferior cluneal nerve, but can't find much. From what I understand it would cause posterior lower buttock pain like around where the butt connects to the leg, but I've also read it can cause PFD and perineal pain similar to PN. I don't have pain in the posterior lower butt, but I do have pain around the ishcial tuberosities and can't stand for anything to touch them when sitting. I know there are others who have had PNE and had ischial tuberosity pain, but I would hate to have surgery only to find out it's not PNE but maybe another nerve like the inferior cluneal nerve. Are their any other doctors addressing the Inferior cluneal nerve, other than dellon? If not PNE docs who would address this...regular neurosurgeons? I think it's likely that PN blocks also numb around the ICN because with most of my blocks most of my butt was numb along with my pernieum so this doesn't help diagnostically either.

Any input would be appreciated.

[helenlegs 11]

I know Faith, maddening isn't it! we don't always know what to believe. It's confusing enough without contradicting info.
I have looked at the pudendal facebook site a couple of times and one girl posted part of the section of Dr Dellons book that quoted that part about ischeal tuberosity pain (remember Dr Hibner said completely the opposite ' ischeal tuberosity pain is Alcocks canal in the blogtalk radio broadcast)
Anyway back to the face book story, another girl had been to see Dr Dellon, and when he examined her said; because she didn't have buttock or ischeal tenderness she did not have PN ? ? ? There was a bit of a debate about it with different people chiming in.
It's quite a way down the page now posted at September 23 at 1:50am (oh but that's my time sorry) It's late here . Shawn will know what I am on about I think.
Sorry this probably just adds to everyone's confusion.

[Faith]

I wonder if Dr. Dellon was talking about ishcial spine tenderness. This is different than ischial tuberosity of course. I can't remember exactly what Dr. Hibner said in that BlogTalk Radio. I may try to listen to it again sometime. I did find this article which was interesting. http://thejns.org/doi/pdf/10.3171/2008.11.JNS081248 It mostly talks about the perineal branch of the Posterior Femoral Cutaneous Nerve. But a few interesting statements:

"Interestingly, some surgeons have blocked the PFCN concomitantly with pudendal nerve blocks."

"We found that the PBPFCN was on average located 4cm inferior to the ischialinferior to the ischial tuberosity, and this would be the best location at which to inject an anesthetic to block this nerve. Interestingly, Bergman et al.3 have stated that the PBPFCN may pierce the sacrotuberous ligament. Therefore, one could envision compression of this nerve at this location as has been described for the pudendal nerve at this same site."

Sounds to me like PN surgeons might benefit from researching the PFCN a little more. Maybe some of the poor surgical outcomes are because this nerve is entrapped. I can't find any research hardly on what symptoms would be like with this type of entrapement.

[Faith]

This one gives more info about symptoms and diagnosis of inferior cluneal nerve pain http://books.google.com/books?id=ZGA5vz ... in&f=false pg 365

It says:

"A postive diagnostic external ishcial block associated with a negative anesthetic block of the pudendal nerve in the pudendal canal is suggestive of a lesion at this [inferior cluneal] level"

What exactly does this mean? Like someone injects the ishcial tuberosity from the outside and it's postive, but if they inject the PN vaginally it's negative?

[Violet M]

Faith, some people have had relief from steroid injections/blocks into the ischial tuberosity confirming that they probably had ischial bursitis rather than pudendal neuralgia. Have you tried a block there yet?

Great article on the PFCN, Faith. I went ahead and added it to our list of publications on the website here:

http://pudendalhope.org/sites/default/f ... NTubbs.pdf

I changed the other link to the book so that it won't expire:

http://tinyurl.com/3sg9oov

[Faith]

Faith, some people have had relief from steroid injections/blocks into the ischial tuberosity confirming that they probably had ischial bursitis rather than pudendal neuralgia. Have you tried a block there yet?

No, I have not tried that, but ischial bursitis wouldn't cause vulvodynia, would it? Wouldn't the pain be localized to the around the ischial tuberosities?

How would they diagnose infeior clueneal nerve entrapement or involvement of the Perineal Branch of the PFC nerve? From the article I linked to it sounded like an injection into the ischial tuberosity is what is used for blocking hte PBPFCN....is that what you understood?

[Violet M]

You're right, Faith -- some of these nerves/structures are so close together it's hard to isolate them. And I agree that it doesn't seem likely that ischial bursitis would cause vulvodynia.