Health Organization for Pudendal Education

Are there any out there? Someone who could identify pathology associated with the SIJ, the SI Ligament, the inguinal ligament, the SSL, STL, piriformis tendon, and whatever else is in there. Is this an orthopeadic issue? And is the hip study separate from all of this? I'm inquiring about imaging and who may be able to interpet/ treat the aforesaid.
It's been my experience that there's a difference of opinion of whether the hips are part of the pelvis or not. Maybe I shouldn't have put in that . There are also many others who don't consider the sacrum part of the spine. OK... the stays.

Any insight/comments?

Kind regards,
Karyn

Karyn, are you looking for a physician only or would you also consider physical therapists or manual therapists? If you want a physician maybe a sports medicine or physical medicine and rehabilitation specialist which is like an ortho surgeon without the surgery training.

Violet

Thanks for the reply, Violet. I was not very clear about what I'm looking for. I guess what I'm inquiring about is the diagnostics available. In other words, could one get a script for an MRI for the pelvic joints/tendons/ligaments and have a radiologist be able to detect pathologies? I know it's possible for the hips. But I've haven't heard of anyone getting imaging for their SSL, STL, inguinal ligament ....

From what I have learned from some doctors and literature is that there would have to be some calcification of the tendons showing on imaging to warrant a problem there being a diagnosis for the cause of (some) pelvic pain.
I have to say that I think this is a little short sighted.
Guidelines to Chronic Pelvic Pain, 2012 (on home page) mentions this;
2.3.3 Muscles and pelvic pain
In the urogenital pain syndromes muscle tenderness and trigger points may be implicated as a source of pain.
Central mechanisms are of great importance in the pathogenesis of this muscle hyperalgesia. The muscles
involved may be a part of the spinal, abdominal or pelvic complex of muscles. It is not unknown for adjacent
muscles of the lower limbs and the thorax to become involved. Pain may be localised to the trigger points
but is more often associated with classical referral patterns. As well as trigger points, inflammation of the
attachments to the bones (enthesitis) and of the bursa (bursitis) may be found
I would say that this could also happen in relation with spasmed and tight pelvic muscles that can cause pelvic nerve entrapment.
The enthesis is where the muscle attaches the tendon to the bone.
I was told that enthesitis or tendonosis can occur as people age anyway, maybe especially if people are fairly active? I suppose it will depend on how much of a problem is reported on imaging and if that can match with a patients current pain and history.
I think that the problem would probably need to be assessed by a physiotherapist as Violet mentioned.
You have raised other valid points too Karyn.
Did you realise that recent European guidelines as to where the lower back ends is 'to the gluteal fold'. So medical notes can mention low back pain but it was not what you or I (or most people) would describe as low back. It could be sacroiliac or anywhere in the pelvis by that definition, although agreed the hip is a separate speciality. So is urogynae section but it can get very confusing if not just plain WRONG sometimes. Thank goodness I do know my bum from the rest.
Interestingly our NHS (NICE) guidelines also mention ESWT for tendinosis, although not exactly 'recommended' just mentioned.
Unfortunately only in connection with shoulders, heels and arse. . . .sorry elbow What was I saying?
Your question does highlight the which bit belongs to which medical speciallity. In our case none!
Helen

helenlegs 11 wrote:From what I have learned from some doctors and literature is that there would have to be some calcification of the tendons showing on imaging to warrant a problem there being a diagnosis for the cause of (some) pelvic pain.

Yes, Helen! That's what I was trying to get at. Thank you for helping me sort out the bungle I made of this thread.
We know imaging is available for (some? all?) joints and tendons of the hips, but aside from Potters MRI's, I've never heard of anyone getting imaging of the SSL, STL, inguinal ligament ...
We also know the STL and SSL can indeed ossify. And don't these things attach to the hips? You had mentioned in another thread that you had hip pain when your piriformis acts up. Is the piriformis tendon imagable?
I was once informed by a PM Specialist, who had a sub-specialty in SIJD and wanted to inject my SIJ with steriods, that the SIJ was NOT imagable. Fortunately, a physiatrist I was seeing at the time strongly disagreed and ordered imaging for it. Needless to say, the SIJ is indeed imagable and the findings were bilateral ankylosisng and bone spurs.
So, I guess this is all an imaging question, really.
Thanks, Helen!
xx

Karyn wrote: We also know the STL and SSL can indeed ossify. And don't these things attach to the hips? You had mentioned in another thread that you had hip pain when your piriformis acts up. Is the piriformis tendon imagable?

I can't answer this with any certainty, I know that a recent posting of someone's Potter imaging did show a tendon issue, no mention of ossification but a definite reference to the tendon so that was image-able.
My own 1T scan also showed 'gross enthesitis' of the medius and minimus glutes. The radiologist went on to report that this was possibly the cause of part of my pelvic pain, although he has noticed PN signal intensity on the right (where it is so he was correct with that.
I have to say that this gross enthesitis is only noticeable if I rub these places and do not cause me pain otherwise. I can also feel this all the way along my illiac crest so glute max too?? I would also say that it's probably from when my muscles went into a major spasm after I (stupidly) kept on going after my fall.
I'd just had a new Grandson so HAD to travel to see him.
I ended up face down in bed for 5 days, stuck! This would not hold up if I had to argue the case however as the radiologist mentions nothing with regard to any entheitis gross or otherwise in my piriformis muscles. That also must be image-able even tho will constitute a smaller area.
I don't know if this will show on the usual MRI, but muscles do so tendons do too??
H x

When I had Potter MRI it have shown bad tendons at hamstring, SI joint problem, some bursitises. I do not know in how much detail it evaluated ligaments of Alakok canal. My physiatrist listed all nerves she wanted to see. May be if she would add ligaments, or tendons, or bursa it would show as well.
After I came from New York CT Scan of affected joints was ordered and have shown problem in more details.
I would have to say that my doctor Dr. Morton could find some problems only by physical evaluation. And she has list of PTs like 'SI joint', 'First rib', 'Second rib' etc. But obviously it is too early to recommend her.

My Potter MRI showed scarring on my ST ligament. But that info doesn't really help me. If you are wanting to know if you have laxity of these ligaments or biomechanical dysfunction in your pelvis then a manual physical therapist is your best bet. Jerry Hesch of Hesch institutes in Nevada seems to be one of the most knowledgeable I've communicated with (haven't seen) as he has a total body approach. Also Diana Lee out of BC Canada has a wonderful website and has trained some therapists in the states. You can contact them and they can tell you if there is anyone else in your area. If you want a doc I agree a physiatrist is probably your best bet.

this is what I want to ask.
Who do I go to, what kind of specialist to discover what structures are causing the PN

Kia kava


How many blocks can we have. You said you had 8 times blocks.


Hopeman