Health Organization for Pudendal Education

I visited a neurologist today who isn't familiar with PN, but wants me to have an EMG because I have burning in my feet at times. She says the pudendal nerve shouldn't cause this. The EMG is of the sacral nerves I believe. I don't know that I want to go through with this especially since the Dr. isn't PN aware. But I noticed that EMG is listed as a tool on the diagnostic work up section on this site. Have others on here had EMG's and if so are they specific to the PN (or is that only the PNMLT that is specific)? I don't want to waste more money or time trying to get a diagnosis, but I don't want to miss something either.

Hi Faith,
I suggest you try to hook up with doctors that are familiar with PN.
Best regards,
Karyn

Karyn,

You are Johnny on the spot, aren't you I always appreciate your quick replies. Yeah, I agree. I just called to talk to the EMG technician and the doctor ordered an EMG for sacral radiculopathy. She said there is a specific pudendal nerve study, but they didn't order that (of course). Why is it so hard to find doctors that deal with PN?! By the way, it's been 4 weeks I've been waiting for my phone consult with Dr. Conway and I called their office today and he's just still backed up. I also called Dr. Hibner's office and found out in order to get an appt with him I've got to get all my records sent to him (that will take a while).

But is it true that PN won't cause burning in the feet (I have no burning in my legs)? I think there are others on here who also have feet pain, right?

Hi, I'll take a stab at answering some of your question, and will cite an article given to me by my local neurologist, Director of Clinical Neurology at George Washington University Hospital in DC. He is board certified in Neurology, Electrodiagnostic Medicine, Clinical Neurophysiology, Pain Medicine...and with Clinical Interests in Peripheral Neuropathy and Pain Management. He is also rated a top doc in DC by his peers (ie who would they go to). I sought him out for his expertise and opinions in tests like PNMLT. I considered him my second opinion (no ax to grind) as I headed to surgery on 11/1/10.

OK, the article: http://www.ncbi.nlm.nih.gov/pubmed/17996810
"What is the place of electroneuromyographic studies in the diagnosis and management of pudendal neuralgia related to entrapment syndrome?"

The takeaway he cautioned me about was an electrodiagnostic like the PNMLT has "limited sensitivity and specificity in the diagnosis of pudendal nerve entrapment syndrome and does not give direct information about pain mechanisms." So in his opinion, it has limited value. And under the Nantes Criteria for PN, the PNMLT is not an essential criteria, but rather a complementary one.

In my case, my pain has always been on the Right side. My PNMLT was perfectly normal on the Right, and abnormal on the Left. My "Potter MRI" was normal on the Left, and was validated perfectly by surgical observation on the Right. Just my experience....

Re: feet pain, when I occasionally experienced pelvic floor spasms, the pain would refer down my inner thigh and to the ball of my foot.
RR

Here is the abstract RJR linked to:

Neurophysiol Clin. 2007 Aug-Sep;37(4):223-8. Epub 2007 Aug 2.
What is the place of electroneuromyographic studies in the diagnosis and management of pudendal neuralgia related to entrapment syndrome?

Lefaucheur JP, Labat JJ, Amarenco G, Herbaut AG, Prat-Pradal D, Benaim J, Aranda B, Arne-Bes MC, Bonniaud V, Boohs PM, Charvier K, Daemgen F, Dumas P, Galaup JP, Sheikh Ismael S, Kerdraon J, Lacroix P, Lagauche D, Lapeyre E, Lefort M, Leroi AM, Opsomer RJ, Parratte B, Prévinaire JG, Raibaut P, Salle JY, Scheiber-Nogueira MC, Soler JM, Testut MF, Thomas C.

Club d'électrophysiologie périnéale (CEP), service de physiologie, explorations fonctionnelles, hôpital Henri-Mondor, AP-HP, 51, avenue de Lattre-de-Tassigny, 94010 Créteil cedex, France. jean-pascal.lefaucheur@hmn.aphp.fr

Abstract

Entrapment of the pudendal nerve may be at the origin of chronic perineal pain. This syndrome must be diagnosed because this can result in the indication of surgical decompression of the entrapped nerve for pain relief. Electroneuromyographic (ENMG) investigation is often performed in this context, based on needle electromyography and the study of sacral reflex and pudendal nerve motor latencies. The limits of ENMG investigation, owing to various pathophysiological and technical considerations, should be known. The employed techniques do not assess directly the pathophysiological mechanisms of pain but rather correlate to structural alterations of the pudendal nerve (demyelination or axonal loss). In addition, only direct or reflex motor innervation is investigated, whereas sensory nerve conduction studies should be more sensitive to detect nerve compression. Finally, ENMG cannot differentiate entrapment from other causes of pudendal nerve lesion (stretch induced by surgical procedures, obstetrical damage, chronic constipation...). Thus, perineal ENMG has a limited sensitivity and specificity in the diagnosis of pudendal nerve entrapment syndrome and does not give direct information about pain mechanisms. Pudendal neuralgia related to nerve entrapment is mainly suspected on specific clinical features and perineal ENMG examination provides additional, but no definitive clues, for the diagnosis or the localization of the site of compression. In fact, the main value of ENMG is to assess objectively pudendal motor innervation when a surgical decompression is considered. Perineal ENMG might predict the outcome of surgery but is of no value for intraoperative monitoring.

PMID: 17996810 [PubMed - indexed for MEDLINE]

Thank you so much for the info. I'm scheduled to have an EMG in January and am not looking forward to it to say the least. I'm seriously thinking that Dr Potter's MRI is the way to go.

Hi Griff,
If it's at all possible, I strongly recommend the 3T MRI. I wish I was aware of it before I went through the slew of doctors, nerve blocks, infustions, PT, etc ....
Even if you don't have PNE, the images would at the very least point you in the direction you should be heading in; instead of spinning your wheels. It may save some traveling.
For instance, take your appointment with Dr. C in January as an example: Say you have your appointment with him, you have the EMG and it shows abnormal nerve conductivity.
Now what? You've already done the PT and you've already had nerve blocks. You've also done the med trials. Do you want to keep doing what doesn't work over and over again? It's very possible Dr. Conway would offer you TIR surgery. If surgery is presented to you, after you've exhausted all other means of conservative therapies, with no improvements, you then have to consider if you're comfortable with the TIR approach or not. If not, that means traveling to yet another doctor. While the 3T MRI isn't currently changing the surgical techniques, I think it's at least an explanation as to why all the treatments you've gone through haven't been effective.
Warmest of regards,
Karyn

I just want to add one more thing, Griff. Say you keep your appointment with Conway and have the EMG and it comes back with normal nerve conductivity. What then?
You know something is definitely wrong but now the big question is WHAT??? The 3T may pick something up that isn't pudendal related but would still have the potential to explain your pain.
I understand this is all very overwhelming. And the related expenses are scary and overwhelming, too! Please know, that whatever you decide, you have my utmost support.
Hugs,
Karyn

Hey Karyn, you mustve been reading my mind

What I want to do is continue with my PT for now, schedule a MRI with DR Potter and see what the results are. If there is no entrapment or problem and my current PT doesn't improve my pain, then I want to travel to Jerry Hesch. If there is entrapment and some kind of surgery is needed I would probably try to see Hibner. That's the plan I have been considering. Now I need to talk it over with my husband and get him onboard.

Hi Griff,
I'm really glad you're seriously considering the 3T. I'm even more happy to hear you're considering Hesch!!! It sounds like you have a solid plan and I wish the very best for you. Please let me know if there's anything I can do to help, or if you just need a shoulder or an ear!
Warmest regards,
Karyn