Sitting Pain: Is it PN related?

[pmurali1]

Hi,

My symptom is having burning sensation when sitting for more than 20 minutes at medial aspect of Right Ischial Tubersoity region. I am having this problem for the past 7 years. MRI done from Hibner ( St Joseph hospital) and Hollis Potter doesnt say any problem with Pudendal nerve and also Dellon mentioned the same that there is no Pudendal involvement. I do have SI joint point but this not bother me every day.
But I am confused now as how to proceed further. Please share your thoughts
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Potter MRI Impressin on Sep-6-2013
MRI of pelvis demonstrates no scar encasement pf posterior femoral cutaneous nerves adjacent to ischial tuberosity
although there is hamstring tendonosis without tear.There is mild asymmetric thickening of right
sacrospinous ligament effacing the fat planes of adjacent right pudendal nerve.

Hibner MRI Impression - Mar-2013
No MRI evidence of pudendal neurovascular bundles asymmetry. Correlate with clinical symptoms of pudendal neuralgia

Dellon diagnosis: Nov-6-2012
It is my impression that you have perineal branch of PFCN adherent to muscular scar region at the hamstring origin, despite MRI not demonstrating this. The perineal branch of pudendal nerve might be stuck in this region too, but your butt pain with sitting does not go into territory of the pudendal nerve, but rather hurts just at this location.

Pudendal Blocks:
Two pudendal blocks on Jan and Mar 2012: does not get any relief
Two Block at Alcocks canal: Apr and Oct 2012: Did not even had any numbing sensation and did not find any relief

MRI Lumbar spine is normal.

[Violet M]

I noticed you have some thickening of SS ligament on the side where your pain is but I don't know how significant that is.

If you have a nerve block and it doesn't cause a loss of sensation or at least some numbness in the PN distribution area you have to wonder if the block even reached the target area. Did you have temporary relief -- even for an hour or two -- with any of the PN blocks?

Do you have any tenderness when your physical therapist presses along the course of the pudendal nerve at the ischial spine or alcock's canal?

Violet

[pmurali1]

I am not sure whom to consult with again. In St Joseph hospital in Phoenix, I had 30 to 45 min evaluation from physical therapist Loretta Roberstson. She tried to palpate ischial spine and the alcock region but did not produce any pain.She said my problem was some tightness in superficial muscle and asked me to undergo soft tissue release near the ischial tuberosity region. Later Hibner diagnosed me and said that 90% of the time his physical therapist opinion is true and he just prescribed some muscle relaxants..

I had complete numbness both the times when I had block at ischial spine region. My symptoms will not be immediate and have to sit continously for more than 20 to 30 mins to reproduce. But I did not notice much difference after the block after sitting for about an hour. I noticed mild numbness at the alcocks region during both the blocks and the not much improvement with the burning.

As per recent MRI report from Dr Potter, will this burning be from untreated hamstring tendonosis?

Murali

[Violet M]

I don't know that much about tendinosis but here is an interesting article about it.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312643/

http://tinyurl.com/qfuplhz

Violet

[jon]

Hi,

I had Dellon cut the perineal branch of my pudendal nerve but it was no cure for me. It did get rid of the trigger point in my perineal branch that had developed after a couple years of testicle-like pain (I had already had an orchiectomy on that side that did not help). He also cut the genital branch of my genitofemoral nerve earlier and that did not help at all.

As they say, desperate times call for.....

I did a trial implant of the new DRG nerve stimulator that's in clinical trials. Before I get the full implant I am considering trying Dr. Hollis Potter's MRI because you can never get another MRI once you get a full implant.

Are there any success stories on pudendal hope of people who got this MRI? What did they do after the MRI that helped them. Anyone?

Jon

[konedog4]

Have you considered shock wave therapy directed at the painful tuberosity? It may help. Shockwave is the only therapy (I am not considering surgery) that has helped me improve. Shockwave therapy followed by stretching to keep the area loose and limber and prevent scar tissue formation. Who do you respond to stretching that area?

kone

[rugby]

Can the shockwave therapy break up scar tissue on pudendal nerve. Where can u get shock wave therapy.

[Violet M]

Dr. Kirk Andrew in Canada. He's listed on the website under Canadian physicians although I think he is a chiro, not an MD. There are other places that do it but he specializes in ESWT for pudendal neuralgia since he had it himself.

Violet