Role of nerve block as a diagnostic tool in pudendal nerve entrapment

Object To improve diagnostic accuracy and achieve high levels of treatment success in patients with pudendal nerve entrapment (PNE) syndromes, the author of this study applied advanced technology diagnostics in distinguishing the various syndrome types according to the different entrapment locations and evaluated new minimal access surgical techniques to treat each subtype. Methods Two hundred cases were prospectively evaluated using a standardized set of patient-completed functional and symptom assessments, a collection of new physical examination maneuvers, MR neurography, open MR image–guided injections, intraoperative neurophysiology, minimal access surgery, and formal outcome assessment with the Oswestry Disability Index, pain diagrams, and analog pain scales. Results Four primary types of PNE syndromes were identified based on the different locations of entrapment: Type I, entrapment at the exit of the greater sciatic notch in concert with piriformis muscle spasm; Type II, entrapment at the level of the ischial spine, sacrotuberous ligament, and lesser sciatic notch entrance; Type III, entrapment in association with obturator internus muscle spasm at the entrance of the Alcock canal; and Type IV, distal entrapment of terminal branches. The application of new, targeted minimal access surgical techniques led to sustained good to excellent outcomes (50–100% improvement in the pain score or functional score) in 87% of patients. Most of these patients obtained most of their improvement within 4 weeks of surgery, although some continued to experience progressive improvements up to 12 months after surgery. Conclusions The application of advanced diagnostics to categorize PNE syndrome origins into 4 major subtypes and the subsequent treatment of each subtype with a tailored strategy greatly improved therapeutic outcomes as compared with those reported when only a single treatment paradigm was applied to all patients.

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Concerns about the use of colour doppler in the diagnosis of pudendal nerve entrapment

Pain ◽

10.1016/j.pain.2009.06.009 ◽

2009 ◽

Vol 145 (1) ◽

pp. 261 ◽

Cited By ~ 2

Author(s):

Jacques Beco ◽

Jack Mouchel ◽

Thomas Mouchel ◽

Jean-Pierre Spinosa

Keyword(s):

Pudendal Nerve ◽

Nerve Entrapment ◽

Colour Doppler ◽

Pudendal Nerve Entrapment

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Pudendal Neuralgia Due to Pudendal Nerve Entrapment: Warning Signs Observed in Two Cases and Review of the Literature

January 2018 - Pain Physician ◽

10.36076/ppj/2019.19.e449 ◽

2016 ◽

Vol 3;19 (3;3) ◽

pp. E449-E454 ◽

Cited By ~ 5

Author(s):

Stéphane Ploteau

Keyword(s):

Diagnostic Criteria ◽

Pelvic Pain ◽

Pudendal Nerve ◽

Warning Signs ◽

Nerve Entrapment ◽

Perineal Pain ◽

Pudendal Neuralgia ◽

Red Flags ◽

Pelvic Magnetic Resonance Imaging ◽

Pudendal Nerve Entrapment

Pudendal neuralgia is a chronic neuropathic pelvic pain that is often misdiagnosed and inappropriately treated. The Nantes criteria provide a basis for the diagnosis of pudendal neuralgia due to pudendal nerve entrapment. The 5 essential diagnostic criteria are pain situated in the anatomical territory of the pudendal nerve, worsened by sitting, the patient is not woken at night by the pain, and no objective sensory loss is detected on clinical examination. The fifth criterion is a positive pudendal nerve block. We have also clarified a number of complementary diagnostic criteria and several exclusion criteria that make the diagnosis unlikely. When pudendal neuralgia due to pudendal nerve entrapment is diagnosed according to the Nantes criteria, no further investigation is required and medical or surgical treatment can be proposed. Nevertheless, a number of warning signs suggesting other possible causes of pudendal neuralgia must not be overlooked. These warning signs (red flags) are waking up at night, excessively neuropathic nature of the pain (for example, associated with hypoesthesia), specifically pinpointed pain, which can suggest neuroma and pain associated with neurological deficit. In these atypical presentations, the diagnosis of pain due to pudendal nerve entrapment should be reconsidered and a radiological examination should be performed. The 2 cases described in this report (tumor compression of the pudendal nerve) illustrate the need to recognize atypical pudendal neuralgia and clarify the role of pelvic magnetic resonance imaging (MRI), as MRI provides very valuable information for the evaluation of diseases involving the ischiorectal fossa. The presence of red flags must be investigated in all cases of pudendal neuralgia to avoid missing pudendal neuralgia secondary to a mechanism other than nerve entrapment. Key words: Pudendal nerve, pudendal neuralgia, Nantes criteria, pelvic pain, pudendal canal, perineal pain

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