Femoral Acetabular Impingement (FAI) and Pudendal Nerve

[winged_cent]

The surgeon said several weeks to a month in the few cases that he personally saw.

This study shows spontaneous resolution in 3 weeks to 6 months: http://www.sciencedirect.com/science/ar ... 6813001758.

The prospect of having some kind of flare for up to 6 months is, of course, a source of great worry. I spoke with Lernica, who had the same procedure done on both hips, and she noted that while they did take time to improve, her PN symptoms did not feel worse after the surgery. I just hope that the fact that I have this pre-existing condition does not make the rare side effect of pudendal nerve injury more likely. I have advised the doctor of the issue, and because the tear is small the surgery is likely to be shorter than average (unless they find something else that's not on the imaging). All in all, it's a risk, but given that the alternative seems to me to be muddling ahead with continued PN irritation and no clear way to improve it, I think it's worth a shot.

[winged_cent]

Hi all,

Just wanted to give an update - I had my labral repair/FAI surgery yesterday at NYU Langone Hospital. Everything is going well - and thankfully there are no PN-related side effects or a worsening of symptoms. The doctor said the tear was "moderate" in size and required three anchors to reattach. Of course I'm hobbling around on crutches and have limited mobility, but pain is minimal and I'm only taking Tylenol for it. It'll be a number of months and PT before the muscles fully normalize and I'll be able to see if it'll help the PN symptoms, but I hope that it will!

[stephanies]

Sending healing thoughts your way! Keep us posted.

[winged_cent]

Thought that I'd post an update for those interested.

I am 9 weeks after the surgery. As far as the hip goes, I'm feeling great - I can walk around without limitations and use the elliptical without pain, though I am not cleared for more intensive activity like running as of yet. Hip PT is going well and working on strengthening core and gluteal muscles.

Unfortunately, there has not yet been significant progress on the pudendal symptoms. Interestingly, though over the last several years the symptoms have been associated with tenderness and pain immediately to the left of the coccyx, this has dissipated after surgery: instead there are now some tender areas in the muscles towards the front that did not exist before. The intensity/nature of the nerve symptoms themselves is roughly the same - mostly on the left, tingling/burning, aggravated by sitting, and altered sensation in the distribution of the PN, especially after prolonged sitting.

I also had anther 3T MRI done (not with Potter but at a different NYC facility, last one was in 2014)and it showed "mild asymmetry of the pudendal nerves with minimal increased size on the left as compared to the right, with minimal increased signal" -- basically consistent with the prior MRI, except that that one had shown bilateral irritation. The reason I got it is because upon internal physical therapy, the therapist had found a small "lump" on the left side of the sacrum, and we wanted to make sure that it was nothing serious. Thankfully, that looks like it's just a normal anatomical deviation.

My next steps (in addition to waiting and hoping for improvements) is to potentially start a Restorative Exercise program with David McCoid from "Freedom from Pelvic Pain" via Skype. I also happen to be going to France to visit friends and for tourism purposes, and thought that as I was "in the neighborhood", I would stop in for a diagnostic from Dr. DeBisschop in Aubagne (near Marseilles). I know he worked with Dr. Bautrant in Aix-en-Provence and now has his own facility where he practices a supposedly minimally invasive decompression with a "balloon probe" and is the author of numerous of the articles on PN diagnosis linked to on this website. He does sacral reflexes and doppler ultrasonography, which are not techniques which are used in the USA for diagnosis, as far as I am aware. I feel that with this condition, the more diagnostic specificity the better, and the MRIs' explanations of "your nerve is mildly inflamed without any apparent reason" is not exactly convincing. I'd also like to learn about the balloon method, which seems to be the least invasive of the surgical methods out there and does not resect any ligaments, though I am also skeptical about it because it is essentially "blind" and does not allow visualization of the nerve. I am not considering it for right now, as I must give both the recovery from the hip arthroscopy time to run its course and exhaust all possible non-invasive methods, but if I'm in the same or worse situation one year down the line, it might be an option.

Has anybody interacted with Dr. DeBisschop in any capacity?

[Violet M]

I saw Dr. de Bisschop when he was still working with Dr. Bautrant. If you know anyone who speaks French you might want to go on the French PN forum and see what people there have to say about him. At the time I saw him he was only doing the testing, not surgery. He's nice and I felt that the tests he did gave valuable diagnostic information but I can't speak to his skills as a surgeon.

Violet

[Scotland1]

Hey yall,

I had Cam and Pincer form of FAI with a torn posterior Labrum and I had a Surgery done in Vancouver, Canada. It took almost 4 years to diagnose me and more time being put on waiting lists. I'm 6 months post op and I feel a lot better and my pelvic floor calms down and can take more of a beating before I get a flare up which normally means my Perinial Raphe gets all red and goes all the way to the tip of my penis. They still are not sure if I have PN or my pelvic floor tightens around the nerve and causes this life ruining symptom although after the surgery it clears up in about 1/4 of the time. If you don't have any Arthritis there is a good chance you will recover fine, but be prepared to be on Crutches for about a month maybe less if your labrum isn't torn. My FAI was not detected on the MRA, but my torn Labrum was. I'm at the point now where I'm waiting again to get a Pudendal Nerve block done which I will probably have to wait 6 months for and I am really hoping I don't have FAI in my other hip. Maybe I should get a scan of my other hip done just incase? anyway my Doctor is still trying to get to the bottom of why my Perinial Raphe gets all inflamed. Do any of you have a symptom like that? most of my pain is with sitting and walking too far or over exerting myself which for a former athlete it's been killing me.

[Violet M]

I have known a few PN patients who developed redness in either the perineum or legs/feet but I haven't experienced it myself. Must be difficult to wait so long for treatments.

I wouldn't really call myself a former athlete but I do like to exercise and I know it can be discouraging not to be able to do all of the former activities.

Violet

[Buttercup28]

Hi All,

For those that have had FAI hip surgery and were successful could you please provide details of who your surgeon was?

For those that had the FAI hip surgery and it failed to help them with pudendal nerve pain, could you please provide details on that as well?

Did anyone have surgery with Dr. Bryan Kelly at HSS in NYC? Thoughts on him?

Did anyone have surgery with Dr. Struan Coleman at HSS in NYC? Thoughts on him?

Thanks,

Buttercup

[Violet M]

Several people have posted about these doctors. You can do a search in the upper right corner on the word "kelly" and on "coleman".

Violet

[shljk]

Although I did see Dr. Ernest Sink at HSS before getting set up for hip surgery (not the best appt), I haven't seen Dr. Kelly or Coleman. My right hip scope was done by Dr. Shane Nho at Rush in Chicago. I can't recommend him highly enough. He and his staff took my pelvic pain seriously. They had me stay in the hospital for a 23 hr hold after surgery to make sure they could take care of my pain post-op (since I was on narcotics and therefore had a high tolerance), and they made sure to triple pad the perineal post during surgery. I had no flare up at all after surgery although the left side is really my worst PN side. I have the same issue in my left and I wish I could afford to go out to Chicago again. I'll be going down to Mayo Clinic (I live in MN) to see Dr. Bruce Levy. I've heard good things about him too. I'd advise anyone who is not a professional athlete to stay away from Dr. Chris Larson in Minneapolis. He's supposed to be one of the best surgeons in the country but he is incredibly dismissive to people who aren't young, fit, healthy athletes. Which is odd b/c his wife works at a pain clinic (or at least she did).