Hello i have a question please.
From what i read Ss/St ligaments are the most common site of entrapment for pudendal nerve , is it possible to evaluate this possible entrapment zone in a physical exam ? If so how is this done , involves a rectal examination for men or is possible to palpate it outside ? Also what are the physical examination signs of possible entrapment ? Sorry if my questions are stupid but i am really interested in a answear.
With respect !
Sacrospinous and sacrotuberous ligaments
Re: Sacrospinous and sacrotuberous ligaments
The ischial spine where the SS and ST ligamental grip is can be palpated via the rectum in men, via the vagina in women. The PT or doctor can press on the nerve and the pelvic floor muscles via that route. Some doctors have said that tinel's sign where they press on the nerve helps to determine entrapment. You can read about it here: https://pelvicpainrehab.com/male-pelvic ... ntrapment/
Dr. Hibner discusses tinel's sign in this article. https://www.glowm.com/section-view/head ... a/item/691
"Also, tenderness over the ischial spines and Alcock’s canal is consistent with pain originating from the pudendal nerve. Palpation of this area precipitates a tingling sensation commonly known as Tinel’s sign. Tinel’s sign may also be present when percussing the dorsal clitoral/penile branch as it emerges from underneath the inferior ramus of the pubic bone. Even after a detailed examination, it may be difficult to distinguish whether tenderness is caused by nerve injury or muscle spasm. In these cases, nerve blocks or Botox injections into the pelvic floor muscles may aid in the diagnosis of pudendal neuralgia."
The Nantes criteria discusses palpation of the nerve. https://www.pudendalhope.info/sites/def ... iteria.pdf
"Presence of Exquisite Tenderness on
Palpation of the Ischial Spine
Palpation of the ischial spine (posterior and slightly lateral)
during digital rectal or vaginal examination is very often
tender. This does not constitute a true Tinel sign, as this
palpation is locally tender, but does not trigger the distal pain
described by the patient. Many anatomical structures are
situated at this level, making this tenderness very difficult to
interpret: passage of the pudendal nerve in the sacrospinous
ligament, insertions of the sacrospinous ligament, ischiococcygeal fibers of levator ani muscles, diffuse hypersensitivity.
Furthermore, tenderness of this region is not specific as it is
also observed in asymptomatic subjects. However, unilateral
tenderness at this site is suggestive."
Dr. Hibner discusses tinel's sign in this article. https://www.glowm.com/section-view/head ... a/item/691
"Also, tenderness over the ischial spines and Alcock’s canal is consistent with pain originating from the pudendal nerve. Palpation of this area precipitates a tingling sensation commonly known as Tinel’s sign. Tinel’s sign may also be present when percussing the dorsal clitoral/penile branch as it emerges from underneath the inferior ramus of the pubic bone. Even after a detailed examination, it may be difficult to distinguish whether tenderness is caused by nerve injury or muscle spasm. In these cases, nerve blocks or Botox injections into the pelvic floor muscles may aid in the diagnosis of pudendal neuralgia."
The Nantes criteria discusses palpation of the nerve. https://www.pudendalhope.info/sites/def ... iteria.pdf
"Presence of Exquisite Tenderness on
Palpation of the Ischial Spine
Palpation of the ischial spine (posterior and slightly lateral)
during digital rectal or vaginal examination is very often
tender. This does not constitute a true Tinel sign, as this
palpation is locally tender, but does not trigger the distal pain
described by the patient. Many anatomical structures are
situated at this level, making this tenderness very difficult to
interpret: passage of the pudendal nerve in the sacrospinous
ligament, insertions of the sacrospinous ligament, ischiococcygeal fibers of levator ani muscles, diffuse hypersensitivity.
Furthermore, tenderness of this region is not specific as it is
also observed in asymptomatic subjects. However, unilateral
tenderness at this site is suggestive."
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.