Dr. Elkwood's concern is that physicians may take an approach that is too compartmentalized when diagnosing the cause of pelvic pain, rather than considering all of the possible causes. Pudendal neuralgia may be just one of the factors contributing to the patient's pain.
Process used to make a differential diagnosis may include the following (not necessarily in this order):
Dr. Elkwood uses a surgical approach that is appropriate to the patient’s needs. He believes in a minimally invasive approach if possible.
Double Crush Phenomenon
Considering the nerve to be one cell; the nerve may swell proximally as well as distally. If only the distal portion is treated, pathology may remain and continue to cause pain. (Sewer pipe analogy – pipe may be clogged out at the street but may also be clogged at the kitchen drain. If the clog at the street is removed but the clog at the kitchen drain is not removed the sink backup may continue.)
During surgery, free-running intraoperative EMG is used, in particular for motor nerves. This allows for mapping and to confirm that the proper nerve is isolated. The amperage of the current needed to elicit a response in the muscle is measured prior to release of the nerve and post release of the nerve. There can be a significant difference in the amount of amperage needed to stimulate the nerve prior to release as opposed to post-release of the nerve. If a patient has a significant improvement in that measurement, it can indicate a more favorable outcome.
Sacrotuberous ligament spared if possible but if the pudendal nerve is entrapped in that ligament it may be severed.