PN is a simple nerve compression and can be decompressed now Robotically

[kimc]

I am a retired Internist and pain physician. My personal history of bilateral PNE following a Microwave Prostate Procedure in 2023 (age 50) follows along so many others who report their pain journey on this site. Because this condition does not show up even on MR Neurography, Nerve Conduction Tests, CT Scans etc, there has been inherent misunderstanding of PNE as a cause of severe chronic pain. Thanks to dedicated work from the now retired Stanley Antolak, there are clear objective clinical findings on the physical exam of ALL of these patients that have a true Pudendal nerve compression. That is simple touch and pin prick! All patients with significant PN compression will have an abnormal sensory exam of the PN. Specifically, Hypersensitivity, Dysthesia, and/or Allodynia (touch feels sharp/painful) in the distribution of the PN Branches is enough to make the diagnosis. A nerve block in Alcock's canal can be done to further confirm this, but is no longer necessary to confirm the dx.

Aside from giving patients some solace in knowing that their daily sitting, standing and often even lying down pain has a reason has a positive psychological impact Dr. Antolak's work has also has helped drive insurance companies to pay for attempts at Pudendal Nerve Decompression. Almost all nerve pain comes from nerve compression. It is to be expected that as the day goes on, the PN, trapped between S-T and S-S Ligaments will get ever escalating pain. That worsens as the day goes by, and is why most patients start out with minor pain in the am which becomes quite miserable until they can get onto their left or right side at bedtime.

Attempts have been made, primarily by plastic surgeons, some by Dr. Antolak, some by European surgeons to decompress the nerve by cutting and sometimes removing the S-S ligament and cutting the S-T ligament from an "external approach". Surgery has demonstrated these ligaments to be thickened, leathery and even ossified which trap, scissor or compress the nerve. That is why the patient cannot find a comfortable position. The initial external approach has been trans-perineal. This was followed by mainly plastic surgeons using a Transgluteal Approach. This requires cutting the gluteal muscle (s) and approach the ligaments that way. It is a painful approach but worth if if decompression achieved. These surgeries cumulatively report a reduction in pain at around 75% of the time. Generally a reduction, not full relief! Technically this is a difficult approach to get at the pathology in the ligaments and to clearly see what is the cause of pain. Worse, it makes it hard to get a wide enough surgical field to relieve all the compression points. This is further complicated by at least 13% of patients having anatomical variants in the PN distribution and this approach will make it hard to detect and relieve that ( as reported by Dellon)

Tibet Erdogru was the first to report 14 cases approached laparoscopically in 2014. This approach clearly gets better exposure, a better view of the PN and the ligaments and does not require cutting muscle. His original report showed improvement in pain level in 81% of operated patients. His results have been reproduced in various case reports since that time. Technology has improved the procedure dramatically.

What appears to be a big improvement in outcome for these patients was several MD's in Europe, one gynecologist in New Jersey( Dr. Shakiba), and Dr. Tibet Erdogru in Istanbul Turkey is Robotic Laparoscopic Surgery. With the Da Vinci Robotic approach, the surgical field is magnified and the steadiness of the instruments gives the surgeon both the excellent visualization and control needed to release the nerve from its compression points. The results of this would be expected to be in the 90 plus percentile in pain relief due to this and the obvious relationship of this occult nerve compression to the pain. The case numbers are too low to guarantee that, but the pathophysiology here is obvious and release of this compression should, over time, be little different from other nerve decompression surgeries ( Carpal Tunnel, Morton Neuroma, Lumbar Disc, etc).

The use of Da Vinci has accelerated in both Gynecology and Urology and I expect those surgeons will ultimately be the surgeons of choice for this nerve decompression procedure (neurolysis). The plastic surgeons have been limited by their "tool" and the need to approach from the outside. Even that may be improved as it becomes accepted that this is simply a nerve compression syndrome, not som vague condition. For instance, Carpal tunnel surgery can now be done as a microsurgery with a scope introduced thru the wrist. It is time to innovate as the pathology is clear.

This also explains the lack of any evidence for treatments such as Steroids, Gabapentanoids, Anti -depressants, Physical Therapy and mindfulness. While the latter can improve how one processes pain in your brain, even to near elimination of pain in a few, it will not relieve a compression pain signal from an ossified ligament rubbing on a thin nerve with the consistency of spaghetti!

Cryoablation or other forms of simply "killing the nerve" can still be done in the patients who do not respond to decompression. That is not an ideal approach, but it is far more livable than the typical pain from Pudendal Nerve (often Bilateral) Compression. I would consider that a back up position. Having had this for 23 years myself, I was prepared to do that if Dr Erdogan was unsuccessful. However, he relieved 90% of my pain as of surgery on 12/8/25 and I continue to see small improvements from there. My pain is so much less and so much more tolerable that that is no longer a consideration. I marvel as I am lying on my butt here writing this note. In months prior, I would already be facing 7/10 bilateral ischial tuberosity pain after just 30 minutes of typing this. I am sitting at 1/10.

Lastly, I have seen others who describe this pain "as hell". I can relate to that to that exact description. It is not hyperbole. 20 years of hell from a nerve compression from a burn from a microwave prostate procedure that interfered with sitting, lying and standing every day.... Sometimes you wonder how you survived it! That is not to mention all of the life threatening steroid complications I got from Steroids and the hundreds of thousands of dollars spent trying to relieve this pain and treat the complications.

In terms of cost. Plastic Surgeons typically expect cash payment and the fees I have seen mentioned in this blog represent, in my opinion, the desperation of the patients in pain and their willingness to do anything to get rid of the pain. In fact, if I had to , I would have literally paid over a million dollars to get rid of this pain. But, the severity of pain should not be the price tag for a surgery. It is the complexity and time it takes. Da Vinci Surgery should be covered by insurance in the future and be accessible to anyone with this devastating pain syndrome.

Luckily, even paying case, the charge from Dr. Erdogan was US $13,000 and the 3 day hospitalization and surgery costs was $6000. Hotel, food and Travel costs to surgery have to be added to that. I did do some touring while I was there. Some great sites to see in Istanbul!!

[Violet M]

That's a very hopeful story about your successful surgery. Glad to hear you are doing so well. Most people who have posted on this forum have had a much longer recovery from PNE surgery than you, so you are one of the lucky ones.

the charge from Dr. Erdogan was US $13,000 and the 3 day hospitalization and surgery costs was $6000. Hotel, food and Travel costs to surgery have to be added to that.

Did you mean to say Dr. Erdogru?

Best wishes for some good years ahead,

Violet

[kimc]

My mistake, Dr. Tibet Erdogru.

I agree with having some degree of luck as my nerve has been compressed for over 20 yrs. it could have been so damaged that I would have no relief. It is still possible that I will not get the final 10% of relief I would hope to get. There is reason for that hope and why I felt it was worth trying in the first place.

In my entire time with PNE, my pain would start the day at 1 to 2/10 and then escalate to 7/10 by the end of the day due to the effects of sitting/standing and even laying on my back to read. Once on my side, there would be deescalation after 30 to 60 minutes and I could sleep. Of course, with my pain being so much better on my sides, I would tend to "waste" 1 to 3 hours in bed in the am, enjoying the relief, but hating the need to be in bed. The point being is that since I clearly had a mechanical component to my pain, relieving the compression could still lead to significant pain relief such as I have experienced.

The pain relief makes me think as an MD that the nerve was never completely dead from compression and still has room to improve. Since my Sacrsospinous ligaments had ossified bilaterally, it was clear to Dr. Erdogru that they needed to be removed and not just cut. Just cutting a "thickened ligament" would have been his preference. If just cut, some bony spur from the remaining ligament could have been left behind to torture me with sitting in the future.

What is the risk to me due to cutting SS ? From my AI search, the SS ligament contributes to pelvic stablity, but known clinical syndromes from removing them are not known in the literature. Clinically, I would expect it would be a bigger problem for a younger, athletic person. There is a person identified as "Ali" on this site who has had numerous complaints posted on this site following the laparoscopic approach to PNE by Dr Erdgru circa 2014. It is important to note that he did not have the Robotic Laparoscope, a.k.a. Da Vinci, as it was not available then. This important diagnostic and treatment tool could well have made a difference for his case as the visualization of the PN and the steadiness of the cutting instruments are exponentially better.

Functionally, the SS ligament gives improved pelvic stability and ideally would only be cut, not removed. But, when inflammation from prior injury (in my case, microwave burning of my prostate) leads to progressive thickening of both the SS ( SacroSpinous) ligament and the Sacrotuberous ligament (ST). The ST only required cutting as it had not ossified (turned to bone).

It is notable that ossification of the SS ligament is a sign of chronic ligamental damage and IS associated with pelvic pain and PNE, ref: https://pmc.ncbi.nlm.nih.gov/articles/PMC11144494/

At age 72, I doubt I will have any effect on my normal activities by losing some pelvic stability. I can hardly imagine a pain worse than what I have had for over 20 years and it is chance I am willing to take. Again, it has been a month and I see no ill effect from losing the ligaments. I will report such side effects should they arise. In terms of positive effects, I am lying down as I type this with at most a one-half over 10 pain ( after 30 minutes +). In the past, that would have already been 3-4/10 and escalating by the minute from an ache to burning. I am sure many of you can relate.

[Violet M]

Thanks for the clarification and the information you've provided.

Dr. Bautrant told me that my SS ligaments were hardened and sclerosed when he did my surgery over 20 years ago. I don't know if that meant they were ossified like the article you posted describes. I did not have the ST ligaments cut -- just the SS ligaments, because I already had pelvic instability and I didn't want it to get worse. My recovery took way longer than yours though - 9 months before I could go off pain meds.

I would be interested to know why you waited 20 years for PN decompression surgery when you were in so much pain. Is the medical community still pretty much in the dark about this disease and you just didn't have an accurate diagnosis, or were you hoping conservative treatments would work? If you would rather not answer that's fine, but it's sad if the diagnosis is still not widely known in the medical community.

Violet

[kimc]

Happy to answer.

The United States and basically the entire world is still way behind on this diagnosis. Probably the main reason I hesitated on surgery is that I was certain the cause of my pain was my microwave prostate surgery. The plastic surgery procedures which approach the ligaments from the perineum or buttocks, clearly, do not give enough exposure that the surgeon could inspect the prostate bed here. Since I felt that could be scarred as well, I did not think that type of surgery would be helpful and possibly could be harmful. That is, because the tissue trauma that will create, will create its own swelling and irritation in the area of the pudendal nerve. Hence the mediocre results they report.

My pain journey started in November 2002 following a microwave prostate procedure. The pain started approximately three weeks, post procedure and escalated progressively with sitting and movement over the next one year. It was misdiagnosed as prostatitis multiple times. Like so many patients, I had to make my own diagnosis. Having read a Cleveland clinic review of complex regional pain syndrome approximately two years after the pain syndrome began, I noted that I had the Peau de orange skin changes seen in occult that nerve compression syndrome. I could see those skin changes in my perineum and perianal area. This along with the severe Allodynia I had convinced me that I had the CRPS, which is also known as reflex, sympathetic dystrophy. What do I mean by Allodynia? In my case, it meant that a innocuous sensation such as light touch felt like someone was scratching my pudendal territory on both sides with a pin. Subsequence to that self - diagnosis, I saw Dr. Stanley Antolak in Minnesota who confirmed the diagnosis twice with a nerve block. This was helpful information, psychologically as at that time no one truly believed my pain safe for Dr. Antolak, but, it didn't stop it from hurting. From there, I found how truly inadequate treatments for this complex regional pain syndrome from nerve compression was. On the plus side, it did make me challenge the area and actually sit on it and put myself through even greater pain so that I could reverse the skin changes on my perineum and buttocks. That worked, and had I not done that, I think my Pain would’ve me gotten much worse as as total avoidance of putting pressure on the area causes a very painful nerve response from your autonomic nervous system and peripheral nerves when you have a nerve compression such as I had.


being a physician, I did have access to the best doctors and multiple types of treatments. Unfortunately, the tools they had it. Their disposals were never going to completely work. I tried all the usual medication's, which include antidepressants, Lyrica, Neurontin, Trazadone, Cymbalta, and many narcotics (codeine, Tylenol, Percocet, methadone, Tramadol and Oxycodone and even a Fentanyl Patch. No help from Lidocaine Patch. Lidocaine injections could give short lived relief but no long-term help.

Steroids were of course, given multiple times by injection in large amounts. Dr. Jerome Weiss actually gave that with hyaluronic acid with the hopes of that would spread it around better. That also was not effective. He did insist that I try anti-depressants, even though I did not feel depressed despite the chronic pain. I felt that leveled my mood and even though it didn’t help my pain, I continued Celexa and at some point, transitioned to Lexapro.
like so many of you, I looked into alternative therapies and being a physician. I was willing to self-experiment quite readily. There was one therapy that did have profound effects and is worth mentioning. In 2011, I ran into some articles about the use on subcutaneous glucose to relieve nerve pain. This was championed by Dr. John Lyfogt from New Zeaalnd and it seemed highly neuroactive. I self-injected the entire bilateral pudendal area with subcutaneous D5 for nine straight days in a row. The results were remarkable. Especially in reducing the area of pain.

The area of pain is an important component of how much you suffer with this illness. Nerve compression is a mechanical pain, so the area of pain in the intensity of pain gets worse from a low level in my case when I woke, say one over 10, two anywhere from 5 to 7/10 by the time I went to bed. In my case, once it got to that level at the end of my workday, I would need to spend 45 minutes on each side to diminish the pain enough that I could sleep. Then the next day, the whole process would repeat itself. Bilaterally, though the left side was always worse than the right side.

The Sub Coetaneous Dextrose injection sounds very “placeboish” but I can assure you, that in my case, it was not. For one thing, putting glucose right next to an exhausted, over - firing nerve is the same as putting food next to a starving animal. Glucose is the only thing a nerve eat. Ischemic peripheral nerves, exhausted and depleted by constant firing all day from trivial mechanical stresses “lap that up”. They stop producing loads of lactic acid, which is noxious and pain producing in the subcutaneous space and they largely stop hurting. This works for a large area of the pain, but will not resolve the area of true compression by ligaments. It will come back hours later. Little periods of heaven followed by renewed hell.

9 days of this and my pain, which by then had expanded to the size of a basketball in my privates, perineum and buttocks region had shrunk to the size of a grapefruit! This was easier to deal with, but frustrating in its own way. I wanted this gone, but I had hit a wall. 9 days of D5 hqd dramatic results. But 9 more years after that only inched the pain down to the size of a tennis ball.

This therapy was called Neuroprolotherapy then and Perineueral Injection Therapy (PIT). I I would recommend it. It may even cure some of you, but it will not cure a severe nerve compression. You will find it has been used in Carpal Tunnel Syndrome and has had moderate success there. But. In bad cases, surgery is required and is still the most successful route to long term success in those pain patients.

I subsequently saw Dr. Dellon for a different surgery than he ultimately pioneered for Plastic surgery that was less invasive. 4 times. Not much help. Then I tried a litany of steroid shots and other futile things that led to too many severe complications to mention.

By 2020, I had given up on treatments save for some unsuccessful attempts of deeper D5W injections into that I thought would be in Pudendal Canal Area and Prostate Area. No response beyond a few hours at a time and an occasional but severe prostatitis infection. I resolved to not treat it and just review the literature and rx options every year.
This led to no major moves till this year. Though the numbers were low, I was strongly considering cryoablating the nerve. This seemed preferable to the chronic pain. During that research I googled “Pudendal Nerve Surgery” and Dr. Erdogru’s website popped up. When I saw the pictures from his 2014 small case series from the laparoscopic approach and the dramatically improved pictures of the surgical series from his Da Vinci Surgeries (he started that in 2023), I was impressed. I compared them also to Dr. Antolak’s 2024 decompression review and other Plastic Surgery approaches. Night and day.

I decided to try the surgery and figured that if it failed, I would just get the nerve ablated on both sides.

Luckily, a month out, that will clearly not be needed.

While my solution was expensive, it was nothing compared to what I have seen from people I have had surgeries from over the years. Plastic Surgeons are a Cash business and little help with insurance coverage. Dr. Dellon alone was over $100, 000 k in 2012 to 2015 dollars. I called Dr. Aaron Fuller and his office manager quoted me “somewhere between $100,000 to 250,000 for evaluation and treatment”. Those numbers are not based on the difficulty of the procedure but the desperation of the patient and should not be tolerated. Dr. Erdogru spent 4 hours in the OR alone on me and charged $12,000 with Hospital charge up front of $6000. Yes, it was Turkey, and there are challenges I can address later, but the transaction was fair.

Some of you can relate to the following. It took me 3 hours Lying on My Back to hunt and peck to type this on the on - screen keyboard. In the past, that would have led to 7/10 bilateral severe pain but I would have powered thru that as I would be determined to share this important message. That pain would have taken an additional half hour on each side to be relieved. If you have had similar discomfort from just lying 9n your back, you are likely compressed and should consider surgery.

But, you should also have dysesthesia or allodynia if you simply touch the pudendal nerve distribution skin. We can thank, thank, thank Dr. Antolak for figuring that out! That will turn out to be the most important test to do to determine if you are a surgical candidate!

If you are a woman, you might even be able to get coverage if you do this with an American Gynecologist. Dr. Shakiba in Hackensack New Jersey has an entire operation you can watch and it looks to me to be technically a sound decompression.

But, there numbers are small, and you likely only get one chance of doing this right. Urologists, I saw 3 in USA, do not really understand that they can and should do this at this time. They do Robotic Prostatectomies every day. They go right past this area on a daily basis.

Happy to answer any inquiries, this thing nearly did me in and made my life hell for over 20 years. I am happy to listen and try to help others get out of this dark hole.

[Violet M]

Very interesting.....thanks for the explanation. Sorry to hear that it took so long to type out the message. I was lucky to have a lying-down computer set-up after my surgery that allowed me to type easily on the computer. If you are lucky enough to know an engineer, maybe they could help you construct something that would allow you to lie down while typing. I had a futon with an adjustable computer table over it that angled downward so I could see the computer screen.

I probably would not have been brave enough to inject myself with subcutaneous D5 like you did, although I guess when you are desperate, you do things you wouldn't normally do. Like pay $100,000 for surgery. Or travel all the way to Turkey!

Take it easy and don't overdo things even though you are feeling better. I discovered you have to add new activities in slowly until you know how you are going to react to them.

Violet

[kimc]

Thank you!

My response was long and detailed so I want to be sure I clarify just 2 points.

The surgery costs were not $100k.

Dr. Erdogan = $13 k. I paid him by Wire in advance. This paid for a 4 Hour surgery with Pudendal Neurolysis Bilaterally. In my case that was removal of Both SS ligaments and cutting, but not removing ST ligaments bilaterally along with cutting the Obdurator aponeurosis to give the PN more room as it goes to and enters the Pudendal Canal.

Abicadem Medical Center which provided the Da Vinci machine, OR costs, 2.5 day hospital stay. Anesthesia Pre-op Consult 2 days before surgery. Cardiology Consult with a Bedside Echocardiogram, Chest Xray for $6000 . I paid for by Credit Card before leaving hospital. I did pre-op exam , EKG and labs in US which they largely accepted. I believe had I done Preop tests with them it would have been paid for with the $6000 bill. Anesthesia and OR costs were also covered with that same fixed fee.

Medical costs for Turkey surgery comes out to $19,000.

I can explain the Flight Costs and Hotel costs if anyone is interested. The Hotel I stayed at, The Metropolitan was fine and just 100 yards from the Abicadem Private Hospital.

The Hospital was modern and quite good. Language barrier is a real challenge.

[kimc]

The 2nd point. Before surgery, typing the longer initial notes I wrote while lying on my back would have caused my PN pain to escalate to a 5 to 7/10 burning sensation that spread to my buttocks, perianal, perineal areas and scrotum bilaterally.

With surgery, after 3 plus hours of same position to type those responses the pain got to 1/10 on the left side only and just by the Ischial Tuberosity.

That. is a World of Difference and is actually quite trivial compared to my prior 20 + yrs of pain.

I also feel the area is improving further as time goes on, but I can say even a day after surgery I was 90% better.

On exam with simple touch, I no longer have the allodynia to touch in a bilateral PN distribution. That is a notable change to say the least and speaks to the PN no longer being compressed.

[Violet M]

The surgery costs were not $100k.

Dr. Erdogan = $13 k. I paid him by Wire in advance. This paid for a 4 Hour surgery with Pudendal Neurolysis Bilaterally. In my case that was removal of Both SS ligaments and cutting, but not removing ST ligaments bilaterally along with cutting the Obdurator aponeurosis to give the PN more room as it goes to and enters the Pudendal Canal.

Sorry, I wasn't clear about the $100k -- I was thinking of treatment with Dellon or Filler who you say charge $100 k or more. I know you went to Erdogru and paid less, but I expect some desperate people have gone to Dellon or Fuller and paid a lot. Just thinking how sad it is that people with this disease are in a desperate state. I know I was in a desperate state at one point. So glad to hear you are better now and you don't need a lying down set-up for your computer.

Violet

[kimc]

Thank you.

I need to be clear to anyone following on the costs since they are extreme in my experience and we all need to be transparent about our experiences with that. It is clear to me that they will come down once it is accepted that is a nerve decompression condition and not "rocket science". Even a Da Vinci robotic prostate cancer surgery in USA ranges from $16k to 40K and that is a lot more complex then a PN Decompression surgery. Prices will come down for this as more such procedures are done.

I did see Dr. Dellon for 4 surgeries and each was around 15 - 30,000 in 2011 to 2014 dollars. At the time, there were very few in the US who were approaching this at all, the French/Egyptian literature was not that impressive, and it seemed worth a try. Led to some small improvement from removing extremely allydynic scrotal skin. Far from a cure.

After I saw him, Dr Dellon had invented a direct approach via the Tran-perineal route and had, I believe had 3 pain level, or more improvements in about 75% of patients.

Overall, he was a great innovator in his field, but he could only work with the tools he had.He did help some patients moderate their pain and, while a bit arrogant, a major figure in the treatment of pain from peripheral nerves. He really started that field and created many nerve decompression surgeries. He was 100% correct in saying that all pain is Impingement, Ischemia or both.

It was from his work that Plastic Surgeons have gotten involved in Nerve Compression Surgery for this and other conditions. Out of pocket costs are high with Plastic Surgeons traditionally. They tend to be charge the patient directly in cash and it is largely up to patient to get reimbursement from insurer. In USA, that has been difficult and they still make it hard for patients. That needs to change as it is clearly a nerve compression and often will need decompression. It is essentially a carpal tunnel nerve compression in a very hard to get to spot - the bottom of your pelvis. So it will cost more to get there to fix it, and it is often bilateral, so that costs more too. But, there is nothing about this that is psychological or mysterious and insurers pay for every other nerve decompression. The medical community needs to keep publishing this basic fact and the insurers will be forced to do the right thing. As I note below, Laparoscopic Robotic Surgery is now common in Urology and Gyne. Modifying current procedures to do Pudendal Neurolysis is a natural target for that tool.

In 2023 I looked at a Plastic Surgery Group in South Carolina. Preliminary cash payment expected for a Trans Buttocks approach was approximately $30k. As an Internist, knowing what I know about the pain and how long it takes to heal from a trans-gluteal transection was enough to convince me that it was a bad idea. The degree of exposure from this and transperineal approach is limited. You should note that Urologists used to try external approaches for prostate resections for cancer. NOBODY does that any more. If fact, almost ALL Radical Prostatectomies are done via Da Vinci Robot Surgery. Why? Far better visualization, steady instruments, far lower complication rate.

It is very important to realize that the Prostate Gland is within inches of the PN, the SS and ST Ligaments and Alcock's canal. Urologists and Gynecologists are familiar with Da Vinci and are soon going to become comfortable with the anatomy and how to free up the PN. However, it will take a decade or more for any of them to get the experience needed to get the best results.

Experience does matter. Case in point, I had a tiny branch of the PN that came out separately from the main trunk of the PN. It was very thin and easy to miss. Due to experience with other cases, Dr Erdogru identified it, protected it from surgical injury and got the SS ligament off of that as well. Things like that require an experienced set of eyes and hands

I was only quoted by Dr. Aaron Filler's office, I did not see him. It was clear that the fee range would "minimally" be in the range of $100 - 250k for Diagnosis and Treatment. I believe it was Dr. Filler who early in his career was the first to publish what I believe is the best diagram of the areas normally effected by PN. This diagram is shown on this website. I am certain any of the readers can relate to it:
https://orthoregenerative.com/pudendal-neuralgia/.

These are VERY important areas to test with your own touch or a pin. In PNE, the sensation will be painful and amplified. That approach to Diagnosis was endorsed by Dr. Stanley Antolak in his fine review of PNE in 2024:
https://onlinelibrary.wiley.com/doi/abs ... /nau.25555

Dr. Filler, at time of my call, was operating in Santa Monica and Houston. He was also having patients doing MRI's in his own 1.5 Tesla machines which he would charge for doing and interpreting. MR Neurography is a very insensitive test for PNE and I recommend against it. A pin or light touch is far more sensitive and accurate. In some confusing cases, a Nerve Block can aid in diagnosis. There is NO ROLE for ANY imaging in PNE, or for that matter, for another nerve compression syndrome in the wrist = Carpal Tunnel Syndrome!!

I was told that it would take Dr Filler at least 1 month to even read the MR Neurography. That was one of the "red flags" that made me feel he was far too busy for me to entrust my body for his surgery. Sometimes you need to think of what type of follow up and effort will you get if a surgery is not successful. A month to read an MRI is a big clue that he would have no time for you if you are not a 100% surgical success.

For women in the US, I would definitely consider at least getting an opinion from Dr. Shakiba's group in Hackensack, New Jersey. I do not know the charge, but I would think Insurance Coverage would be easier to get from a Gyne Surgeon than a plastic surgeon.