update - any views welcome

[Question]

Hello all - its me again - the person with the all the questions.

Just had my sixth cortisone injection - this time in Alcock's canal. Yet again, so far, it has made no difference. Not sure whether this one reached the intended spot cos when I woke up I wasn't number in my genitals like when I had the injections at the Ischial Spine. Anyway - starting to get to my wits end as spend my most of my life planning around which doctors I am going to see next, including ones abroad.

Still have some questions though. Has anyone had any experience with dealing with the superior gluteal nerve or the cluneal nerves as think they may responsible for my bottock pain/ischial tub pain. And how do u treat this?

Although I still have doubts about whether my problems emanate from the pudendal area (i.e I have labral tears but no hip pain and mildly bulging disc at L5/S1), I still can't get over the fact that whenever I break wind it reproduces tingling symptons in perineum and back of my testicles but not my bottock pain. Quite possible my bottock pain and my perneum symptons are seperate issues I suppose.

Also, I find that stretches and movement do not have any impact or reproduce my symtpons - even squatting doesn't make a difference. Just wondering what this implies as I think many people with PN have issues with squatting etc.

I am also, i have recently, getting pins and needles in my toes at the end of my feet recently (although no leg pain). Not sure if this is related or to my problems or not.

One other thing does anybody know of a a physio/osteo who specialises in SI issues relating to pudendal problem in London, UK similar to Peter Dornan in the OZ?

[Violet M]

You could see if you can find a doc who will do nerve blocks on those nerves. Try a pain doc, interventional radiologist, orthopedist, or sports medicine doc.

http://www.ncbi.nlm.nih.gov/pubmed/11097676

Reg Anesth Pain Med. 2000 Nov-Dec;25(6):648-50.
Superior cluneal nerve entrapment.
Talu GK, Ozyalçin S, Talu U.
Source

Department of Algology, Medical Faculty of Istanbul, Istanbul University, Monoblok, Capa Klinikleri, 34390 Capa, Istanbul, Turkey.
Abstract
BACKGROUND AND OBJECTIVES:

Pain due to superior cluneal nerve entrapment is an infrequent cause of unilateral low back pain. Here we present a case of acute unilateral low back pain treated by superior cluneal nerve (SCN) block.
CASE REPORT:

A 55-year-old woman presented to the outpatient clinic suffering from unilateral low back pain localized to right iliac crest and radiating to the right buttock. Her history was taken, physical examination was performed, and a thorough radiologic evaluation was performed to minimize radiculopathy and facet syndromes as causative. After transient pain relief with a diagnostic trigger point injection, entrapment of SCN was diagnosed and therapeutic nerve block with local anesthetic and steroid combination was performed.
CONCLUSION:

SCN is prone to entrapment where it passes through the fascia near the posterior iliac crest. Unilateral low back pain and deep tenderness radiating to the ipsilateral buttock are the clinical findings accompanying SCN entrapment. The case presented emphasizes the relief of possible SCN after limiting other etiologic causes of low back pain.

PMID:
11097676
[PubMed - indexed for MEDLINE]

I never had immediate pain with bending, stretching, or squatting -- not sure why. Pain due to activity was usually delayed. I've heard other people say the same thing.

[carolynm]

My pain is also delayed. Usually hours later or into the next day.

[helenlegs 11]

I think that is the nature of pelvic nerve pain, it is a delayed pain. I think that is how it can be differentiated from lumbar back pain if the sciatic nerve is involved especially. A sneeze, a bend can give an instant pain reaction if it is back related (been there) but it might take a morning of 'activity' (which includes non active sitting) and not that much activity to up any base line pain or induce symptoms. I put this down to softer entrapments in the pelvis (muscle and ligament) than disc/bone related in the spine, but that is just my theory.
Dr Filler did tell me that my superior gluteal nerve could be involved but I have no clue what separate symptoms are involved there.
I do get a line of pain that travels just under where the cluneal nerve is indicated here http://www.google.co.uk/imgres?imgurl=h ... BQ&dur=311 when my clitoris is touched, it's a bit like a nasty buzzer game, just not funny the pain jumps from there to a third of the way along my thigh and travels horizontally.
It follows that same path so closely that I must have some involvement ? ? unless it is part of a regional pain syndrome. . .
If you do find a physio, please let us know.