Technique Q?

[pomegranate]

I had flouroscopy guided PN blocks done in 12/09 and 2/10 by Dr. Shobeiri. To my knowledge, he performs them as he was trained by Antolak. I've had lingering issues on my left side ever since. Don't these injections have to pierce the sacrotuberous ligament to reach the pudendal nerve when performed through the buttock? Anyone know?

[Celeste]

I never asked, but I don't believe they do intend to pierce the ligament. Every image I've ever seen of the guided needle shows them alongside the bone, trying to put the liquid in where they can bathe the nerve in it.

I had what I feared was permanent new pain from an unguided injection; it melted away in a year's time post op. My guided injections did not cause any problems; I had one before and two after the unguided one.

I don't know what to think in this case, could it have caused some kind of scarring or did it somehow nick the nerve? Not much is written about the Why of a bad block experience. You could go back and ask Dr. Shobeiri if he pierced the ligament, or maybe see if he has an explanation.

I'm sorry that this happened to you, Lauren.

[pomegranate]

Celeste,

Thanks for your reply. Dr. S and I have had many a discussion about my bad block experience, and the only conclusion we really came to was that perhaps there was the small possibility of a nicked nerve. As my case has progressed (not with intensity of pain, but just progression of time) I'm learning much more about my multi-factorial pelvic pain. That's a story for another day though...

I am seeing him in Sept. for one of my infrequent follow up appts., as all I really need him for these days is medication refills and PT scripts. I'm going to question him about his technique then. I've discussed my particular left-sided pain pattern (that definitely started days after the first block) with now four pelvic floor physical therapists, and gained some additional understanding of why blocks can "go bad".

I definitely have pain at the sacrotuberous ligament, but it doesn't really refer to any type of true burning, stabbing, shooting pain in the distribution of the pudendal nerve. It's very localized, and actually more of the area where the posterior femoral cutaneous nerve innervates. I'm currently going through post hip surgery rehab, and of course have to modify some of the exercises due to pelvic pain. Today I was doing one and had a very clear shot of pain each time directly where I imagine the ST ligament and SS ligament are in my body. However, NO referred pain, just very internal buttock localization.

I'm very curious about this, as I'm really leaning more and more away from a PN foundational diagnosis for myself. I believe PN is more a symptom that has developed along the way due to my other issues. I'm wondering about the sacrotuberous ligament and its relation to SIJD, as I definitely have a crazy SI joint on the left side.

I just wonder a few things: did I sustain some type of other nerve damage from an injection? Did the ligament get inflamed and respond with scar tissue?

It's nowhere near a level of pain that requires a surgical fix. I just am putting together the pieces of my puzzle.

Final disclaimer to anyone who is suffering a flare from an injection: yes, I still have pain 18 months after a nerve block, but it has greatly decreased in intensity from its initial disabling onset!!

Gosh that was a long response. I'm boring even myself now.

Lauren

[donstore]

Hi Lauren,
I have also given some thought to nerve blocks since the unguided block I got from Dr. Weiss gave me sciatica for 5 months that finally went away (what a relief). If Celeste hadn't warned me away after my first post on TIPNA, I could have very well gotten a second one. I am now of the opinion that if a patient decides to try blocks, have them done by an interventional radiologist under CT guidance if you can. Hope your recovery from your hip surgery continues to progress well. As I have mentioned earlier, this is one area of the body that has a high success rate.

Don