Is a block in Alcock's really diagnostic for PN?

[Faith]

If someone gets a CT-guided block into Alcock's canal and it doesn't relieve their pain couldn't they still have PNE but at a higher level such as at the grip of the SS/ST ligament or the piriformis? It's my understanding that blcoks only numb distal to the injection site so why is Alcock's canal preferred to the ischial spine by some PN specialists?

[carolynm]

I didn't know that was the case, Faith. It seems like they would start at the ischial spine and then work their way down.

Is that what they did to you at Hibner's? Just at Alcock's?

cari

[Faith]

I did not have a block in Phoenix (other than the non-guided block vaginally with my botox), but their protocol is 3 Ct-guided blocks into Alcock's. I think the reason being at the ischial spine you can get spill over into other nerves such as the Posterior femoral cutaneous and sciatic, but I am confused as to how Alcock's would be diagnostic if the entrapment was at higher locations as mentioned previously.

[donstore]

Faith and Cari,
This would be a good question to ask Dr. Hibner. Since you are both officially his patients, maybe he would be willing to address this in an email. Seems like a reasonable request. I would also be interested in the answer. My unguided block with Dr. Weiss was above the ST ligament where he palpated the entrapment (later confirmed on Dr. Potter's MRI) and numbed my perineal pain area but there was definitely spillover into my sciatic nerve (which Dr. Weiss said was normal for injections at that level) and resulted in sciatica that lasted for 5 months after the injection.

Don

[A's Mommy]

This is the huge conundrum of PNE diagnostics. What really constitutes a positive block? There are so many little nerves in there....

Let's take me for an example: I had a CT guided block at the level of the is goal spine and I felt the lidocaine seep into the pathway of the PN and it's distal branches--- I remember feeling an intense burning pain in my left vulva area as the medication went there. Then about 5 min later, the block at the Alcocks canal. I didn't feel the block at Alcocks-- bcz the block higher up had numbed it!

I truly feel that MRI and high res ultrasound (like the 17mHz one I had by Dr Bodner in Austria) combined with history is going to mean so much more in dx. I don't think they have 17mHz ultrasound here in the USA. Prof Aszmann and Dr Bodner could see th nerve on the ultrasound and the scarring. Additionally, Prof A really thinks so highly of Hollis Potter's images. He says they are some of the best in the world. And it turns out that even though I was one of the first to get her pudendal MRI, she was dead on.

My eternal thanks to Pelvis Stressly for finding Dr Potter and to AliPasha and pianogal for finding the wonderful Prof Aszmann. I will post an update soon, but as a teaser... I was able to sit in the car today for 40 min with only incisional pain- 2 wks out!

A's Mommy

[A's Mommy]

And that was sitting WITHOUT a cushion!!!!!

[donstore]

That is so great.

[PaulSa]

Great news! Here's to a quick and full recovery.

[Violet M]

If someone gets a CT-guided block into Alcock's canal and it doesn't relieve their pain couldn't they still have PNE but at a higher level such as at the grip of the SS/ST ligament or the piriformis? It's my understanding that blcoks only numb distal to the injection site so why is Alcock's canal preferred to the ischial spine by some PN specialists?

Faith, the typical protocol for PN blocks used to be that you would get 2 at the ischial spine about 4 weeks apart and then one into alcock's. It's my understanding that Hibner's team does them differently. Because alcock's canal is not that far from the ischial spine, they just inject into alcock's but they use a larger volume of medication so that it diffuses to the ischial spine area also. At least, this is what I read from one of his patients who posted on the forum awhile back.