I got my MRI results, but don't know what they mean

[Hopeitworks]

Here is what the results state:

IMPRESSION:

1. No discrete imaging abnormality of the pudendal nerves.

2. Intramuscular course the proximal S2 nerve roots the pelvis, of uncertain significance.

3. Bilateral gluteal insertion tendinopathy with associated mild trochanteric bursitis.

4. Small free intrapelvic fluid, nonspecific, may be physiologic.

Images and interpretation personally reviewed by: Aaron VanDreel, DO

Images and interpretation personally reviewed by: Laura Fayad, MD
Narrative
INDICATION: Bilateral pudendal neuralgia symptoms

TECHNIQUE: High resolution MRI was performed of the pelvis employing MR neurography techniques on a 3-Tesla system using multiplanar 3-D anatomical and fluid sensitive sequences. Contrast material material was not administered.

COMPARISON: No comparison

FINDINGS:

NERVES: Intramuscular course of the proximal S2 nerve roots through the piriformis, proximal to the sciatic foramen.

MUSCLES / TENDONS:

Bilateral gluteal insertional tendinopathy with associated mild trochanteric bursitis.

BONES: Unremarkable

JOINTS: Unremarkable

VASCULAR: Unremarkable

MASSES: No mass is seen.


Other: Prominent bilateral ovarian follicles noted.

So you guys know I just spent an hour looking up medical terms and here are definitions:
Tendinopathy - Refers to disease of tendon.
Trochanteric bursitis- inflammation point of the hip.
Piriformis- muscle in gluteal region.

Does this mean I don't have PN?
Can someone make sense of this and put it in terms that I could understand please? Could this be the cause of my PGAD?

Thank you in advance Hope

[Violet M]

The S2 nerve root is one of the nerve roots that the pudendal nerve comes off of. It sounds like the piriformis muscle could be impinging on that nerve root -- on both sides. Or possibly the nerve root is going through the piriformis muscle. Whether or not that is the cause of your PGAD, I can't say for sure. You would probably find doctors who would say that it's significant and others that would say it isn't. The nerve may have gone that route all of your life and not caused problems but sometimes as you age and things start to fibrose or sclerose, they may start becoming significant in causing pain.

There are other hip problems such as labral tears and femoral acetabular impingments that have caused symptoms of pudendal neuralgia in some people so I wouldn't say that absolutely no, the bursitis and tendinopathy are not related to your pelvic pain but it seems unlikely since they are mild. You might be able to find a doc who would do a steroid injection or block into those areas for diagnostic purposes to see if the injection relieved your pain or you could try some PT to relieve the inflammation in those areas. Are you an active person who exercises a lot? Just brainstorming what might have caused the inflammation in those areas.

The reality is, MRI's are not extremely accurate in diagnosing the cause of pelvic pain, pudendal neuralgia, and PGAD. One of the reasons is that you can have someone present with an MRI that looks bad but they aren't in any distress while on the other hand you can have someone present with a very normal looking MRI who is in severe distress. This is what I've been told by an orthopedic physician. Some of the PN surgeons don't put much stock in MRI's for diagnosing PN. So, in answer to your question does this mean I don't have PN, the answer is no. Some people have normal looking MRI's but they have PN.

Have you been evaluated by a good PT yet? I think they could do a clinical exam of the piriformis muscle to see if their findings correlated with what is seen on the MRI. For instance are there positional symptoms related to the piriformis muscle when you stretch it, etc. You could also try a nerve block at the S2 nerve roots to see if that relieved your symptoms but if you are sensitive to steroids you might just want to go with marcaine and skip the steroids. I don't know -- see what your physician recommends on that.

Violet

[Hopeitworks]

Hi Violet,
Thank you for responding to my email. I haven't been an active person for 6 years due to the vulvodynia pain. But at my job I sit 12 hours a day or longer, I wonder if that caused the muscle to impinge the S2 nerve root.

I went to PT 2 years ago, but I did not get a good PT therapist, so I stopped going. This time around Dr. M told me to wait before going to PT until the Ampitriplyne kicked in and we got my MRI results. I see the doctor on Thursday and will follow up with you to let you know what he thinks of the MRI results.

If the doctor suggests a nerve block at the S2 nerve root to see if it relieves PGAD I think I will try it. I don't think I am sensitive to steroids because I had a cortisone injection in my neck many years ago and it took the pain away for at least 3 years. The pain in my neck has now spread down my arm. I keep telling myself to get it looked at my PGAD trumps it. I read an article yesterday that stated my neck pain (3 bulging disks) could cause problems down my entire spine that could result in PGAD symptoms. I plan to mention this to the doctor as well. I wish I would have saved that article.

I am happy that nothing serious showed on the MRI,but at the same time I wanted something concrete that would explain PGAD symptoms. But I guess we all want that! And know that I know MRI results are not 100% accurate that leaves with me with more questions than answers. I have to buy me a detective hat, or better yet buy my doctor one. LOL... I just want the PGAD to go away!!!! I can live with pain, but not PGAD.

The bursitis explains why it hurts to sit and why the front and sides of my thighs burn. I also get burning around my waist where the hips start, almost like where a belt would sit.

Thank you Violet for taking the time to read and answer my questions.

[Violet M]

Hey Hope,

Well, I don't have many answers but sometimes all you can do is brainstorm and hope that eventually you stumble on the right thing, eh? I totally agree about PGAD, it's the worst. Even though the MRI didn't show anything definitive it does seem like you have enough mechanical issues going on that you have some things you can try to see if maybe it is a mechanical problem. I think that it would be worth it to have a pelvic floor evaluation/clinical exam to see if there is tenderness or irritation along the course of the pudendal nerve, or if the pelvic floor is overly tense and possibly contributing to the problem, even if you decided not to pursue PT. It might help you figure out some pieces of the puzzle. I think some of the PN surgeons put more stock in the clinical exam than some of the other diagnostic tests.

All the best as you sort through this.

Violet

[faezehsm]

hi there
i'm a 25 year old girl with having pudendal neuralgia for 7 years. i recently knew the name of my problem that is pudendal neuralgia by searching in the websites. i have got 3 tesla mri of my pelvic diaphragm and my pudendal nerve area. but i don't know any radiologists who knows this problem to find out whether i have pnl/pne or not. please someone put the email of radiologist so that i can send them my mri images of pudendal nerve. thanks alot.

[Hopeitworks]

Faezehsm,

Dr. Donlin Lond reviews MRI/N images. I hope this is helpful.

http://www.donlinlong.com/

Hope

[faezehsm]

Hi , thank you for telling me his email. I sent my mruli images to him and i'm waiting for his response.thanks alot.

[Hopeitworks]

Faezehsm,

You are very welcome! Let me know how it goes.

Hope

[faezehsm]

dear hopeitworks
the email from the site "http://www.donlinlong.com" doesn't accept incoming emails.it doesn't work.maybe it's expired.do you know any other radiologists' emails for pudendal neuralgia?thanks again.

[Hopeitworks]

I don't know his email address. You would have to call his office. If you can do that I can give you his phone number, just let me know.

Hope