Suspected PN but not too sure

[Findo]

Hi I'm from Christchurch New Zealand and have had pain in sitting for almost a year now. It started with an inflammed upper left leg, then pain in the sit bone area and eventually an achy periformis. I had PT right from the start but none of the exercises seemed to work. I thought I may have had some SIJ issues after emailing Peter Dornan in Brisbane Australia but my sportsmed doctor thinks my SIJ's are okay. He did however order an MRI and this showed 2 labral left hip tears. (Superior location) but these give me very little trouble except for when my left leg is bent in toward my pelvis and it catches. My only symptoms are pain in sitting with some inner thigh tingling and sweats but this comes and goes. The sportmed Dr thought this symptom was coming from my pelvis but wasn't sure where. If I work in the garden too much I end up with an inflamed thigh after putting pressure on the left leg. I feel real tight around the adductor area and into my sit bone area. Could this be PN related or maybe OM issues?

I had some massage therapy on my periformis, hamstrings and lower back and this has helped alleviate the periformis ache. I'm finding recently that the inner thigh issue has spread to the right thigh which is very puzzling. I do not have any middle pelvis pain, no stabbing or cutting feelings, no feeling of objects in my rectum, no perineal pain or burning or other usual general PN complaints. However when sitting on the toilet the pain goes. I guess this shows it's coming from either the pelvis or adductor area? I did do some pelvic strengthening exercises a while ago and this caused some urinary urgency and some urinary hesitancy but it settled down and cleared after I stopped the exercises.

I recently tried acupuncture and this showed up some real tight adductor muscles. I'm off back to see my GP this week who wants to refer me to an Orthopaedic Surgeon for the labral tears but I'm not sure if that is the cause. I'm also going to try the massage again. I feel I'm getting nowhere and it's all a bit of a mystery really! I sit at work most of the time and end up putting either a hot or cold pack under my sit bone or upper thigh area. I have a donut cushion but this still causes discomfort in the thigh area. Any thoughts on this collection of issues would be well received. Thank you.

[Violet M]

Hello Findo,

Unfortunately, I've not heard of many practitioners in NZ who are very good at dealing with PN. I don't know if that's what you have but before making any surgery decisions you might at least want to have someone who knows the pelvic floor well do an internal exam to assess the state of your pelvic floor if you haven't had that already. I can tell you that when my obturator internus (OI) muscles were in spasm it caused intense pain and burning in the inner thigh area. The pudendal nerve runs between the OI and levator ani muscles and if it is irritated, can set them into spasm. The converse may be true also, that is if the muscles are tense and in spasm they can irritate the pudendal nerve.

I'm not an expert on Labral tears so I can't comment much on that but hopefully Lernica will. Or you could search her most recent posts for more info.

Take care,

Violet

[kia kaha]

See Dr Michael East, Oxford Clinic in Christchurch.
He's the only NZ doc who knows about PN, I've seen him twice.
Very efficient in pelvic exam , knows the course of Pudendal nerve, and has done the Botox procedure for it.

He says he has trained under Theirry Vancaillie in Sydney.

[kia kaha]

Instead of sitting at work, I'd suggest you try a kneeling chair, there is one listed on trademe at the moment local pickup christchurch at $1 reserve, currently $1.50 bid, worth a try.

http://www.trademe.co.nz/business-farmi ... 064492.htm

[Findo]

Thanks Kia Kaha

I actually emailed Deborah Bush at the Oxford Clinic today so hopefully I'll get a reply soon. I've also been in contact with Peter Dornan in Brisbane who is a Physiotherapist who specialises in pudendal issues. He would actually like to see me because based on what I've told him he suspects SI Joint and inferior cluneal nerve involvement. I have enough 'Flybuys' to take a return trip so might just do that. My parents live there too so a bonus. As for 'not sitting' I'm able to stand at work at my computer workstation thanks to an old coffee table I took in! Might take a look at the kneeling chair too thanks.

I originally had a similar condition 9 years ago after garden squatting but a stretching exercise I did caused something to 'pop' in my butt somewhere and after 3 weeks of urinary urgency, discomfort and hardly any sleep I slowly came right. The tingling in my thighs stopped instantly. Unfortunately the beast has returned and the same exercise does nothing!

Again thanks for the 'heads up'.

[kia kaha]

I too phoned Deb Bush August 2011 explaining that I suspected Pudendal Nerve issues, and was told that she could not help me, so good luck there.

And again, via email, with my issues Peter Dornan suspected SI with me too, and again a couple of times I've experienced a POP and been pain free for a short time, I think there is a thread here about it.

Good luck with your OZ trip,

[helenlegs 11]

Hi Findo, welcome
Some of the inner thigh is innervated by the obdurator nerve , see this pic from the Nantes criteria, on page 2
http://www.pudendalhope.info/sites/defa ... iteria.pdf
It does sound as if you do have some tight pelvic muscle issues which I would advise you get a physio examination for as Violet mentioned. Labral hip tears have been found to have a correlation with pelvic nerve pain so I wouldn't completely rule that out but the complexity of the pelvis makes the whole thing difficult thing to detect an actual cause.
There is a long thread about labral hip tears on the forum http://www.pudendalhope.info/forum/view ... +hip+tears again it is something that doesn't affect me so I can't comment personally.
hope you find the answers or at the very least treatment that helps
Take care,
Helen