PUDENDAL NEURALGIA: A CASE FOR MULTIMODAL CHIROPRACTIC INTERVENTION

Main Article Content

Kevin M. Percuoco
Michael M. Olson
Tiffanne McArthur
Nathan Hinkeldey

Keywords

Pudendal Nerve; Neuralagia

Abstract

Objective: The purpose of this case report is to describe and discuss the management of pudendal neuralgia utilizing a multimodal chiropractic treatment approach.


Clinical Features: A male patient sought care for 3 years of ongoing left sided medial gluteal pain and genital paresthesia in which he thought to be caused from an intense squatting workout. The patient had remained refractory to prior treatments including a regimen of antibiotics, pelvic floor therapy, conventional physical therapy, and activity modification.  Provoking activities included urination, ejaculation, physical activity, sitting, and bowel movements.


Intervention and Outcome: Multimodal chiropractic intervention, including spinal manipulative therapy, instrument-assisted soft-tissue mobilization (IASTM), manual myofascial release, cupping, and an at home stretching program focusing on tension in the obturator internus muscle. The patient reported near resolution of symptoms after 7 treatment sessions and complete abolition of symptoms following one month adherence to at home exercises.


Conclusion: Conservative management for pudendal neuralgia is not well documented within the literature.  This case provides preliminary evidence, at best, for the use of multimodal chiropractic intervention for pudendal neuralgia and suggests that further research is needed in this area.

Downloads

Download data is not yet available.
Abstract 93 | Pudendal Neuralgia.pdf Downloads 34

References

1. Campbell JN, Meyer RA. Mechanisms of neuropathic pain. Neuron 2006;52(1):77-92
2. Possover M. Voiding dysfunction associated with pudendal nerve entrapment. Curr Bladder Dysfunct Rep 2012;7:281-285
3. Labat JJ, Riant T, Robert R, Amerenco G, Lefaucheur JP, Rigaud J. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes Criteria). Neurology and Urodynamics 2008; 27(4):306-310
4. Pilhe R, Chiron P, Reina N, Cavaignac E, Lafontan V, Laffosse J. Pudendal nerve neuralgia after hip arthroscopy: retrospective study and literature review. OrthopTraumatol Surg Res 2013;99,785-790
5. Waldinger MD, Venema PL, van Gils AP, Schweitzer DH. New insights into restless genital syndrome: static mechanical hyperesthesia and neuropathy of the nervus dorsalis clitoridis. J Sex Med 2009;6(10):2778-2787
6. Ramsden CE, McDaniel MC, Harmon RL, Renney KM, Faure A. Pudendal nerve entrapment as source of intractable perineal pain. Am J Phys Med Rehabil 2003;82(6):479-484
7. Martin R, Martin HD, Kivlan B. Nerve entrapment in the hip region: current concepts in review. Int J Sports Phys Ther 2017;12:1163-1173

8. Ploteau, S, Perrouin-Verbe MA, Labat JJ, Riant T, Levesque A, Robert R. Anatomical variants of the pudendal nerve observed during a transgluteal surgical approach in a population of patients with pudendal neuralgia. Pain Phys 2017;20:E137-E143

9. Olson HM, Zetoca A, Olson C. Chiropractic management of a patient with perineal numbness after arthroscopic hip surgery: a case report. J Chiropr Med 2016;15(4):305-309
10. Olson HM. Diagnosis and conservative chiropractic care of chronic idiopathic pudendal nerve entrapment causing saddle-like paresthesia and restless genital sndrome: a case study. J Spine 2016;5:6
11. Sancak E, Avci E, Erdogru T. Pudendal neuralgia after pelvic surgery using mesh: Case reports and laparoscopic pudendal nerve decompression. Int J Urol 2016;23:797-800
12. Lee JW, Lee SM, Lee DG. pudendal nerve entrapement syndrome due to a ganglion cyst: a case report. Ann Rehabil Med 2016;40(4):741-744
13. Hough D, Wittenberg K, Pawlina W, et al. Chronic perineal pain caused by pudendal nerve entrapment: anatomy and CT-guided perineural injection technique. AM J Roentgenol, 2003;181(2):561-567
14. Leahy, M. Active release techniques soft tissue management system for the lower extremity, 2nd Edition. 2008