Atormac
briv
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 980  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (828 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References
   Article Figures

 Article Access Statistics
    Viewed6065    
    Printed130    
    Emailed1    
    PDF Downloaded59    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
LETTER TO EDITOR
Year : 2015  |  Volume : 63  |  Issue : 1  |  Page : 105-106

An unusual cause for a rare neuropathy: Pudendal nerve entrapment syndrome secondary to obturator internus muscle edema


1 Department of Physical Medicine and Rehabilitation, Norobilim Medical Center, Denizli, Turkey
2 School of Physical Therapy and Rehabilitation, Denizli, Turkey
3 Department of Radiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey

Date of Web Publication4-Mar-2015

Correspondence Address:
Figen Kocyigit
School of Physical Therapy and Rehabilitation, Denizli
Turkey
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.152671

Rights and Permissions



How to cite this article:
Turkmen MB, Kocyigit F, Kocyigit A. An unusual cause for a rare neuropathy: Pudendal nerve entrapment syndrome secondary to obturator internus muscle edema. Neurol India 2015;63:105-6

How to cite this URL:
Turkmen MB, Kocyigit F, Kocyigit A. An unusual cause for a rare neuropathy: Pudendal nerve entrapment syndrome secondary to obturator internus muscle edema. Neurol India [serial online] 2015 [cited 2021 May 8];63:105-6. Available from: https://www.neurologyindia.com/text.asp?2015/63/1/105/152671


Sir,

A rare cause of pudendal neuropathy (PN) due to compression by edematous obturator internus muscle is described.

A 34-year-old female patient was admitted complaining of pain in the right perianal, gluteal and vulvar region for the past year. The pain was exacerbated while sitting. She did not respond to pregabalin or nonsteroidal analgesics, and a pelvic MRI revealed edema of the right obturator internus muscle [Figure 1]. Electromyographic activity of bulbocavernous muscle was normal. The bulbocavernosus reflex latency was 48ms, and pudendal nerve terminal motor latency was 3.5ms on the right side. Her electroneuromyography findings were consistent with PN. A pudendal nerve block with marcaine decreased the pain for only a few hours. Due to the intolerable pain, she was referred to an orthopedic surgeon. The orthopedic surgeon thought that the pain was due to a coccygeal fracture and resected the coccyx. However, her pain increased after this operation.
Figure 1: (a) Contrast-enhanced T1 fat sat coronal image demonstrated enhancement at the inferior part of internal obturator muscle. (b) T2 fat sat coronal image showed edema at the same location


Click here to view


On physical examination, the muscle strength and deep tendon reflexes were preserved. She had no sensory loss. She had reported frequent consensual sexual intercourse (8-10 times/day) during the preceeding months before the symptoms began.

In our hospital, suspecting a pudendal neuropathy due to compression by edematous obturator internus muscle (based on the clinical and electrophysiological findings), she was placed on duloxetine 75 mg/day, tramadol 50 mg/day, and diclofenac sodium 75 mg/day. She has been using this regimen for 3 months. She reported 50% pain relief at the last follow-up visit.

The main feature of PN is pain in the distribution of the pudendal nerve that is exacerbated on sitting. PN is a diagnosis of exclusion but was made in our patient as he fulfilled Nantes' criteria, a set of simple diagnostic features. [1]

The pelvic MRI documented edema of the obturator internus muscle as the cause of PN. The edema was thought to be due to frequent sexual intercourse. There was no history of trauma or pelvic muscle overuse. Insola et al., presented a similar case that was diagnosed as PN and was associated with obturator internus muscle fibrosis. [2] A combination of detailed history, a thorough physical examination, imaging techniques, and neurophysiological tests will aid in an accurate diagnosis. The symptoms may be refractory, and a step-by-step, individualized approach is necessary in each case.

 
  References Top

1.
Labat JJ, Riant T, Robert R, Amarenco G, Lefaucheur JP, Rigaud J. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourol Urodyn 2008;27:306-10.  Back to cited text no. 1
    
2.
Insola A, Granata G, Padua L. Alcock canal syndrome due to obturator muscle fibrosis. Muscle Nerve 2010;42:431-2.  Back to cited text no. 2
    


    Figures

  [Figure 1]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow