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    Pelvic Pain With Sitting: Diagnostic Algorithm: A. Lee Dellon, MD, PHD, Johns Hopkins University

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    RudolfGer
    This document presents a diagnostic algorithm for pelvic pain with sitting. It discusses how the posterior femoral cutaneous nerve (PFCN) innervates the lower buttocks and posterior thigh, and is often the cause of pain with sitting. Injury to the PFCN or anterior pelvic nerves like the ilioinguinal or genitofemoral nerves can also cause pain with sitting by affecting posture. The pudendal nerve does not innervate the ischial tuberosity region so injury to it would not typically cause pain directly in that area. Nerve blocks are identified as the best way to distinguish the etiology of pain experienced with sitting.

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    Pelvic Pain With Sitting: Diagnostic Algorithm: A. Lee Dellon, MD, PHD, Johns Hopkins University

    Uploaded by

    RudolfGer
    399 views1 page
    This document presents a diagnostic algorithm for pelvic pain with sitting. It discusses how the posterior femoral cutaneous nerve (PFCN) innervates the lower buttocks and posterior thigh, and is often the cause of pain with sitting. Injury to the PFCN or anterior pelvic nerves like the ilioinguinal or genitofemoral nerves can also cause pain with sitting by affecting posture. The pudendal nerve does not innervate the ischial tuberosity region so injury to it would not typically cause pain directly in that area. Nerve blocks are identified as the best way to distinguish the etiology of pain experienced with sitting.

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    Pelvic Pain

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    This document presents a diagnostic algorithm for pelvic pain with sitting. It discusses how the posterior femoral cutaneous nerve (PFCN) innervates the lower buttocks and posterior thigh, and is often the cause of pain with sitting. Injury to the PFCN or anterior pelvic nerves like the ilioinguinal or genitofemoral nerves can also cause pain with sitting by affecting posture. The pudendal nerve does not innervate the ischial tuberosity region so injury to it would not typically cause pain directly in that area. Nerve blocks are identified as the best way to distinguish the etiology of pain experienced with sitting.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    399 views1 page

    Pelvic Pain With Sitting: Diagnostic Algorithm: A. Lee Dellon, MD, PHD, Johns Hopkins University

    Uploaded by

    RudolfGer
    This document presents a diagnostic algorithm for pelvic pain with sitting. It discusses how the posterior femoral cutaneous nerve (PFCN) innervates the lower buttocks and posterior thigh, and is often the cause of pain with sitting. Injury to the PFCN or anterior pelvic nerves like the ilioinguinal or genitofemoral nerves can also cause pain with sitting by affecting posture. The pudendal nerve does not innervate the ischial tuberosity region so injury to it would not typically cause pain directly in that area. Nerve blocks are identified as the best way to distinguish the etiology of pain experienced with sitting.

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    PELVIC 

    PAIN WITH SITTING: DIAGNOSTIC ALGORITHM
    A. Lee Dellon, MD, PhD, Johns Hopkins University
    Department of Plastic Surgery
    OBJECTIVE: RESULTS:
    PFCN through its inferior cluneal (IC) 
    Painful sitting is a common  nerve and distal branches innervates the 
    complaint of both male and  lower buttocks and posterior thigh skin, 
    female patients with pelvic pain.  the regions in which the pain of sitting is 
    The most common peripheral  perceived.  PN, sciatic nerve (SN), 
    nerve implicated in this problem is  obturator nerve (ON), ilioinguinal (II), 
    the pudendal nerve (PN). The  iliohypogastric (IH) and genitofemoral 
    “classic history”:  pain is not  (GF) nerves cannot transmit information 
    present when sitting on a toilet  about sitting that is interpreted as pain. 
    seat.  The posterior femoral  (A) PFCN nerve innervates the region 
    cutaneous nerve (PFCN) that  about the ischial tuberosity.(B ) Injury to 
    innervates the ischial tuberosity  the anterior pelvic region can injure the II, 
    and lower buttock (inferior cluneal  IH, GF, and ON, and cause the patient to 
    nerve), and, with its perineal  sit leaning backwards, causing secondary 
    branch, overlaps the pudendal  pain with sitting (C), interpreted as 
    nerve, giving rise to the  “sciatica”, and can also cause compression 
    probability of diagnostic confusion  of the PCFN, which, through its perineal 
    (A). B branch, can result then in secondary pain 
    Ischial
    in the perineum and labia/vestibule, 
    METHODS: Tuber. simulating PN compression symptoms. 
    Treatment must be directed primarily to 
    Anatomic pathways related to  resection/decompression of the anterior 
    the nerves surrounding the pelvis  A nerves.
    were reviewed. Clinical experience  (D )PN compression causes symptoms in 
    with more than 50 pelvic pain  distribution of its branches; anus, 
    SITTING POSITION perineum, labia/scrotum, vestibule, 
    patients who complain of painful  E WITH GROIN PAIN
    sitting are reviewed. A model of  vagina, clitoris/penis, but not true pain in 
    chronic nerve compression for the  D C the ischial tuberosity region, because the 
    pelvis, based upon carpal tunnel  PN does not innervate this region.
    syndrome, is constructed, in which 
    it is realized that the median nerve 
    CONCLUSION:
    crosses the wrist, but yet  PFC nerve is the most common 
    compression of median nerve  cause of pain with sitting. PFC is usually 
    results in numbness in fingers, but  injured in sports (hamstring tear) or as a 
    CAUSES 2ND
    does not result in wrist joint (bone)  SITTING LOW complication of previous PN or SN surgery.  
    WITH PRESSURE BACK PAIN Nerve blocks are best way to distinguish 
    pain because the median nerve 
    ON PUDENDAL etiology of pain with sitting.
    does not innervate the wrist joint. NERVE
    Dellon, AL, Pain with sitting related to injury of the posterior femoral cutaneous nerve, Microsurgery, 35:463‐468, 2015.

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