Nasty referred pain - Pudendal/Perineal numbness with Groin pain

[shortlegger]

Hello

I have had nasty referred pain symptoms for the last 11 years, and am only now getting to the reason behind it, but really need some input over contradicting diagnosis from various specialists.

in 1996 I undertook an intensive running program for about 6 months, then developed chronic symptoms that included abdomen/psoas/ pain, Groin/Testicular sharp pain, Perineal numbness which continued for about 2 years until it settled into mainly neuralgia type pain and numbness, particularly pernineal/pudendal nerve numbness and psoas/stomach pain - the testicular pain has completely gone however.  I get partial/severe sexual dysfunction when not exercising, complete dysfunction if I go for a run or do any heavy impact on my spine, so logically I am definitely impinging on a nerve root..

Saw a Urologist who said it could be varicocele - spent 3 £ Grand on an operation that was a complete waste of time.( had three days cure through the anesthetic in my stomach though  :)

Basically I have spent years going through the UK health which is very disheartening - finally decided to take action myself - got an MRI scan done privately and saw a Harley Streen Spine specialist.

The harley street doctor said that I have 10 ml left leg shorter than right (which explains why I always, from the age of 18/19 felt uncomfortable walking and standing - something didn't feel right at all), and my musculature has adjusted to this leg length difference with spasms e.t.c - he didn't look at the MRI scans as he says 'they are a waste of time and don't get to the underlying reason' - he diagnosed referred pain from L1/L2 as I have minimal lateral movement in that area (he did tests)- also a tap test on my right knee didn;t get any twitching or reaction.

On the other hand, the MRI report says this :

L2/3 minor height loss and degenerative dehydration
L4/5 shows broad based far lateral protrusion narrowing the neural foramen but just allowing sufficient room for the left L4 root to emerge above it.
L5/S1  very similar left far lateral disc protrusion which at this level fills most of the neural foramen and slightly indents the theca resulting in mild compression of the left S1 root as the disc compresses it against the medial aspect of the left facet
Conclusion: degenerative disc protrusions at L4/5 and L5/S1 with a degree of compression of left nerve roots at the later.


I am confused here - my Doctor says I need to see a Neurosurgeon as he is certain it is the L5/S1 that is causing the referred pain ... on the other hand the harley street specialist(the only person to ask me detailed questions for 40 minutes to try and diagnose the problem) says L1/L2 causing the referred pain - who should I believe?  Also a pain clinic said I should have a Neck MRI and Pelvic MRI as referred pain can come from there too.

Secondly I want to take action and try to cure this - I am 1) getting foot insoles by specialists to correct the leg length problem that should balance my musculature in the long term , but need to know the best painkilling solution in the short term, as well as the best guides I can buy regarding this condition?

[kimpton]

hi.  it really comes down to how much pain you're in.  my advice would be to start working with someone who specializes in physical therapy/biomechanics to address the soft tissue issues & try to get some of the inflammation under control.  see if you make any progress.  if not, steroids would be the next step & i don't think you need another MRI for that.  you were referred to a neurosurgeon.  what i know about them is they are very detailed and highly specialized so the third professional opinion might help.  i herniated my disc in london & if i remember correctly (however i was very medicated at the time) i went to harley street.  i saw michael beverly who is an otho surgeon & trauma specialist.  i only saw him once but i liked him- and he read the mri report.  i also went to sloane street chiropractic.  hope this helps.  kimpton

[Zak_Han]

Hi,there
The pelvic MRI scan isn't necessary for your condition.I guess.
Physical examination play a main role for your diagnosis.plus practitiner's experience.
Good luck!

[shortlegger]

Thanks for that again - I so do appreciate a forum like this with people who have gone through the same thing and experienced specialists who give input.

Yes, I was told too that the psoas muscles cause mahem with referred pain, and is especially common with groin pain e.t.c.

The back pain specialist I saw measured my leg whilst I was laying down, and said it is definitely a mechanical short leg causing the muscle imbalance rather than the other way round, so I *think* I can eliminate that as a cause, but need to clear it up as the symptom of the pain.

Regarding the possible soft tissue damage, should I get a pelvic MRI scan to rule this out for the pelvis as well (since the muscles down there are really tight and in my mind referring pain)

Thanks again for the replies ; I will attack this from all the angles suggested and use it as a process of elimination.

[kimpton]

this is why i asked.  it's a lot & took me a long time to figure it out.

it also sounds like your si joints might be out of normal rotation and your hip flexors might be tight and not working correctly, which can pull your si joint out.  leg length discrepancy can be from a rotated si joint.  it's very common. i would suggest stretching your hip flexors religiously, especially if you sit for long periods of time.  sitting shortens the hip flexors and they become tight and contracted.  the psoas major attaches to L1-T12 and pulls on the spine when strained.  nerves can become trapped behind the psoas.  for me, the psoas major was trapping the femoral nerve.  i think the pernineal/pudendal nerve is part of the femoral nerve path as well.   a chiropractor can adjust the si joint to create mobility, but you need to stabilize them in the correct position.  if you have to get the si joint readjusted all the time than muscular imbalances is the next thing to address.  a p therapist can teach you how to release the hip flexors manually.  bad biomechanics are reinforced with repetetive exercise, walking, or sitting for long periods of time.  if you can't find someone in your area that specializes in biomechanics, an experienced pilates instructor could help you.  the school of thought is very similar.  once my nerve became trapped i the muslces along the nerve path stopped working.  in pt, i could not make the connection to the muscles (they just would not work- very frustrating) so i had electric stim acupuncture on the muscles nerve path along the spine as well as the muscle itself.  this is a very common problem, but i couldn't resolve it until i went to acupuncture.

these are some websites that desribe what i'm talking about.

http://stronglifts.com/the-psoas-is-it-killing-your-back/
http://www.oralchelation.com/calcium/DegenerativeHipJoint/p7.htm
http://www.protraineronline.com/past/2003/apr03/howto.cfm

[shortlegger]

Thank You Zak nd Kimpton for your replies!

my toes do point out - i think the reason is definitely caused by my short leg which has twisted my pelvis and probably doing all sorts of mechanical damage, therefore I will correct the short leg with orthotics.

I get muscle spasms deep inside my pelvis too when walking, so i am wondering if any of those muscles are impinging on the pudendal nerve since every one of my symptoms come from the pudendal nerve,

so, 1) is it referred pain , e.g, L4/L5/S1 inflammation referring pain to L1/L2 to the pudendal nerve (what pain specialist thinks)

2) could it be a Sacro- Iliac dysfunction from the short leg and impact activity that causes spasms and pain?

or 3) Pudendal Nerve Entrapment

4) Zaks theory above (I will be in contact Zak thanks)

Thank You

[kimpton]

it sounds like you have a trapped nerve.  steroid injections around an the nerve can help.  when you walk do your toes point straight ahead or do they tend to point out?  

[Zak_Han]

Hi,sorry to know it.
My opinion is different from your neurosurgeon and harley street doctor,of course,i'm not doctor in UK,but I have practised in other country hospital for long time.I have a lot of cases which is very similar.
I think that you suffer from soft tissue injury around lower back and thigh root area due to spine degeneration (L4/L5/S1),which can lead to conductible pain and numbness in groin and  pudendal area. and affect your sexual function as well.

I just quoted a few cases from my blog for you.( acupuncture.blog.co.uk)

_________________________________________

Zak acupuncture for lower abdomen abdominal distention, abdominal pain, groin pain case
by Acupuncturist @ 2008-05-07 - 14:44:57
M, female, 60-year-old, six months ago, suffering from urinary tract infection, the hospital examination, found no cause. Bilateral abdominal pain, groin pain, unable to walk a long time.

Clinical examination: straight-leg raising test, both are 45 °, leads the medial thigh pain, pain at the knee medial radioactive bilateral suprapubic tenderness highly sensitive point, the hip flexor knees at a consolidated trial, leads to the roots of thigh pain, Diagnosis: Bilateral thigh soft tissue damage to the thigh roots pain and groin pain.

Treatment: zak acupuncture
Results: After a period of treatment, symptoms disappeared.
-------------------------------------------------------------------------------


Zak acupuncture for sexual intercourse pain case
by Acupuncturist @ 2008-05-07 - 15:46:51
W, female, 45 years old, lower abdominal pain for nine years, perineal pain for 14 years, accompanied by menstrual pain, sexual intercourse pain, frequency and urgency, particularly in the menstrual period, after hospital treatment, are not effective, pain remains ,can't lateral thigh, can not walk step.

Clinical examination: straight-leg raising test both are 70 °, the roots of bilateral thigh have severe pain. Other inspection normal, the diagnosis: bilateral, the roots of the thigh, a soft-tissue damage, caused the abdominal pain, genital pain, pain in sexual intercourse.

Treatment: zak acupuncture
Results: After a period of treatment, symptoms disappeared.

____________________________________________________________

Zak acupuncture for scrotal pain case
by Zak on Sun Mar 16, 2008 9:52 pm

W, male, 49 years old, left scrotal pain and the sense of falling for eight months, no history of trauma, pain affect walking

Clinical examination: straight-leg raising test negative, tenderness at the root of bilateral thigh highly sensitive 'knees hip flexor legs at the root of test leads to thigh pain, diagnosed as: Bilateral thigh soft tissue damage to the roots of scrotal pain

Treatment: zak acupuncture
Results: After several cycles of treatment, all kinds of pain disappeared, patient feel satisfactive.
___________________________________________________________________

Zak acupuncture for sexual dysfunction case
by Zak on Sun Mar 16, 2008 10:30 pm

X, male, 44 years old, low back pain, for 11years,sacral pain, right leg pain for 1 year, and the right abdominal pain associated with urine frequency, urine urgency, and sexual dysfunction for 12 years, non-surgical therapy for six months, to no avail.

Clinical examination: Spinal no abnormal appearance, straight legs bending test hand fingertip 25 cm from the ground, straight leg extension waist limited test, have aroused increasing low back pain, straight-leg raising test Bilateral 85 °, the roots of both the waist and thighs highly sensitive point of tenderness, knees hip flexor legs at the root of test leads right thigh pain.

Treatment: zak acupuncture
Results: all Bilateral waist, sacrum pain, the abdominal pain, knee pain disappear, sexual dysfunction disappear, all kinds of inspections negative.

_______________________________________________________

So,deep and intensive acupuncture can help! Take care!