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|LETTER TO EDITOR
|Year : 2015 | Volume
| Issue : 1 | Page : 105-106
An unusual cause for a rare neuropathy: Pudendal nerve entrapment syndrome secondary to obturator internus muscle edema
Mehmet Besir Turkmen1, Figen Kocyigit2, Ali Kocyigit3
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 Publication||4-Mar-2015|
School of Physical Therapy and Rehabilitation, Denizli
Source of Support: None, Conflict of Interest: None
|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 Mar 9];63:105-6. Available from: https://www.neurologyindia.com/text.asp?2015/63/1/105/152671
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|
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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. 
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.  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|| |
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.
Insola A, Granata G, Padua L. Alcock canal syndrome due to obturator muscle fibrosis. Muscle Nerve 2010;42:431-2.