22nd Annual Pain Medicine Meeting 2023

Treatment of Pudendal Nerve Entrapment by Iliococcygeus and Coccygeus Trigger Point Injections with Combined X-Ray and Ultrasound Guidance

Bengt J Grua, MD & Kim Youngren, MD

Dartmouth Health Center for Pain and Spine

INTRO

•Pudendal Nerve Entrapment (PNE) is a rare, overlooked cause of chronic pelvic, genital, and anorectal pain.

•PNE occurs most commonly at the greater sciatic notch but can occur anywhere along the path of the pudendal nerve.

CASE

•33-year-old male bodybuilder with 9 months of right pelvic and penile pain.

•On exam, several trigger points were identified in the pelvic floor, suggestive of PNE due to hypertrophy of pelvic floor muscles.

•Combined X-Ray & US were used to perform TPI with bupivacaine and dry needling.

•Pain relief has lasted 9 months thus far.

DISCUSSION

•While PNE often occurs at the greater sciatic notch, pelvic floor hypertrophy should be considered in patients with intensive exercise history.

•TPI can be an effective treatment for PNE due to pelvic floor hypertrophy.

TREATMENT OF PUDENDAL NERVE ENTRAPMENT BY ILIOCOCCYGEUS TRIGGER POINT INJECTIONS WITH COMBINED X-RAY AND ULTRASOUND GUIDANCE