Abstract
Introduction: To describe and discuss the diagnosis and chiropractic treatment of a patient with chronic idiopathic pudendal nerve entrapment that presented with saddle-like paresthesia and caused Restless Genital Syndrome. Aim: A 43-year-old female patient had symptoms consistent with a pudendal nerve entrapment, saddle-like paresthesia, and restless genital syndrome for 1.5 years prior to starting care with a chiropractor. She had been to numerous medical providers, none of which offered the correct diagnosis or treatment options. Methods and Results: Chiropractic manipulative therapy, myofascial release, and instrument-assisted soft-tissue mobilization was directed at the pelvic musculature with the primary focus on the right obturator internus. Through one month of chiropractic care the patient’s symptoms were resolved including restoration of regular sexual function. Conclusion: Chronic perineal pain can be found in cases with numerous diagnoses, with pudendal nerve entrapment being one that is rarely documented. There are a wide variety of causes of PNE that include but not limited to direct injury, tumor, ganglion cysts, anatomical anomaly, and extended time cycling. Documented treatment for pudendal nerve entrapment is limited, primarily to pain injections. This case demonstrates how chiropractic care and soft tissue mobilization can correct the dysfunction.
Highlights
To describe and discuss the diagnosis and chiropractic treatment of a patient with chronic idiopathic pudendal nerve entrapment that presented with saddle-like paresthesia and caused Restless Genital Syndrome
She did have a previous history of horseback riding and had injured her coccyx in the past but previous sacrococcygeal x-rays were negative for fracture. She indicated that she was treated conservatively for that condition with full resolution of coccygeal pain. She did indicate that she had been under chiropractic care as needed for the past 5 years for various conditions but never mentioned her saddle-like paresthesia since it had been ongoing the past 1.5 years
A 3 month follow up via conversation was had and the patient remained symptom free. This is one of the few case reports demonstrating the effectiveness of chiropractic intervention combined with manual therapy to treat Pudendal neuralgia (PN)
Summary
To describe and discuss the diagnosis and chiropractic treatment of a patient with chronic idiopathic pudendal nerve entrapment that presented with saddle-like paresthesia and caused Restless Genital Syndrome. PN is a rare neurological condition and is defined by burning vaginal or vulval pain (anywhere between the anus and the clitoris) associated with tenderness over the course of the pudendal nerve [1,2] PN due to pudendal nerve entrapment (PNE) is related to loss of mobility of the pudendal nerve over its gluteal or pelvic course. As the pudendal nerve courses its way through the pelvis, its loss of mobility is due to anatomical impingement [3] in various locations to include: in the reflection of the obturator fascia, in the space between the sacrospinous ligament and the sacrotuberous ligament or in the infrapiriformis canal. Onset of pain and the range of symptoms can involve other elements related to central sensitization phenomena or muscular or visceral reactions/reflexes
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