Pudendal Nerve Entrapment

Pain or numbness in the leg/genital area

Learn more about pudendal nerve entrapment and its variations

Symptoms: Pain or numbness involving the area between the legs, including the genitals and occasionally some of the inside of the thigh. Often only one side is affected. The pain may be aggravated by sitting.

Diagnosis: The diagnosis is based on matching the affected area to the areas supplied by the Pudendal nerve. MR Neurography imaging can identify entrapments. Injections can confirm the diagnosis and can help.

What causes the problem? There are four common sites of nerve entrapment that can cause a pudendal nerve syndrome. The nerve may be entrapped as it:

  • passes under the piriformis muscle
  • crosses the sacrospinous ligament and dives under the sacrotuberous ligament
  • travels across the obturator foramen within the Alcox canal
    upon exit from Alcox canal and branching in the perineal area (between the legs)

Another cause is entrapment or irritation of the Impar ganglion on the internal surface of the coccyx.

How can it be treated? At the Institute for Nerve Medicine, Dr. Aaron Filler uses open MRI image guidance to inject anesthetic, steroid or anti-scarring materials at the various possible entrapment points. In some cases, injections such as these help relieve symptoms, but most often the injections serve to confirm the diagnosis and pinpoint the cause.

Dr. Filler has also developedinimal access surgical treatments that are directed at releasing the nerve entrapments. In some patients, this involves cutting or trimming the piriformis muscle. In other patients, the sacrotuberous or sacrospinous ligaments must be cut or trimmed. Others require dilation of the Alcox canal.

Overall, the surgical treatments for pudendal nerve entrapment syndrome at INM are new and quite different than those offered elsewhere. Dr. Filler’s success rates are 85-90% good to excellent – far exceeding the uncertain outcomes of older types of pudendal nerve surgery. Many patients can expect significant or complete relief of symptoms from effective treatment – often within days of the surgery.

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    Dr. Aaron G. Filler, MD PhD JD FRCS

    Medical Director, Institute for Nerve Medicine
    Santa Monica, California

    Dr. Aaron Filler is the world’s leading expert in the treatment of nerve pain, revolutionizing this area of medicine by inventing several new technologies. One such technology, MR Neurography, enables doctors to use an MRI scanner to examine nerves, previously a difficult-to-impossible tissue to visualize with MR imaging. Dr. Filler’s research in axonal transport is leading to a whole new generation of advanced pain medications. He has developed many new “minimal access” surgery methods that allow him to treat complex nerve problems with small outpatient surgeries. He has also pioneered the use of the Open MRI scanner to do surgeries and other therapies with the ultra-high precision and safety of the magnetic resonance imaging.

    Dr. Aaron Filler combines three key components in his treatment of each patient:

    • Compassionate personal attention,
    • Expert medical skills, and
    • The best technology in the world

    He combines these components to turn insoluble pain problems into specific treatable diagnoses. Prior to coming to the Institute for Nerve Medicine, many of Dr. Filler’s patients have seen a dozen doctors (or more), experienced failed surgeries, and have even had their very pain questioned.

    Time and again, Dr. Filler demonstrates that in many of these cases the problem is the doctor and not the patient. A cure is in reach when the best available medical care is brought to bear.

    Insurance and Payment Options

    Questions about what insurance plans the Institute for Nerve Medicine accepts?

    We accept all insurance plans (including PPO, POS, etc.) that include out-of-network benefits.

    We have opted out of Medicare.

    We do not insurance-bill any worker’s compensation plan.

    We provide interest-free monthly payment plans for patients with insurance plans that do not fully cover costs of out-of-network and specialty medical services.

    We accept all major forms of payment: VISA, MasterCard, American Express, Discover, personal checks and cash (US currency). We do not accept foreign currencies (e.g. Euro).

    We work with patients of every budget level and want all patients to have access to the best expert care in this field. Accordingly, billing services are offered as a courtesy to all patients.

    More questions? Call us at 310-314-6410.