Sports Medicine and Fitness

Biography

Biography: Steve Middleton

Abstract

Abstract Objective: To present the case of a male who presented with inflammatory pelvic pain consistent with pudendal neuritis. Background: A 49-year-old male machinist presented to the sports medicine staff with chronic testicular and rectal pain of 10 years duration. Subsequently, he was diagnosed with pudendal neuritis and referred for physical rehabilitation. Differential Diagnosis: Epididymitis, pudendal neuritis, sacroiliac joint dysfunction, athletic pubalgia, testicular tumor. Treatment: Post-isometric relaxation and muscle energy techniques were used to correct a left-sided sacroiliac joint dysfunction. The patient was then progressed to therapeutic activities to restore normal mechanics to lumbo-pelvic-hip complex. Several flare-ups have occurred in the 24 months since initial treatment, however, they have been of short duration (< 2 days) and less intense. Uniqueness: Pudendal neuritis tends to affect females more than males. Typically, males with testicular pain suffer from epididymitis or some type of testicular torsion, which was not the situation in this case. Compression also is a common cause of pudendal neuritis, which did not factor into this case making identification and treatment a complex challenge. Conclusions: The pudendal nerve passes between the sacrospinous and sacrotuberous ligaments. When there is dysfunction of the sacroiliac joint, said ligaments can cause compression of the pudendal nerve manifesting with diffuse pelvic pain and dysfunction. Many pain syndromes can be treated via the removal of the original stimulus; however, recognizing the contributing factors of the pain and dysfunction in pelvic pain in males can be a challenge for the sports medicine professional. A vigilant and unassuming approach to male pelvic pain is warranted.