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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Obturator neuralgia (ON) presents with pain in the groin, medial thigh, and sometimes the medial aspect of the knee. The causes include trauma, obturator hernia, pelvic cancer, pelvic surgery, hip surgery, following pelvic fractures, endometriosis, retroperitoneal hematoma, pregnancy, and delivery. Ultrasound (US) guidance facilitates real-time imaging, identification of vascular structures, and improves patient comfort in situations where nerve stimulation can be unpleasant. This is a case report of ON successfully treated with US-guided steroid injection. A 55-year-old man was referred to the pain clinic with groin pain and allodynia in the medial thigh and knee following a fall. He had tried multiple other therapies and none of them provided significant relief. Using a 10-5-MHz multi-frequency, 38-mm linear array transducer, the obturator nerve was scanned in both longitudinal and transverse directions. Under real-time imaging 10 mg of medroxy-progesterone in a volume of 1 mL was injected. Following the injection, a small area of the medial side of knee was still tender to light touch. A second injection was placed inferiorly and provided pain relief for more than 5 months. This successful demonstration of US guidance in ON may further encourage US guidance in pain clinic interventions.
Pain Pract
PMID:Ultrasound-guided steroid injection for obturator neuralgia. 1850 24

Obturator neuralgia is commonly diagnosed and treated in orthopedics. It produces groin pain, sensory alteration in the medial thigh (dysesthesia, sensory loss, or pain), adductor muscle weakness and pain/restriction of hip movements. Basically, the clinical diagnosis of obturator neuralgia is made by producing pain during internal rotation of the hip against resistance ("obturator sign") or by extension and lateral leg movements. We postulate obturator neuralgia can induce lower urinary tract symptoms and dyspareunia and be diagnosed by using three clinical signs characterizing neuralgia everywhere on the body: painful nerve trunk (at the entrance of the obturator canal; by vaginal or rectal examination), abnormal sensibility and painful skin rolling test in its cutaneous innervation territory (inferomedial skin of the thigh). To support our assumptions, three female patients with longstanding lower urinary tract symptoms and/or dyspareunia and a clinical examination suggestive of obturator neuralgia (three clinical signs positive) were treated by perineural injections of dextrose 5% in sterile water (D5W). The three patients were clinically improved or cured after the treatment with two of them being cured after a single injection. While waiting for confirmation of these findings by randomized controlled trials, we suggest that obturator neuralgia should be sought in every patient with lower urinary tract symptoms and/or dyspareunia and that obturator perineural D5W injections be tried to relieve these patients.
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PMID:Perineural dextrose injections in the treatment of lower urinary tract symptoms and dyspareunia induced by obturator neuralgia. 3275 10