Diagnosis and laparoscopic repair of type I obturator hernia in women with chronic neuralgic pain.

 Perry CP, Hantes JM. Journal of the Soc of Laparoendoscopic Surgeons. 2005;9:138-141.

Cindy Neville, PT, DPT, WCS- January 9, 2013

Primary Aim: To describe results of laparoscopic treatment of obturator hernia (OH) in a small cohort of female patients with obturator neuralgia and chronic pelvic pain.

Background: The obturator foramen is formed by the rami of the ischium and the pubic bone, and is partially closed by a strong musculoaponeurotic barrier consisting of an internal and an external obturator membrane and an internal and an external obturator muscle. The obturator canal is situated in the cranial portion of this membrane with the pubic bone above and the membrane below, and measures approximately 0.2-cm to 0.5-cm wide and 2-cm to 3-cm long through which traverse the obturator nerve, artery ,and vein. The obturator nerve may become compressed in the canal leading to neuralgia.

Bedside testing for chronic pelvic pain: discriminating visceral from somatic pain

Jarrell J, Giamberardino MA, Robert M, Esfahani MN. Pain research and treatment. 2011; 2011: article ID 692102.

Cindy Neville, PT, DPT, WCS- January 9, 2013

Primary Aim: To determine the ability of 3 simple bedside tests of cutaneous allodynia, myofascial pain, and reduced pain thresholds to differentiate women with visceral and somatic conditions associated with their chronic pelvic pain.

Background: The concepts of referred visceral pain to a specific cutaneous location and that an irritable focus in certain tissues could be responsible for such localization have been investigated for many years. For example, stimulation of the ureter or the pelvis of the kidney was found to cause a contraction of the muscles of the abdominal wall on the stimulated side and remain contracted for a period of time (Head 1809, Mackenzie 1909).  Visceral disease is known to contribute to the development of myofascial trigger points in biliary, cardiac, and renal disease, and in endometriosis and interstitial cystitis. In the female reproductive system the relationship of the referral of pain through viscerosomatic processes is complex. As the visceral afferents are greatly outnumbered by somatic afferents, there is considerable merging of signals ( viscerosomatic convergence) which makes the specificity of organ of origin a complex message for the central nervous system. This means that pain originating from pelvic organs may not be identified with accuracy. This can lead to situations where investigations and surgery are repeated and in some cases extensively.

1-9-13 Pelvic Physiotherapy Distance Journal Club

Time - 8:30 PM EST for one hour

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This month’s discussion

Diagnosis and laparoscopic repair of type I obturator hernia in women with chronic neuralgic pain. Perry CP, Hantes JM. Journal of the Soc of Laparoendoscopic Surgeons. 2005;9:138-141.

Bedside testing for chronic pelvic pain: discriminating visceral from somatic pain. Jarrell J, Giamberardino MA, Robert M, Esfahani MN. Pain research and treatment. 2011; 2011: article ID 692102.