Stemcelldoc's Weblog

March 3, 2010

Testicle Pain: Next Step Amputation

Filed under: Case Reports, Lumbar Spine — Tags: , — stemcelldoc @ 9:46 am

DS is a 40y/o patient with 7 month history of right testicle pain which is constant in duration, 5/10 in severity, progressive in nature, throbbing in character and principally localized in the right testicle with intermittent radiations into the groin, anterior thigh and third right toe.  Patient denies any traumatic injury.  Treatment to date had included antibiotics, MRI, ultrasound evaluation of the testicle,ultrasound of the inguinal area to rule out hernia and anesthetic block performed by the urologist which provided 3 hours of pain relief.  All studies were normal.  Patient underwent surgical removal of the an appendage of the testicle (epididymis) with no reduction in pain.  Patient has a 3 year history of intermittent lower back  and right leg pain.

Physical examination was most significant for an abnormal neurologic and musculoskeletal examination.  Specifically patient had decreased sensation to light touch and temperature along the right big toe and lateral aspect of right foot, profound muscle banding with multiple trigger points in the lower back and most importantly along the inner right thigh.

A thin gauge needle was inserted in the adductor magnus at the most tender trigger point.  This simple therapy provided DS with 40 % reduction in his testicular pain.

DS has a classic example of myofascial pain syndrome.  A dysfunctional muscle caused referred pain.  In DS’s case, his adductor magnus was responsible for some his testicular pain.  He has just started therapy.  He may also has some referred pain from lumbar disc.

The adductor magnus is a large fan like muscle that attaches on the pelvis and femur. It’s referral pattern is typically into the groin and testicle.  There are other muscles with similar referral patterns.

A thorough musculoskeletal examination is essential in the evaluation of pain.  This is the standard of care at The Centeno-Schultz Clinic.

March 9, 2009

Myofascial Pain Syndromes

Myofascial pain syndromes are a large and diverse group of painful conditions that occur in the musculoskeletal system.  They affect muscles and their connective tissue attachments.  They are named according to the location of the painful area.  Common examples include lateral epicondylitis and achilles tendonitis.  Myofascial pain syndromes are unique in that they typically arise and persist in the absence of any detectable injury or inflammation.

What is a myofascial trigger point (MTP) ?  Heguenin defines a MTP as a the presence of exquisite tender nodule in a palpable band of muscle.  They produce referred pain either spontaneously or with compression.

What is intramuscular stimulation (IMS).  It involves the use of small acupuncture like needles to deactivate trigger points and loosen tight (shortened) muscles.

IMS

IMS

 

 Gunn MD contends that long term pain relief requires treatment at the affected spinal level to reduce nerve root compression as well as treatment of peripheral trigger points.

Sources of MTP?  Unclear, however Chan Gunn MD advocated that neural injury or compression at a specific spinal level results  in abnormal activity in the peripheral nerve. The goal of IMS is to release muscle shortening, promote healing and decrease spontanesous electrical activity at the trigger points.

So if you are snowboarding and catch an edge and find yourself face planted, you may have injured your C5.6 disc.  It may be a transient pain but the injurymay have  resulted in an irritation of the C6 nerve root.  You may not have neck pain or shooting pain down the arm typcial of a C6 nerve root irriation.  More commonly you will have pain in the muscles of the rotator cuff, the rhomboids, latissimus dorsi, biceps and triceps all of which are innervated by the C6 nerve root.  At the Centeno-Schultz Clinic we understand the importance of treating both the affected spinal level as well as the peripheral trigger points.  Long term success requires treatment of both.

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