American Society for Peripheral Nerve

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Sitting Is a PAIN in the Ischia
A. Lee Dellon, MD, PhD
Plastic Surgery, Johns Hopkins University, Towson, MD

Purpose: The ischial tuberosity, referred to as the “sit bone” by patients with pain when sitting, is surrounded by critical nerves. Depending upon how a person places weight on the ischial tuberosity, symptoms can vary from pudendal nerve symptoms, to sciatica, or to posterior femoral cutaneous nerve (PFCN) symptoms. This research relates, for the first time, the involvement of the PFCN, including its perineal and inferior cluneal branches to the symptom of “Pain in the ISCHIA”. The outcome of resecting this nerve is presented.

Methods & Materials: From 2010 through August of 2013, 14 patients had surgery on the PFCN. Twelve were women. Mean age of the 14 patients was 54.6 years (range 30 to 74 years). Each patient had pain with sitting and symptoms involving the buttock, posterior thigh and perineum. Patients spent much of the day standing or lying down. Mean symptom duration was 63.5 months (range 12 to 180 months). Mechanism of injury was a hamstring tear in 7 of the 14, usually related to an athletic event or a fall. Previous misdiagnosis: Nine had transgluteal pudendal nerve decompression, two had pyrimiformis excision and sciatic neurolysis. Each of the 14 patients in this series had a resection of the PFCN through an incision in the gluteal crease.

Results: Of the 14 patients, at a mean of 19.4 months post-operatively, there were 6 excellent, 5 good, 2 fair, and 1 poor result: 79% good to excellent results (pain relief, improvement in sitting). Two fair results were in the first patients, the only two in whom the entire PFCN was not removed. There were no surgical complications.

Conclusion: Ischial pain can be due to injury to PFCN, a previously unreported etiology. Good to excellent results can be expected in 79% of carefully selected patients.

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