Dr Andreas Loefler - Orthosports

1 Dr Andreas LoeflerJoint Replacement & Spine SurgeryDr Andreas 31 Dora Street, Hurstville160 Belmore Road, RandwickDr Andreas LoeflerJoint Replacement & Spine SurgeryPudendal Nerve EntrapmentAndreas LoeflerHip, Knee, and Spine SurgeonDr Andreas LoeflerJoint Replacement & Spine SurgeryPNE Pudendal Neuralgia Alcock s Syndrome Cyclists Syndrome Pudendal Nerve EntrapmentDr Andreas LoeflerJoint Replacement & Spine SurgerySymptoms Pelvic pain Genital numbness and paraesthesia Bladder and bowel dysfunctionDr Andreas LoeflerJoint Replacement & Spine SurgerySymptoms Pelvic pain Genital numbness and paraesthesia Bladder and bowel dysfunction Pain and numbness.

2 Typically worse with sittingDr Andreas LoeflerJoint Replacement & Spine SurgeryCyclist Syndrome Recurrent numbness of penis and scrotum More common with long distance cycling Compression of nerves and or arteriesDr Andreas LoeflerJoint Replacement & Spine SurgeryCyclist Syndrome Recurrent numbness of penis and scrotum More common with long distance cycling Compression of nerves and arteries Special seats with central gapsDr Andreas LoeflerJoint Replacement & Spine SurgeryFor the Delicate CyclistDr Andreas LoeflerJoint Replacement & Spine SurgeryFor the Delicate CyclistDr Andreas LoeflerJoint Replacement & Spine SurgeryFor the Delicate CyclistDr Andreas LoeflerJoint Replacement & Spine SurgeryCauses Inflammatory and auto immune Infection Pregnancy and difficult labour Forceps delivery Pelvic surgery, particularly for prolapse Accidents.

3 Especially falls onto buttocks Physical training and sportsDr Andreas LoeflerJoint Replacement & Spine SurgeryEntrapment Carpal tunnel of the pelvis Narrow gap between sacro tuberous and sacro spinous ligaments Variable anatomy Dynamic changesDr Andreas LoeflerJoint Replacement & Spine SurgeryAnatomyDr Andreas LoeflerJoint Replacement & Spine SurgeryAnatomyDr Andreas LoeflerJoint Replacement & Spine SurgeryAnatomyDr Andreas LoeflerJoint Replacement & Spine SurgeryDiagnosis History No clinical signs Digital palpation Pudendal block MRIDr Andreas LoeflerJoint Replacement & Spine SurgeryDr Andreas LoeflerJoint Replacement & Spine SurgeryTreatment Modification of activities Ergonomic seats and cushions Pelvic floor exercises Stretches and dilator therapy Change of sport and trainingDr Andreas LoeflerJoint Replacement & Spine SurgeryMedications Analgesics Antidepressants Anti epileptics Lyrica NeurontinDr Andreas LoeflerJoint Replacement & Spine SurgeryNerve Blocks Local anaesthetic Diagnostic.

4 Trans gluteal Should cause numbness and relieve pain Steroids? Botox Radiofrequency pulsedDr Andreas LoeflerJoint Replacement & Spine SurgerySurgery The last resort With persistent symptoms Failed non operative treatments Nante criteriaDr Andreas LoeflerJoint Replacement & Spine SurgeryNante Criteria Pain in pudendal distribution Worse with sitting Little or no night pain No objective sensory loss Positive nerve blockDr Andreas LoeflerJoint Replacement & Spine SurgeryNante Criteria Pain in pudendal distribution Worse with sitting Little or no night pain No objective

5 Sensory loss Positive nerve block Positive MRIDr Andreas LoeflerJoint Replacement & Spine SurgeryApproach Trans vaginal or ischio rectalDr Andreas LoeflerJoint Replacement & Spine SurgeryApproach Trans vaginal or ischio rectal Trans gluteal Better visualization Variable anatomy seen Better decompression of nerve Complete division of ligaments Transposition of nerveDr Andreas LoeflerJoint Replacement & Spine SurgeryPositioningDr Andreas LoeflerJoint Replacement & Spine SurgerySurgery One hour per side Two thirds bilateral 4 to 1 Female to Male One or two nights in hospital Early mobilization Hamstring stretchesDr Andreas LoeflerJoint Replacement & Spine SurgeryDr Andreas LoeflerJoint Replacement & Spine SurgeryResults Chronic pain patients May take six months to recoverDr Andreas LoeflerJoint Replacement & Spine SurgeryResults Chronic pain patients May take six months to recover One third good recovery One third partial recovery One third no recoveryDr Andreas LoeflerJoint Replacement & Spine SurgeryMy Results To date 64

6 Pudendal decompressions No patient worse Some spectacularly betterDr Andreas LoeflerJoint Replacement & Spine SurgeryMy Results To date 64 pudendal decompressions No patient worse Some spectacularly better Independent follow up Pain scores MRI at 6 monthsDr Andreas LoeflerJoint Replacement & Spine SurgeryFAQ Will the pelvis be stable? 25 yrs experience no instability Mechanical testing no instabilityDr Andreas LoeflerJoint Replacement & Spine SurgeryFAQ Will the pelvis be stable? 25 yrs experience no instability Mechanical testing no instability Complications Haematoma Infection Nerve damageDr Andreas LoeflerJoint Replacement & Spine SurgeryTeamwork Pelvic pain specialist(A gynaecologist who sees men!)

7 Psychologist Physiotherapist SurgeonDr Andreas LoeflerJoint Replacement & Spine SurgeryTeamwork Worldwide 5 centers Two in France ( Nante and Grenoble) Two in the USA (Huston and San Diego) One here in SydneyDr Andreas LoeflerJoint Replacement & Spine SurgeryPNE Not well known Can be debilitating Diagnosis often delayedDr Andreas LoeflerJoint Replacement & Spine SurgerySupport A lively internet community Wikipedia more than text booksDr Andreas LoeflerJoint Replacement & Spine SurgeryPudendal Nerve Awareness DayDr Andreas LoeflerJoint Replacement & Spine SurgeryAwareness You can help with the diagnosis and cureDr Andreas LoeflerJoint Replacement & Spine SurgeryThank you.