Doubleday Kathryn L, Kulig Kornelia, Landel Robert
Depart,ment of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
Arch Phys Med Rehabil. 2003 Dec;84(12):1903-5. doi: 10.1016/s0003-9993(03)00283-1.
Unsuccessful recognition of the origin of testicular pain and a high failure rate of surgical interventions lead to poor outcomes, psychologic distress, and increased costs of care. A frequently overlooked cause of testicular and buttock pain is irritation of the T10-L1 sensory nerve roots, the genitofemoral nerve, and the ilioinguinal nerve. We present the case of a 36-year-old policeman with a 5-year history of back pain and testicular pain of unknown origin. Physical examination of the thoracolumbar region revealed that active movement provoked the patient's buttock symptoms, and local mobility restrictions were present in the thoracolumbar region. A central disk protrusion at T12-L1 was noted on upper lumbar spine magnetic resonance imaging, which supports dysfunction of this region. The diagnosis of thoracolumbar stiffness led to implementation of passive and active mobilization of that region and to specific hip stretching and strengthening exercises. After a course of direct and guided physical therapy, the patient attained complete symptom resolution. The patient returned to full work duties as a police officer and resumed his full recreational activity. The excellent outcome achieved in managing this patient was attributed to identifying the origin of referred pain from the thoracolumbar junction.
对睾丸疼痛来源的识别失败以及手术干预的高失败率会导致不良后果、心理困扰和护理成本增加。睾丸和臀部疼痛的一个经常被忽视的原因是T10 - L1感觉神经根、生殖股神经和髂腹股沟神经受到刺激。我们报告一例36岁警察的病例，他有5年不明原因的背痛和睾丸疼痛病史。胸腰段体格检查发现主动活动会引发患者的臀部症状，胸腰段存在局部活动受限。上腰椎磁共振成像显示T12 - L1中央椎间盘突出，这支持了该区域的功能障碍。胸腰段僵硬的诊断导致对该区域进行被动和主动松动，并进行特定的髋关节伸展和强化锻炼。经过一个疗程的直接和指导下的物理治疗，患者症状完全缓解。该患者恢复了警察的全职工作，并重新开始了全部娱乐活动。成功治疗该患者的原因在于确定了胸腰段交界处牵涉痛的来源。
