Kaur Jasmeen, Leslie Stephen W., Singh Paramvir
Augusta University
Creighton University School of Medicine
Pudendal neuralgia caused by pudendal nerve entrapment is a chronic and often severely disabling neuropathic pain syndrome. The condition manifests within the sensory distribution of the pudendal nerve and affects both male and female patients. The most characteristic symptom, reported in over 50% of cases, is perineal pain exacerbated by sitting and relieved by standing or lying. The syndrome is frequently misdiagnosed or underdiagnosed and often inappropriately treated, resulting in delayed initiation of appropriate management and substantial negative impact on quality of life. Chronic pain associated with pudendal nerve entrapment imposes significant mental and economic burdens. These factors warrant careful consideration during clinical assessment and therapeutic planning. The pudendal nerve arises from the ventral rami of the S2, S3, and S4 roots of the sacral plexus. This nerve carries sensory, motor, and autonomic fibers. Injury to the pudendal nerve primarily produces sensory deficits. The nerve initially courses between the piriformis and coccygeus muscles, exiting the pelvic cavity through the greater sciatic foramen, ventral to the sacrotuberous ligament. This neural structure then passes medial to and beneath the sacrospinous ligament at the level of the ischial spine before reentering the pelvic cavity through the greater sciatic foramen. The pudendal nerve continues within the pudendal canal, also termed the "Alcock canal." The terminal branches— the inferior rectal and perineal branches and the dorsal sensory nerve of the penis or clitoris—terminate in the ischioanal fossa. Case reports have documented anatomical variability of the pudendal nerve. For detailed anatomical information, refer to the companion StatPearls reference "Anatomy, Abdomen and Pelvis, Pudendal Nerve." Pudendal nerve entrapment syndromes are classified into 4 types according to the anatomical site of nerve compression (see . Key Landmarks for Pudendal Nerve Entrapment). Type I involves entrapment of the pudendal nerve beneath the piriformis muscle as it exits the greater sciatic notch and is frequently associated with piriformis muscle spasm. Type II, the most common form, occurs at the level of the ischial spine and the entrance of the lesser sciatic notch, where the nerve passes between the sacrospinous and sacrotuberous ligaments. Type III is characterized by entrapment at the entrance of the Alcock canal, often in association with obturator internus muscle spasm. Type IV represents distal entrapment of the pudendal nerve’s terminal divisions.
由阴部神经卡压（PNE）引起的阴部神经痛是一种慢性且常导致严重功能障碍的神经性疼痛综合征。它出现在阴部神经的感觉分布区域，男性和女性都会受到影响。超过50%的患者出现的最典型症状是坐位时会阴疼痛加剧，站立或卧位时缓解。它经常被误诊或漏诊，治疗不当，最初会导致正确治疗的显著延迟，并严重负面影响生活质量。阴部神经从骶丛的S2、S3和S4神经根的腹侧支发出。它携带感觉、运动和自主神经纤维；然而，阴部神经损伤引起的感觉影响比运动影响更多。它最初在梨状肌和尾骨肌两块肌肉之间走行，然后通过骶结节韧带腹侧的坐骨大孔离开盆腔。它在坐骨棘水平经骶棘韧带内侧并在其下方通过坐骨大孔重新进入盆腔。然后阴部神经在阴部管（也称为阿尔科克管）中走行。阴部神经的最后三个分支在坐骨肛门窝终止。这些分支是直肠下支、会阴支以及阴茎或阴蒂背侧感觉神经。然而，有病例报告显示阴部神经的解剖结构存在变异。（见我们关于《解剖学，腹部和骨盆，阴部神经》的配套文章）根据压迫部位，阴部神经卡压综合征可分为四种类型。I型——阴部神经穿出坐骨大切迹时在梨状肌下方的卡压。II型——骶棘韧带和骶结节韧带之间的卡压是阴部神经卡压最常见的部位。III型——在阿尔科克管内的卡压。IV型——终末分支的卡压。
