Buttock-Posterior Thigh Neuropathic Pain – Posterior Femoral Cutaneous Nerve Injury and Treatment

Pain in butt and hamstring is not uncommon and usually involves hamstring. However, neuropathic level pain in areas can happen after surgery or injection suggesting nerve damage to Posterior Femoral Cutaneous Nerve. Present article used cryoablation successfully to treat.

Skeletal Radiol. 2017 Jul;46(7):983-987. doi: 10.1007/s00256-017-2617-6.
MRI-guided cryoablation of the posterior femoral cutaneous nerve for the treatment of neuropathy-mediated sitting pain.
Joshi DH et al
https://www.ncbi.nlm.nih.gov/pubmed/28299433

Posterior cutaneous Nerve Thigh courses :

Here is an anatomical pic:

Here is the sensory area in one case:

Branches include:

  •  medial posterior buttock
  • parts of the scrotum or the labia
  • posterior thigh to the mid-calf.

Symptoms –

  • throbbing burning pain
  • radiating to  posterior part of the thigh to the popliteal fossa
  • worse sitting

Most likely injury is injections but present case was after right pudental nerve surgery

Rx:

  • blocked first with 10 cm needle (?overkill)-  block using 2 ml
    of 1% ropivacaine
  • “Introduction of a 15-cm long 20-G probe for cryoablation of the posterior femoral cutaneous nerve using two 3-min freeze/3-min thaw cycle”

Result – immediate substantial relief and still good 5 months later

 

Comment – was not aware of this problem – is another sitting disease like pudental neuralgia but it goes down back of thigh to knee.

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