A Lee Dellon1. 1. Professor of Plastic Surgery and Neurosurgery, Department of Plastic Surgery and Department of Neurosurgery, Johns Hopkins University, Baltimore, MD.
Abstract
PURPOSE: The ischial tuberosity, referred to as the "sit bone" by patients with pain, is surrounded by critical nerves. This research relates, for the first time, the involvement of the posterior femoral cutaneous nerve (PFCN), including its perineal and inferior cluneal branches to the symptom of "sitting pain." An experience with PFCN resection for treatment of pain with sitting is reported. PATIENTS AND METHODS: The computer records were searched from 2010 through August of 2013, identifying 17 patients who had surgery on PFCN. Fifteen of these 17 were women. Mean age of 17 patients was 54.6 years (range 30-74 years). Each patient had pain with sitting, and spent much of the day standing or lying down. Each had symptoms involving posterior thigh and buttock. Three patients had bilateral problems. Each of 17 patients in this series had resection of PFCN through an incision in the gluteal crease. Resection included inferior cluneal branches and perineal branch. RESULTS: Of 17 patients, at a mean of 19.4 months (range 6 to 42 months) after surgery, the visual analog scale improved from a mean of 9.2 to a mean of 2.1 (P < 0.0001). There were 7 excellent, 6 good, 3 fair, and 1 poor result, for 76% good to excellent result in terms of pain relief and improvement in being able to sit. CONCLUSION: Pain with sitting can be due to injury to PFCN, a previously unreported etiology. Good to excellent results can be expected in 76% of carefully selected patients.
PURPOSE: The ischial tuberosity, referred to as the "sit bone" by patients with pain, is surrounded by critical nerves. This research relates, for the first time, the involvement of the posterior femoral cutaneous nerve (PFCN), including its perineal and inferior cluneal branches to the symptom of "sitting pain." An experience with PFCN resection for treatment of pain with sitting is reported. PATIENTS AND METHODS: The computer records were searched from 2010 through August of 2013, identifying 17 patients who had surgery on PFCN. Fifteen of these 17 were women. Mean age of 17 patients was 54.6 years (range 30-74 years). Each patient had pain with sitting, and spent much of the day standing or lying down. Each had symptoms involving posterior thigh and buttock. Three patients had bilateral problems. Each of 17 patients in this series had resection of PFCN through an incision in the gluteal crease. Resection included inferior cluneal branches and perineal branch. RESULTS: Of 17 patients, at a mean of 19.4 months (range 6 to 42 months) after surgery, the visual analog scale improved from a mean of 9.2 to a mean of 2.1 (P < 0.0001). There were 7 excellent, 6 good, 3 fair, and 1 poor result, for 76% good to excellent result in terms of pain relief and improvement in being able to sit. CONCLUSION:Pain with sitting can be due to injury to PFCN, a previously unreported etiology. Good to excellent results can be expected in 76% of carefully selected patients.