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Too small to be “real hernia” …. ultrasound vs MRI?
Thanks for the follow up Robo. Appreciate your kind thanks and not a problem at all. So they are definitely identifying something on the ultrasound which is hard to interpret as whether it is causing your pain. I asked the belt question because this is a common cause of irritation of the nerves in that area with tool belts. Any exercises you have started (p90X, crossfit, etc) recently that may be to blame. Any specific circumstances at work? As far as the block goes that would require a referral to a pain management specialist that specializes in nerve blocks. Most surgeons know “the guy” in their area and your PCP or surgeon could refer you. All it really does is say that if we numb the nerve does the pain go away. In some cases it is yes and that indicates there is inflammation associate with the nerve or something impinging it. In that case I often explore, repair the hernia, and if the nerve looks super inflammed or like it is bow stringing on the external ring in a thin patient (which happens more often than we think, then I will often excise the nerve at the orginal surgery. Not ideal but alleviates the pain and fixes any hernia or weakness in the floor of the inguinal canal. I am not sure this will be of super benefit unless it helps guide your decision on surgery or no surgery. With neurectomy you will often get numbness on the medial thigh, lateral scrotum, and sometime in suprapubic area to varying degrees. Most often I tell my male patients to think about when they are walking and they dont feel their testicles clanging against their legs for the most part so you really will not even notice that much and everything will work just fine in the bedroom. I have never had someone complain about this long term but I have had patients with chronic pain that is worse to deal with. Best of luck and happy to review the films if you wanted to send them over to my office. Just let me know. Paul pszotek@iupui.edu