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Pain and Spine Medicine

Session Name: Learning Center: Pelvic examination and Interventions for pelvic pain- A Hands on Learning Model for Physiatrists

Learning Center: Pelvic Examination and Interventions for Pelvic Pain- a Hands on Learning Model for Physiatrists

Saturday, October 22, 2022

10:00 AM – 11:00 AM ET

Session Director(s)

MS

Malathy Srinivasan, MD MBBS

Attending Physiatrist
Rothman Orthopedics Institute
Media, Pennsylvania

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

PDF of Slides

Faculty(s)

Ameet S. Nagpal, MD MS MEd

Division Chief, Physical Medicine & Rehabilitation; Professor, Department of Orthopaedics & Physical Medicine
Medical University of South Carolina
Mt. Pleasant, South Carolina

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Mehul J. Desai, MD MPH

Medical Director
International Spine, Pain and Performance Center
Washington, District of Columbia

Disclosure: Abbott (Consultant/Advisory Board)Avanos (Consultant/Advisory Board, Research Grant includes principal investigator, collaborator or consultant and pending grants as well as grants already received)Nalu Medical (Research Grant includes principal investigator, collaborator or consultant and pending grants as well as grants already received)Nevro (Research Grant includes principal investigator, collaborator or consultant and pending grants as well as grants already received)SPR Therapeutics (Consultant/Advisory Board, Stockholder/Ownership Interest (excluding diversified mutual funds))SynerFuse (Consultant/Advisory Board, Stockholder/Ownership Interest (excluding diversified mutual funds))Virdio (Consultant/Advisory Board, Stockholder/Ownership Interest (excluding diversified mutual funds))
Kelly Scott, MD

Professor, Physical Medicine and Rehabiliation
UT Southwestern Medical Center
Dallas, Texas

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Lab Marketing

Description: : The goal of this learning center session is to provide participants with skills necessary to evaluate and treat patients with pelvic pain conditions. There will be four stations:
1. Demonstrate pelvic examination including pelvic floor examination for physiatrists using an anatomical pelvic model
2. Demonstrate pelvic floor trigger point injections using an anatomical pelvic model
3. Demonstrate peripheral nerve (ilioinguinal, genitofemoral) nerve blocks that are ultilized for pelvic pain management using ultrasound guidance
4. Review techniques for piriformis injection, pudendal nerve block and ganglion impar block using fluoroscopy

Why is this lab needed? : Chronic pelvic pain (CPP) is a debilitating condition and affects 20% women and about 2 million men in the United States. 75-85% of these patients diagnosed with chronic pelvic pain will have a musculoskeletal (MSK) cause for their pain causing myofascial trigger points and pelvic floor dysfunction. In addition to the MSK causes, a rich network of nerves supplies the pelvic structures namely the coccyx, genitalia, anus, rectum and skin over the perineum.Physiatrists are uniquely specialized in treating musculoskeletal (MSK) and neurological pain conditions with both non-interventional and interventional options.In spite of this, only a handful of physiatrists help patients with chronic pelvic pain. This could be because of a paucity of resources - a knowledge gap in pelvic examination/skills gap in performing pelvic injections.
This session aims to address some of the knowledge and skills gap for physiatrists and equip them with resources needed to treat pelvic pain in their practice.

Lab Outline/Format:: Station 1: Pelvic examination (10 minutes)- Dr Kelly Scott
Participants will start from this station where they will have a demonstration of specific components of pelvic exam including external assessment followed by demonstration of internal pelvic floor examination in an anatomical pelvic model. Participants will be able to learn a systematic approach to identify pain generators. Provocative tests to diagnose pelvic pain conditions will be addressed
Station 2: Pelvic floor trigger point injection (10 minutes)- Dr Malathy Srinivasan
Anatomical pelvic model will be used to demonstrate identifying landmarks and techniques to perform levator ani and obturator internus trigger point injections in outpatient setting. Adequate patient preparation, positioning and necessary equipments needed to perform the injection and the techniques will be covered.
Station 3: Ilioinguinal/genitofemoral nerve blocks under ultrasound guidance (15 mins)- Dr Ameet Nagpal
This station will demonstrate how to utilize ultrasound to perform peripheral nerve blocks for pelvic pain conditions such as ilioinguinal neuralgia and genitofemoral neuralgia. Landmarks to identify these nerves using blind as well as ultrasound guided approach will be discussed
Station 4: Review of other pelvic injections that can be done in an outpatient setting using fluoroscopy (15 mins)- Dr Mehul Desai
This station will discuss the techniques and landmarks using fluoroscopy to perform piriformis injections, pudendal nerve blocks and ganglion impar block. Landmarks, needle selection, preparation and equipments needed to perform safe and effective injection will be discussed
Learning Objectives:
Address the knowledge/skills gap and improve their comfort level to treat pelvic pain.
Learn the preparation and equipment needed for performing pelvic injections.
Learn safe pelvic injection techniques.