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RE: Spondylolisthesis and testicular pain
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RE: Spondylolisthesis and testicular pain - September 8, 2007 7:21:19 PM
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treybien
Posts: 85
Joined: August 5, 2002
From: Milwaukee, WI
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Generally testicular cancer is non-painful as was told to me by a urologist. I had this same thing happen to me, left testical pain. US and CT and bloodwork were negative for anything involving the testical. The Urologist (this was the first referral from my primary) after examining me and asking me if I have a history of back pain (which I do, some chronic mod to severe Left L5-S1 facet arthropathy that contacts the nerve root) told me he was 99% sure it was referred pain from my back and he sees this referral pattern a lot. Nonetheless he ordered the rule out tests, which as I stated were all negative. I have practiced 8 years and have not had the experience of people describing this pain pattern in a radiculapathy. I do have some pain in my left testical chronically now and it does flare when my chronic radiculapathy flares up, which follows a more traditional L5-S1 pattern. Not sure if that helps anyone. I did not read all the posts between the start and finish so I apolagize if I have totally restated something.
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RE: Spondylolisthesis and testicular pain - September 8, 2007 7:40:16 PM
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jlharris
Posts: 468
Joined: April 12, 2006
From: Nebraska
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Again, good comments. I think you are trying to compare apples and oranges. Integumentary is with in our scope (wound management/care) and I HOPE every one of us is inspecting wounds (surgical or traumatic) on every patient that has one. Secondly, body systems screening is an integral part of our practice. We must take the time to find out if this new patient is appropriate for PT or not. That is what you did with your Iraqi woman.
Testicles don't fall under Muscle, Bone, Cardio-Pulm, or Integramentary. Although, as above, your reasoning for VISUALLY inspecting is sound.
Every patient should be asked about Hx of cancer. Do we know which 5 CA's most commonly matastisize to bone (and, therefore, have the greatest chance we see them in our clinic for musculoskeletal complaints? I learned a nice little cheat - PB KTL (lead kettle).
P = Prostate
B = Breast
K = Kidney
T = Thyroid
L = Lung
IMO, the decision as to the appropriatness for PT is the most important clinical decision we make.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
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RE: Spondylolisthesis and testicular pain - September 9, 2007 7:57:08 AM
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Dr.Wagner
Posts: 1237
Joined: January 24, 2003
From: Indianapolis
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Let me point this out, do a testicular exam if you wish (all females must have male chaparone), but it should do nothing in terms of your physician referral except perhaps urgency (ie go to the ER vs PCP).
Torsion is acute BUT can be intermittant with DEtorsing and the lawsuit from delayed diagnosis and testicular loss is HUGE.
Epidydimitis is fairly common and is VERY painful.
Orchiitis is not as common but is very painful.
Torsion of the Epidydimal appendix is very painful.
Hydrocele and vericocele are painful and are seen on exam.
Prostatitis is very painful.
Testicular cancer is NOT PAINFUL.
All of these things are the PRIMARY medical differential of testicular pain. These must be ruled out prior to any other diagnosis.
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
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RE: Spondylolisthesis and testicular pain - September 9, 2007 7:33:45 PM
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Tom Reeves DPT ATC
Posts: 390
Joined: March 14, 2006
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I really don't understand why we are discussing this. If someone's testicles hurt, and it is intermittent or not, if it was enough for them to complain about, SEND THEM ON. DUH
I for one was either hungover and didn't go to school the day we talked about testicle evaluation, or maybe we DIDN'T GO OVER THAT PARTICULAR PART OF ANATOMY!!!!!!
next we are going to discuss the differential between pancreatitis and a torn omentum.
GEEZ
If it does not fit into our NMSK world, send it on to those that deal with the other stuff.
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RE: Spondylolisthesis and testicular pain - September 9, 2007 11:40:29 PM
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Dr.Wagner
Posts: 1237
Joined: January 24, 2003
From: Indianapolis
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yeah, maybe this topic should be moved...if the discussion is to continue. And I would imagine, enough has already been said. The above poster makes a fantastic point of which I am in 100% agreement.
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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RE: Spondylolisthesis and testicular pain - September 12, 2007 11:20:07 AM
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alodato
Posts: 22
Joined: April 9, 2007
From: Woodinville, WA
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No Kidding! There is no reason you should have a patient drop their drawers to inspect their testicles. What are you looking for....swelling, discoloration, skin changes? That can be handled by asking the patient. If you are going to inspect the patient's testicles, then make sure you have a lawyer on retainer
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RE: Spondylolisthesis and testicular pain - September 13, 2007 9:07:09 AM
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jma
Posts: 2312
Joined: August 24, 2000
From: NY
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I agree. We can try to investigate groin pain but never heard of this before.
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RE: Spondylolisthesis and testicular pain - September 13, 2007 8:25:24 PM
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bonmar
Posts: 137
Joined: August 15, 2000
From: Boston, MA
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My brother also had testicular pain with a flare up of back pain a number of years ago. He was cleared of any other pathology. When his back pain resolved his testicular pain did as well.
I believe at the time I found that trigger points in the iliopsoas can refer pain to the testicular region. I tried looking it up in Travell and Simon's book today (in work) but got sidetracked. The portion on iliopsoas tp's that I did have time to read stated that stretching the iliopsoas can cause testicular pain. I will look further tomorrow.
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RE: Spondylolisthesis and testicular pain - September 14, 2007 4:50:05 PM
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Tom Reeves DPT ATC
Posts: 390
Joined: March 14, 2006
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that's all well and good bonmar. But if the primary complaint is testicular pain, the iliopsoas is not the first, second, third, or probably 10th thing that I am going to look for. It can happen, but is it likely? probably not. If it were your testicles would you go to your PT or massage therapist and have them work on your iliopsoas? I know I wouldn't. ER then urologist for me thanks.
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RE: Spondylolisthesis and testicular pain - September 15, 2007 12:30:30 AM
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bonmar
Posts: 137
Joined: August 15, 2000
From: Boston, MA
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(lol) Tom, the original question was re: a link between LBP and testicular pain (not a primary c/o testicular pain). I do agree with you that if a patient comes in with primary c/o testicular pain, I would refer out and not go digging around for trigger points. However, tp's in the iliopsoas may be part of my differential diagnosis for LBP with radicular pain to the testicle.
Quoting from Travell and Simons book, Myofascial Pain and Dysfunction, The Lower Extremeties, pg 101:
"The iliohypogastric, ilioinguinal, lateral femoral cutaneous, and femoral nerves all emerge from the later border of the psoas major muscle. The obturator nerve emerges from its medial border. The geniotofemoral nerve passes anteriorly through the center of the belly of the muscle, emerging on its anterior surface. Sometimes, the iliophypogastric nerve and the ilioinguinal nerve also pass through the belly of the this muscle."
"Although symptoms of entrapment of these sensory lumbosacral nerves have not been specifically related to TrPs in the psoas major, this possibility should be considered when a patient suffers enigmatic pain and disturbance of sensation in the distribution of one or more of these nerves. For example, entrapment of the genitofemoral nerve by taut TrP bands in the psoas muscle could cause pain and paresthesias in the groin, scrotum or labia, and proximal anterior thigh."
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