# "I get all tingly at football games"



## mycrofft (Apr 25, 2014)

You are working first aid at the concessions area of a highschool football game. A middle-aged man walks up looking very worried and worriedly  announces "Something's wrong with my crotch!".

He doesn't appear inebriated, his gait is mostly normal, no visible signs of injury. He describes both "a numbness" and "tingling" of his left scrotum, a small area of the antero-proximal-medial thigh, and the left half of his penis. No pain or tenderness .Onset was gradual over about two minutes, and a hasty look under the pantsband reveals nothing visibly wrong. His wife pulls up the car, he gets up off a chair with a grunt and goes with her to the hospital.

Two weeks later you see him at the grocery store, he says he's fine but he won't be at the football games anymore.

VS normal, on meds for BP (metoprolol) and has large bottle of naproxen in his grocery cart.

What happened?


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## 46Young (Apr 25, 2014)

L5/S1 herniation?


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## 46Young (Apr 25, 2014)

Pudenal neualgia?


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## JPINFV (Apr 26, 2014)

Some sort of nerve impingement (slipped disk, spinal stenosis, etc).

Now what if he complained of bilateral numbness to his crotch, urinary retention, and trouble walking?


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## mycrofft (Apr 26, 2014)

46/young gets it on second try. Based on true case. The deciders are the localization and unilaterality of complaint with lack of affect of gait or visible deformity, and absence of perceived initiating event. 

Sitting on a hard surface and twisting once in a while. Grind that nerve. Pt fully recovered in two weeks.

JPINV, yes, a whole different game. Expand?

 Even unilateral pain in that part of the thigh WITHOUT unilateral pudendal nerve complaint would be another can of worms.


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## Chupathangy (Apr 27, 2014)

You guys are good at this. I was gonna just say crabs from sitting on the benches or something.


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## JPINFV (Apr 27, 2014)

mycrofft said:


> JPINV, yes, a whole different game. Expand?


Saddle numbness (perineal numbness), loss of bowel and bladder function (retention or incontinence), and leg weakness/paralysis is the classic triad for cauda equina syndrome. Cauda equina syndrome is compression of the cauda equina (we're simple people when it comes to naming things) and is a surgical emergency.


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## teedubbyaw (Apr 27, 2014)

I had that happen once on a long motorcycle ride. 'fell asleep,' if you will :roflz:


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## NomadicMedic (Apr 27, 2014)

It's a common complaint among long distance cyclists. The majority of the issues can be fixed with saddle angle or position adjustments. As a former long distance biker, I can tell you, it's an unpleasant experience.


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## mycrofft (Apr 27, 2014)

Chupathangy said:


> You guys are good at this. I was gonna just say crabs from sitting on the benches or something.



Yeah that's what he told his wife...


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## mycrofft (Apr 27, 2014)

JPINFV said:


> Saddle numbness (perineal numbness), loss of bowel and bladder function (retention or incontinence), and leg weakness/paralysis is the classic triad for cauda equina syndrome. Cauda equina syndrome is compression of the cauda equina (we're simple people when it comes to naming things) and is a surgical emergency.



Thanks!


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## JPINFV (Apr 27, 2014)

mycrofft said:


> Yeah that's what he told his wife...




Does anyone know if crabs are worse than scabies?


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## mycrofft (Apr 28, 2014)

Never one to shrink from taking a thread sidewise, and not from personal experience as a patient, scabies is harder to cure.


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## NomadicMedic (Apr 28, 2014)

I think we need to get back on topic ...


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## mycrofft (Apr 28, 2014)

I had a topic?:unsure:


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