Quelle est la place de l’examen électroneuromyographique dans le diagnostic des névralgies pudendales liées à un syndrome canalaire? View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2007-04

AUTHORS

J. -P. Lefaucheur, J. -J. Labat, G. Amarenco, A. -G. Herbaut, D. Prat-Pradal, J. Benaim, B. Aranda, M. -C. Arne-Bes, V. Bonniaud, P. -M. Boohs, K. Charvier, F. Daemgen, P. Dumas, J. -P. Galaup, S. Sheikh Ismael, J. Kerdraon, P. Lacroix, D. Lagauche, E. Lapeyre, M. Lefort, A. -M. Leroi, R. -J. Opsomer, B. Parratte, J. -G. Prévinaire, P. Raibaut, J. -Y. Salle, M. -C. Scheiber-Nogueira, J. -M. Soler, M. -F. Testut, C. Thomas

ABSTRACT

Une compression chronique du nerf pudendal dans un site d’étroitesse anatomique (syndrome canalaire) peut être à l’origine de douleurs périnéales invalidantes. Ce type d’atteinte doit être diagnostiqué de façon spécifique, car cela peut constituer une indication de neurolyse chirurgicale. Dans ce cadre, il est usuel de demander un examen électroneuromyographique (ENMG) du périnée, qui sera basé sur l’étude de l’activité électromyographique de muscles périnéaux, des réflexes sacrés et des conductions motrices du nerf pudendal. Différentes considérations physiopathologiques et techniques expliquent certaines limites de l’ENMG qu’il faut connaître. C’est ainsi que les méthodes utilisées n’évaluent pas les anomalies fonctionnelles à l’origine des douleurs, mais plutôt les altérations structurelles du nerf pudendal (démyélinisation ou perte axonale). De plus, seule l’innervation motrice directe ou réflexe est évaluée, alors que l’étude spécifique des conductions sensitives serait sans doute plus sensible à objectiver une compression nerveuse. Enfin, il n’est pas possible de distinguer l’atteinte compressive des nombreuses autres causes de lésion nerveuse pudendale (chirurgicales, obstétricales, liées à une constipation chronique…). Ainsi, l’ENMG périnéal a une sensibilité et une spécificité limitées dans le diagnostic de syndrome canalaire pudendal et ne renseigne pas directement sur le phénomène douloureux. Le diagnostic de névralgie pudendale répond en fait à des critères cliniques précis et l’ENMG ne peut que donner des arguments supplémentaires, mais non formels en faveur de ce diagnostic. L’ENMG périnéal permet surtout de faire un « état des lieux » de l’innervation périnéale en prévision d’un geste chirurgical de décompression, et pourrait éventuellement fournir certains éléments prédictifs de l’intérêt de l’intervention. En revanche, l’ENMG ne permet généralement pas de localiser précisément le site de compression et n’a, dans tous les cas, aucune utilité dans la surveillance peropératoire. More... »

PAGES

73-77

References to SciGraph publications

Journal

TITLE

Pelvi-périnéologie

ISSUE

1

VOLUME

2

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s11608-007-0117-1

DOI

http://dx.doi.org/10.1007/s11608-007-0117-1

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1048762236


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