Case 3

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Case 3

Nerves

Could be: dorsal branch pudendal nerve, genitofemoral nerve, ilioinguinal nerve, and iliohypogastric nerve

palpation of the piriformis does not produce pain in the penis or scrotum

excludes pudendal nerve

normal cremasteric reflex

no genitofemoral nerve

iliohypogastric does not innervate the penis and scrotum

excludes iliohypogastric

based on symptoms compression of ilioinguinal nerve is the source of pain

L convexity and R rotation shown in the x-ray could increase possible compression of nerves passing between the psoas major muscle and L2-4 transverse processes when the trunk rotates to the right side with an ipsilateral stiff psoas major muscle.

Taut, tender structure was found above the middle inguinal canal,

No urinary retention without willingness to urinate; no tingling and numbness

no caudal equina syndrome

Cancer

Acute onset, no unwanted weight loss/gain, no lumps, no night sweating

no cancer

Bones, Muscle

x-ray, and US: negative; muscles have no signs/symptoms of strain

no bone and muscles

Genital Disease

No genital abnormality, normal bilateral cremasteric reflexes

no genital disease

Urinary Disease

urine test, US, and x-ray: negative; no urgency, frequency, or pain during urination

no urinary disease

Herniation

blood test, equal strength, no LE inflammation, no lump and pain

no herniation