AANEM Connect

Hello everyone, I would like your opinion on my approach to patients referred by gynecology for endometriosis. I have incorporated pudendal nerve sympathetic skin response (SSR) testing to demonstrate autonomic fiber dysfunction at the S2–S4 levels, and I use plantar SSR to detect autonomic fiber dysfunction at the T10–L1 levels. I perform tibial and pudendal nerve SSEPs; motor nerve conduction studies on the ilioinguinal, tibial, and peroneal nerves; and sensory nerve conduction studies on the sural and superficial peroneal cutaneous nerves. Regarding EMG, I assess the bilateral paraspinal muscles from T10 to L5 and their respective myotomes to confirm or rule out neuropathies involving the ilioinguinal, iliohypogastric, and obturator nerves. I have found radiculopathies in the majority of these patients that account for part of the pain; the high number of spinal abnormalities in young women has been striking, but I attribute the visceral pain, dysmenorrhea, and dyspareunia to these findings and correlate them with the SSR results, while using SSEPs to rule out or confirm pudendal nerve abnormalities. I have attached my protocol for your review. Thank you very much.