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Pain and Spine Medicine

Testicular Pain Stemming from Sacroiliitis: A Case Report

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 4

    Primary Author(s)

  • MH

    Myla Hummel, MD

    Resident Physician
    University of Texas Health Science Center San Antonio Long SOM PM&R Program
    SAN ANTONIO, Texas

    • Poster Presenter(s)

  • Sanketh Kichena, DO

    Resident Physician
    University of Texas Health Science Center San Antonio Long SOM PM&R Program
    San Antonio, Texas

    • Co-Author(s)

  • Jacob Erickson, MD

    Physician Attending
    South Texas VA Medical Center
    San Antonio, Texas

Disclosure(s):
Sanketh Kichena, DO: No financial relationships to disclose
Jacob Erickson, MD: No financial relationships to disclose
Case Diagnosis: Testicular pain referred from the sacroiliac joint.

Case Description or Program Description: A 46 year-old male was followed in an interventional pain clinic for right lumbar radiculopathy, left SIJ dysfunction, and left orchialgia. His primary complaint of left orchialgia had been going on for 20 years. After physical examination, the decision was made to trial bilateral diagnostic and potentially therapeutic bilateral sacroiliac joint injections with anesthetic and corticosteroid. After a month of significant relief, decision was made to proceed with a left L5 dorsal ramus and S1-S3 lateral branch blocks followed by radio frequency ablation.

Setting: Outpatient pain management clinic at a VA hospital.

Assessment/Results: The patient had complete pain relief immediately after the bilateral sacroiliac joint (SIJ) injections with an average pain score of 2/10 over the next month. In consideration that his chronic right low back pain may have been referred from left sacroiliitis, the left SIJ was targeted next with left L5 dorsal ramus and S1-S3 lateral branch injections using 0.5% bupivacaine. He had immediate complete pain relief of left orchialgia for one day followed by 50% reduction in pain for two months. He subsequently underwent radio frequency ablation of the above left lateral branches with an ongoing resolution of his left orchialgia.

Discussion (relevance): This case presentation highlights the SIJ as a potential pain generator and interventional target in a clinical presentation of chronic orchialgia. The unique referral pattern in this case presentation may be possible due to the proximity of the sacral spinal nerves to the SIJ, presenting another potential source of pathology.

Conclusions: The SIJ can be a possible pain generator in the clinical presentation of chronic orchialgia.