Conservative Treatment of Symptomatic Pudendal Nerve Entrapment Secondary to Sacrotuberous Ligament Ossification

Sacrotuberous ligament (STL) ossification is an exceptionally rare condition that may lead to pudendal nerve entrapment through mechanical compression within the pelvic region. Pudendal nerve entrapment is frequently underdiagnosed despite causing significant neuropathic symptoms and functional impairment. We present a case of pudendal nerve entrapment secondary to STL ossification that was successfully managed conservatively. A 50-year-old male patient presented with chronic right-sided hip and perineal pain associated with burning sensation, foreign body sensation, sensory disturbances, and erectile dysfunction. Symptoms were aggravated by prolonged sitting and partially relieved by standing. Physical examination demonstrated reduced superficial sensation in the perineal region. Pelvic radiography revealed partial ossification of the right sacrotuberous ligament, while three-dimensional computed tomography confirmed the extent and morphology of the ossified structure. No additional pelvic or spinal pathology was identified. The patient was treated conservatively with ultrasound-guided corticosteroid injections administered at three-month intervals over a one-year period, combined with activity modification and specialized seating support. Progressive clinical improvement was observed, with complete resolution of pain, sensory symptoms, and erectile dysfunction. At two-year follow-up, the patient remained asymptomatic without evidence of recurrence. This case highlights STL ossification as a rare but clinically important cause of pudendal nerve entrapment and chronic perineal pain. Careful clinical assessment and appropriate imaging are essential for accurate diagnosis. Although surgical treatment has been described in isolated cases, conservative management may provide substantial symptomatic relief and should be considered a first-line therapeutic approach in selected patients.