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Family Medicine (Expert Forum)
help with diagnosis
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help with diagnosis
by plaudit, Mar 10, 2002 12:00AM
The original symptoms revolved around deep, aching pain in the upper buttock or deep in the posterior hip.This was accompanied by the pain mentioned below (positive Patrick's test?) but this pain was not a problem because it was not continuous. I have had these symptoms on and off for many years. Generally, episodes last only a few weeks and resolve by themselves. The latest episode has lasted considerably longer. About 4-5 months now. I have not participated in any significant activity since the episode began (just walking over the last month or so...). Before this episode, I practised Aikido 5 days a week for about an hour. Aikido does involve a lot of turning and potential twisting, but I do not recall any acute injuries during practise.
At various times, there was additional pain over the right iliac crest, right lower back, right SI joint, in the right groin/testicle, and over the above the outer right knee (minor).
A hip MRI showed no tearing of the laburnum (sp?) of the hip.
I was referred to a PT, who suspected nerve issues in lower back, and tried ultrasound of lower back, strengthening of abdomen and back, pelvic tilts under traction, etc. This aggravated my back considerably. I returned to orthopedic guy who did an injection of lidocaine/dep...something in my lumbar area. I now think there is actually minimal back involvement, and most of the back pain was caused by the PT.
CURRENT SYMPTOMS>>>>>>>>
If I stretch my right iliopsoas and/or other hip adductors by facing forward with my right leg trailing and tilting my pelvis posteriorly, I can not then lift my right knee for a minute or two due to pain. The muscle works fine before stretching, and a similar effect does not happen when I stretch the left side. Also, the stretch itself is painful on the right, but not left, side. During and after the stretch, I feel a vague tightness in the right groin/upper thigh junction. The area fully recovers in about a halfhour depending on the length and intensity of the stretch.
The same problem occurs with a butterfly stretch. This feels like the same tendon/muscle group, just a slightly different area of it. Doing butterfly stretches for extended periods also leads to pain in my upper buttock/deep in the hip.
The basic iliopsoas stretch, however, seems to have quickly relieved the low back and buttock pain, leading me to suspect this muscle/tendon group as the problem. However, the iliopsoas symptoms mentioned above (pain with stretching) have now continued for several weeks , and have not lessened appreciably with stretching (actually increased, to the point where I feel I have perhaps strained the muscles stretching). I wouldn't think a muscle strain would last for several months, so suspect a more serious problem, but don't know what. I seem to have a lot of problems with the right hip/knee/back but no serious identifiable physical abnormalities.
At various times, there was additional pain over the right iliac crest, right lower back, right SI joint, in the right groin/testicle, and over the above the outer right knee (minor).
A hip MRI showed no tearing of the laburnum (sp?) of the hip.
I was referred to a PT, who suspected nerve issues in lower back, and tried ultrasound of lower back, strengthening of abdomen and back, pelvic tilts under traction, etc. This aggravated my back considerably. I returned to orthopedic guy who did an injection of lidocaine/dep...something in my lumbar area. I now think there is actually minimal back involvement, and most of the back pain was caused by the PT.
CURRENT SYMPTOMS>>>>>>>>
If I stretch my right iliopsoas and/or other hip adductors by facing forward with my right leg trailing and tilting my pelvis posteriorly, I can not then lift my right knee for a minute or two due to pain. The muscle works fine before stretching, and a similar effect does not happen when I stretch the left side. Also, the stretch itself is painful on the right, but not left, side. During and after the stretch, I feel a vague tightness in the right groin/upper thigh junction. The area fully recovers in about a halfhour depending on the length and intensity of the stretch.
The same problem occurs with a butterfly stretch. This feels like the same tendon/muscle group, just a slightly different area of it. Doing butterfly stretches for extended periods also leads to pain in my upper buttock/deep in the hip.
The basic iliopsoas stretch, however, seems to have quickly relieved the low back and buttock pain, leading me to suspect this muscle/tendon group as the problem. However, the iliopsoas symptoms mentioned above (pain with stretching) have now continued for several weeks , and have not lessened appreciably with stretching (actually increased, to the point where I feel I have perhaps strained the muscles stretching). I wouldn't think a muscle strain would last for several months, so suspect a more serious problem, but don't know what. I seem to have a lot of problems with the right hip/knee/back but no serious identifiable physical abnormalities.
Doctor's Answer
by Forum-M.D.-DT, Mar 11, 2002 12:00AM
Thank you for visiting the Family Practice Forum.
Without a doubt you are dealing with some type of chronic muscle strain and/or tendinitis. From reading your description, I am suspicious that the muscle groups involved may not have had adequate time to "rest". Like I tell my patients ... "If it hurts ... dont do it".
You may be dealing with a muscle strain of the hip adductors (adductor magnus, adductor longus) or possibly involving some of the deeper muscle groups of the buttock (Piriformis).
Physical therapy typically helps as does moist heat, rest and the use of anti-inflammatory agents such as motrin. It is possible that the physical therapy was too "aggressive". This happens on occasion and will commonly make symptoms worse for a period of time. I like to have the physical therapists use ultrasound for conditions like you describe. Have they tried this?
I hope this helps!
Without a doubt you are dealing with some type of chronic muscle strain and/or tendinitis. From reading your description, I am suspicious that the muscle groups involved may not have had adequate time to "rest". Like I tell my patients ... "If it hurts ... dont do it".
You may be dealing with a muscle strain of the hip adductors (adductor magnus, adductor longus) or possibly involving some of the deeper muscle groups of the buttock (Piriformis).
Physical therapy typically helps as does moist heat, rest and the use of anti-inflammatory agents such as motrin. It is possible that the physical therapy was too "aggressive". This happens on occasion and will commonly make symptoms worse for a period of time. I like to have the physical therapists use ultrasound for conditions like you describe. Have they tried this?
I hope this helps!
