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Bone Lesion/Bone Bruise
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Bone Lesion/Bone Bruise

A few weeks ago, I fell asleep and about 2 hours later I woke up and had excruciating pain in my right shoulder.  I also have pain in my left hip.  It is a burning sensation centered in the joint.  It I did nothing out of the ordinary, I didn't fall or injure myself in anyway.  I went to the EM room, they did x-rays and noted on the report was: "There is a lytic lesion observed within the right proximal humeral metaphysis which requires further evaluation with radionuclide bone scanning.  There is no fracture or dislocation observed on this examination. ".  Reading about 'Lytic lesion" online pretty much caused me to panic and I made an appointment with an orthopedic right away, he wanted me to get an MRI immediately.  When I got the results, the MRI report from the radiologist showed a slight rotator cuff problem, and nothing else.  But the orthopedic noticed a bone bruise, but no lesion on the bone and said that the x-ray could have been incorrect or just had a smudge on the film.  Since there was no trauma, he said a bone bruise can be caused by a blood vessel popping under the skin, and that could have been the cause of the sudden burst of severe pain. He also ordered blood work to test for rheumatology and lymes, which I am waiting on the results.  
My questions/concerns are, do I just accept that the x-ray film had a smudge, and that the MRI supersedes the results of the x-ray. Do I get a second opinion?  Do I get from a general practice doctor, radiologist or an orthopedic?  My shoulder and my left hip are still causing me pain, should I request an x-ray of my left hip as well?   Could the bone bruise be the lesion that showed up on the x-ray?   I was told the two were not related.  Is it possible to have a lesion show on an x-ray that turns out to be just a smudge, a bone bruise when I did nothing to injure myself, a rotator problem (which may just be wear and tear), and it all be explained by lymes or arthritis?

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Avatar_dr_f_tn
Hi,
You haven't mentioned your age. Since when do you have the pain in your left hip? Did the shoulder and hip pain start simultaneously?

An MRI is definitely superior to an X-ray. At times some artefacts may appear as dark shadows on an X-ray. Did your orthopedic surgeon notice the bone bruise in the same area as the lytic lesion? A bone bruise may sometimes occur due to compression which may occur inadvertently during sleep.

It may be a good idea to get your hip evaluated as well. You can get an X-ray of the hip done and if any abnormality is detected, an MRI may be indicated.

All the best!
10 Comments
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Avatar_n_tn
Thank you for the response.  I am 32 year old female.  No history of any serious medical problems.  The pain in my hip has been about 2 - 3 months, and seems to be worsening, while the pain in my shoulder remains steady.  The hip started first and then my shoulder a few weeks following.  The bone bruise is in the same spot as where the lesion was discovered, as if it were the same thing pictured in both the xray and the MRI  (if that makes sense at all?).  
Thanks again.
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Avatar_dr_f_tn
Hi,
Thanks for the feedback. It would probably be a good idea to get an x-ray of the hip at this point since the symptoms are worsening. Both your x-ray and MRI show a lesion at the same site, indicating that this lesion may need further evaluation and may not be just a smudge. It may be a good idea to get a second opinion on your MRI scans. A bone bruise should heal with time. Are you on any medication? At your age the possibility of cancer or degenerative arthritis is unlikely. There is no need to be anxious at this point. Stay positive!

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Avatar_n_tn
Thanks for the response.  I am not on any medication.  I will reach out to another doctore to get a second opinion on the MRI scans.  Thank you so much!
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Avatar_n_tn
I recieved my blood work results back.  Tested negative for Lyme.  
One test was flagged high.  It was the Antistreptolysin O Ab which was 613.7.  My orthopedic said he wasn't sure what that meant and recomended I take it to my general practice doctor.  I brought it to my regular doctor along with my MRI and Xrays, and hopefully he can make some sense?
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Avatar_dr_f_tn
Hi,
An elevated Antistreptolysin (ASO) antibody titre suggests infection with group A streptococcal bacteria which may have occured recently or in the past. Group A streptococci are bacteria which generally cause throat infection which can sometimes lead to Rheumatic fever. This may affect the heart, joints, kidneys, connective tissues etc. Involvement of joints manifests as polyarthritis ie involvement of more than one joint. The joint pain may migrate from one joint to another (migratory arthritis). Treatment includes long term antibiotic therapy with Penicillin and anti-inflammatory drugs to releive the joint pain and inflammation. You may want to consult an Internist or a Rheumatologist for a thorough evaluation. ASO antibody titres may sometimes be falsely elevated in liver disease or other infections such as tuberculosis so other causes need to be considered and ruled out as well.
All the best!
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Avatar_n_tn
I have been having hip pain and had an x-ray.  There was a spot and a synovial hernia.  I went and had an MRI and now have to wait.  What do you think I am looking at going on here.  I am 45.
Thanks
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Avatar_dr_f_tn
Hi,

It is difficult to conclude anything at this point. Lets wait for the results of the MRI.
All the best!
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Avatar_n_tn
I'm back again.  When I brought the blood work to my general practice doctor, he pretty much dismissed the high levels ASO and recommended I see a chiropractor for my continued hip and shoulder pain.  The chiropractor then recommended that I take an xray of the hip, pelvis and my lower back.  The results came back that a few of the facets in my lower back are off center and squeezed together.  There was also another lesion found on my left hip/pelvis, centered in the joint, which is exactly where my pain is.  Which is also similar to the pain in my joint of my shoulder where that lesion was found.  He did look at the xrays and mri of the shoulder and concluded that something is definetely there, it is just a question of what it si, or what is causing it. He recommended that I come daily for adjustments, and physical therapy.  It's been about a week now and it doesn't seem to be relieving any pain what so ever, if not causing more pain in my mid-back which did not hurt before.    
Here is my question - First I am worried that my orthropedic, general practice, and now my chiropractor are quickly dismissing the fact that there are lesions on my shoulder and hip bone, that the MRI showed a bone bruise or "something" in the same exact spot the lesion is in on the xray.  If it is something like cancer, I want to know now.  I do not want to keep seeing a chiroprator, and let more time pass.  I also dont want to keep getting passed from different doctor to different doctor and being told 'I don't know'.  Is there a specific type of doctor that specializes in this sort of thing?  Do I just trust that it is not a tumor and just accept that it is wear and tear?  I'm only 32 years old and it's been months since I've had a pain-free minute.  Thanks for any advice you can give!
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Avatar_dr_f_tn
Hi,
Has an MRI been done for the hip? If not you might consider getting an MRI for the left hip and lower back. A radionuclide bone scan may be helpful to detect additional bone lesions. You can consult a Rheumatologist regarding the elevated ASO titres. What was the radiologist's opinion regarding the lesion on the MRI? Did they think it was suspicious for cancer? If so you need to undergo a diagnostic workup to search for a possible primary tumor. What pain medication are you currently on? Since your pain has not decreased, you should discuss with your doctor regarding a change of pain medication and further diagnostic work up.
All the best
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Avatar_m_tn
A related discussion, bone cancer was started.
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Avatar_f_tn
A related discussion, hip lesions was started.
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