Lumbar Spine MRI

[awareofyou]

Hello, I am a male in my late 20's, no significant health problems in past, within normal weight range, used to be physically active until pain started. . .

Two years ago I began experiencing hip and leg pain. The pain has been constant and increasing over the last 6 months.  It is a dull aching pain in hip and groin area that is now radiating down to my foot. The pain is impeding my ability to participate in sports activities.  It is worse at night but does not seem to change in severity depending on whether I am sitting or standing during the day.

At the same time that the hip pain began two years ago, I noticed a new dimple developing on my hip.  The dimple has increased in size over the last two years.  The doctor dismissed the dimple as the result of a muscle "drooping" with age.  X-Rays showed a narrowing of the hip joint. I had a lumbar spine MRI last week and will get the results tomorrow.  Here are my questions:

Will a lumbar spine show anything about my hip and this dimpled area?  
Should I persist in getting this dimpled area investigated?
Could this dimple be a sign of a tumor?
If the MRI is normal, what should my next step be?  

[CCF-Neuro-M.D.-JT]

1. The MRI of the lumbar spine is designed to look at the spine, not the hip, so a primary problem in the hip will not show up on the MRI.  However, disc disease in the lumbosacral region (lower back) can present with pain in the hip, buttock, groin and leg. So depending on what the MRI shows, it's possible that the problems could be related to disc disease in the lower back. As for the dimple, I'm not exactly sure what it could represent as I have not personally examined you and do not know firsthand what this "dimple" really looks like. If you have significant wasting of the muscles over your hip, I suppose it could look like a dimple. But again, I'd have to see it myself before I could give you an accurate opinion.
2. It may be related to the hip and leg pain, especially if it's on the same side. If it's concerning you, then it's ok to pursue further investigation. But if the hip and leg pain is the primary problem and is affecting your life, then take care of this first.
3.Can't say, would have to see for myself.
4.Consider an EMG to look for any nerve damage and neurological  consultation. If that's normal or your physicians suspect a joint problem rather than a neurological problem consider an orthopedic specialist for further evaluation with possibly an MRI of the hip. Talk to your PCP as they have personally examined you and know your case. GOod luck.

[Annika]

Dear Awareofyou,

I'll be interested in reading what the doctor says about this.  I know he'll talk a lot about the hip joint, and the possible factors that could account for your pain.  I do have one thought about connecting this with your hip dimple, and thought I'd note it here.

It's interesting to me that you notice an indentation (a dimple) in your hip/buttocks.  The side of the buttock overlying the hip is the area which is normally filled by the hip stabilizing muscles — among others the gluteus medius, gluteus minimus, and piriformis muscle.  Sometimes an indentation in this area is a sign of weakness/atrophy of one or more of these or other supporting muscles.  This can happen if there's an impingement on the nerves normally controlling these muscles (which normally stabilize the hip).  When the hip is unstable, it can wobble abnormally within the socket as you move and bear weight, creating pain.

Another way these things can theoretically be connected is through something called "piriformis syndrome."  Normally the sciatic nerve (to your lower limb) exists next to the piriformis muscle.  Apparently, there can be problems along the course of this nerve as it passes by the piriformis muscle, which end up in some way compressing the nerve, creating pain and/or muscle weakness.  I don't know as much about this syndrome as about other causes of hip weakness, but I have seen reports describing pressure on the nerve from piriformis muscle hypertrophy, spasm, or scarring (as can develop sometimes after a fall to the buttocks).  At least it's a syndrome that can be looked up, to see if it fits with your situation.

You describe symptoms with your "hip", not "hips", so I'm assuming you only have problems on one side.  If there's a new indentation in the buttocks/hips that's present on only one side, that would personally make me suspicious there's something going on other than just "drooping with age" (in your twenties!).  Of course, sometimes pain will cause a person to hold a joint in a different position, and this could possibly make the outside hip contours look different too.  People sometimes don't use a painful joint as much, and that can cause disuse atrophy — in this case the muscle atrophy would be a result of the pain, not a cause of it.  I don't know how often that happens with hips.

My own experience with new hip pain stems from nerve damage within my spinal cord after a tumor, which caused muscle weakness/atrophy in the buttocks and resulting hip instability/pain.  I'm sure that's not remotely what's going on with you.  The whole issue of piriformis syndrome has come up a lot in my reading for my own problems, however, because there's a certain overlap in the symptoms.  I know there are a billion other possible causes of hip pain, though, and I'm sure the doctor will pass on lots of useful info about those.  Normally I'd wait until he gave his answer — just wanted to pass this on while it's on my mind.

Good luck,
Annika (age 32)

[ErinF]

I have one word for you...sciatica.  That sounds a lot like what you have.  I had the same symptoms, more or less...pain in my hip and buttock, sore to the touch some days like a sore muscle would be, pain radiating to behind my knee, into my calf and foot.

It was terrible.  I'm 25 myself, and some days walked with a cane.  Can you believe that?!?!  

I want you to know the following is just what worked for ME, with MY problem.  You may have something different going on, but it's worth looking into.

I had an MRI as well, which revealed I had somehow herniated the disc at L5.  No clue how I did that, but anyway.  The doctor who did my MRI put me on Celebrex, which did nothing but make me vomit.  Then we did cortisone injections, which only helped temporarily.  He recommended surgery.  

I was hesitant, as I'm in good health otherwise and only 25 so I sought the help of a chiropractor.  It has been a hard 5 months since when I first experienced pain, but I am 95% better now thanks to his help.  No drugs, no surgeries, no nothing...just helping your body heal itself.

Normally I don't take much stock in the so-called "natural" remedies, but depending on the nature of your trouble, you might look into a chiropractor.

[usedtobecatchy]

Back problems can cause buttock pain, side pain, and down the leg pain, but using the word groin usually points to a hip problem-however, not all people describe the parts of the body with the same words. When I say groin it means in front of the body where the leg meets the pubic region? Also, a dimple can also show up when a muscle is cramping? Is it there even when fully relaxed and not bearing weight? You can spend alot of money investigating back problems.

[dizz]

I'm with Erin, your symptoms describe sciatica. It is caused by pressure on the sciatic nerve which runs down into the leg. The cause of pressure can be varied from a Slipped (Prolapsed) disk to muscle tension (Piriformis syndrome) or something less common such as a tumours, bony growths and infections.

It "can" be caused by a partially herniated disc in the L4 or L5 or S1 lumbar regions (depends on where the pain is as to which it is). Suggest going to google.com and doing a search on sciatica.  There you'll find remedies for relieving the pain. Would suggest seeing a sportsinjury doctor.  

[stormcloudfyre]

Regardless the outcome of your   MRI  DO Not  pursue  surgical  means if its spinal!

Do not   Undergo a partial or total diskectomy  or  Fusion !  your Way to young to  become   handicapped by that  .

IF you think  the surgerty will help   the Pain   think three times  Becasue it will not ! Sciatica  2 ways to go  right and wrong !

  IF you were active  get active again.  NO BS about how pain full.   NO BS about no time  NO BS   DO IT !
as you WIMP OUT yopu get worse not better  Rest will  make it deteriorate and require  surgical removal.
   exercoise wil strengthen the muscles around the   problem area ! that will  help it  feel better .  exercise is now a WAY OF LIFE not   keep fit thing !
I mean  heavey work outs in the weight room of your Gym.  Leg presses  till eternity freezes over.  bicyclking will yeild a new dimension in pain relief. 20 to 100 km per day is  your target for a few days a week.

Whats my  reason for this reply !  
11987 and 1988 I had diskectomies on L45/l5s1   2 of them   I was active before and rehabed cycling  as much as  800 Km per.    this was  moderated larter on as I went back to work but not stopped   week. and workouts in the gym 3 hours a week.  This was moderated  when I returned to work but not stopped   unfortunatly  I fell and broke  L12345 and  That slowed me down   but I still do  3 to 400 kms aweelk and work out  2 hours a week in the gym !   PAIN yes! BUT only when I quit  the exercising !
try it   It beats Surgery. and its Free as well as  envigerating.

Best of luck  
peter
  
  

  
        

[princessdi]

I would like to know more about why surgery for a herniated lumbar disc is or is not a good choice. I have a herniated disc at the s-1 l-5 level. I have suffered with sciatica and numbness in the left leg for 6 months. 3 epidural injections solved the problem for about 2 months, but now the problem is back, and I need to do something definitive in order to get back to work. A discectomy has been recommended by a spine specialist. The disc is bulging, not totally disconnected. What are the odds of a complete recovery (no recurrent problems) after this procedure? Can it make the problem worse? Any new treatments on the horizon?Also, has anyone had experience with the Texas Back Institute? Is this a good place? Thanks.

[Ron3]

Hi Awareofyou,

If you are able to cause a shooting pain in your leg by pressing on the area in your hip between the backbone and the hip joint
(while bending forward) then Piriformis syndrome is a logical
possibility.   If there is an inpingement where the sciatic nerve passes through the muscle area it can cause your symptoms.
Usually it is not constant, but an injury to the area could entrap the nerve causing more chronic results.

Avoid surgery until the easier stuff is ruled out for sure.
You will notice that the docs want you to be in real dificulty before they would risk the surgery... They want you to beg for it and then NOT sue when thing don't improve.

Here is a link that explains further

Good luck...
Ron

http://www.drmirkin.com/fitness/f230.html

Something very new....
http://www.drmirkin.com/joints/9313.html