Hip pain -- not sure if it's neurological in nature

[curious43]

I will try to make this as brief as possible.  In September of 1999 I gave birth to twins via C-section following a complicated, high risk pregnancy which entailed eight weeks of bedrest leading up to delivery.  During the C-section, my OB had a very difficult time delivering my daughter (Baby B) because of her position -- breech with her head and shoulders virtually wedged in my right ribcage.  It took several minutes of pulling and tugging through my VERY stretched incision (according to my husband, who watched the surgery) to deliver her.  

Two days after the delivery I noticed that the skin on my upper right thigh, moving into my groin area and over to my hip, was totally numb.  My OB told me this can happen with surgical incisions, and that sensation would likely return to normal in time (which it did at about 8 months post-partum).  At about the same time the numbness began, I started having episodes of searing, burning pain deep inside my right hip (with the pain being on the side of my hip, not the back or buttocks).  If I turned quickly or put weight on my right leg a certain way, I would feel what can only be described as a searing pain through my hip that would eventually diminish and leave me with a dull ache for an hour or so.  Gradually those episodes decreased in number and eventually went away.  

At about three months post-partum, following a bout with mastitis, I began to experience severe joint pain in every joint in my body EXCEPT my hips.  Months of trial and error drug prescriptions and care with a rheumatologist left me with no relief and a tentative diagnosis of rheumatoid arthritis (despite a negative rheumatoid factor).  I am happy to say that within the last four months the joint pain has completely resolved and I have been medication-free since May.  I am hoping that my OB's hunch that the joint pain was somehow post-partum in nature is correct.

Now, more than a year following my C-section, I am again experiencing pain in my right hip.  It is more of a constant, dull burning pain, rather than a sudden pain as before.  If I am sitting at my desk for long periods of time or laying on my right side in bed for a long time, the pain becomes worse and my hip feels very stiff.  I have even on one occasion suffered a sudden, out-of-the-blue episode which left me unable to walk without a limp for about three days.  I have tried Advil, Celebrex and heat, all to no avail.  I am not sure if this pain is related to my surgery, and could in fact have neurological implications, or if I am dealing with another arthritic-type of inflammation.  I should also mention that I have been dealing with right-sided pelvic pain for the last several months, and a transvaginal ultrasound has revealed no abnormalities on my ovary or uterus.

Does this sound like there could have been a pinched or damaged nerve during my c-section and a neurological consult could lead to some relief?  I'm just not sure if I should approach this with my rheumatologist or seek the advice of a neurologist. (By the way I am in no way trying to place blame on my OB, who is a dear friend and without whom my babies would likely not be here today.)

Thanks for any advice or suggestions you can offer.

Susan

[Jan55]

A related discussion, Pain after hip Replacement was started.

[Bill Gilson]

I am a 54 year old male. This sounds exactly like the symptoms I had before a total hip replacement. I was diagnosed with Osteonecorsis or AVN with an MRI of my hips. I had one hip replaced and got more problems than before. Please check about Osteonecrosis. <***@****>

[Bill Gilson]

I am a 54 year old male. This sounds exactly like the symptoms I had before a total hip replacement. I was diagnosed with Osteonecorsis or AVN with an MRI of my hips. I had one hip replaced and got more problems than before. Please check about Osteonecrosis. <***@****>

[Judy - Follow-up question]

Hi Susan,

Rereading your post, I noted you actually had mentioned more than one joint.

If the rheumy thinks you could have this palindromic rheumatism or even RA, this is what I would do if I had the benefit of the new studies. Get on minocin right away. There are minimal risks and considerable benefit to be gained. Check it out to see if it is for you. See arthritis.org - search for antibiotic it will show you Jan/Feb. 2000 anouncement about this in arthritis today. Arthritis today is the patient publication by the arthritis foundation. I consider them a reputable source - so should your rheumy.

I was treated for lyme with doxycycline and it seemed to put it to bed for a couple years. Recent studies have shown that minocin early in a rheumatic disease ( 3 months of treatment) can dramtically effect the results downstream. With a 60% probability that it will go away, the minocin just might be the boost you need to make it go away. There were significantly more remissions in the minocin treated group.

Consider this drug and also consider using the brand. I was using the brand and got switched to the generic. Flare big time. Coincidence?? who knows. I decided I would rather take the brand - although that flare never came back under control until more drugs were added.

I'd be interested to hear what your rheumy says. Post back.

Best wishes.

[carolyn robles]

During my first pregnancy, I began having pain in the right hip/ sacroillac area, my OB/GYN said this was not that uncommon, that many women had this sympton during pregancy and later developed arthritis in the region.  Sure enough, forty years later, I had cortezone (sp) injected and two years later again.  My orthopaedic doctor, did an X-Ray and discovered non rheumatic arthritis.  So, once every two years, is not bad.

[curious43]

Thank you Dr. and Judy for your replies.  

Judy, I have an appt. to see my rheumy in two weeks, so I will definitely discuss it with him then.  I had originally planned to cancel the appointment because my joint pain has resolved and I've been feeling so good.  But it can't hurt to have him check it out.

I will also seek a referral to a neurologist.  The fact that I am experiencing this hip pain again and am also experiencing pelvic pain makes me wonder if there isn't more nerve involvement.  Time will tell.

Thanks so much for the info and support.  This is a wonderful forum.

[Judy - Follow-up question]

Hi Susan,

These things get so complex,I'm not sure how the Drs. figure anything out. I think it could be either neurological or auto-immune.

Let me relay my story since it is similar - but different as well.

About a year after my daughters birth I started to get sudden attacks in joints. (It seems like many women get diagnosed with RA within a couple of years of the birth of a child). When the attacks happened I literally could not use the involved joint without excruciating pain. If it was my knees, I could barely walk. It would last only a matter of hours, until the pains started to subside. Within 48 hours, I was 99% better. One time I got on a plane with a tiny bit of pain in my left foot. Two hours later I needed a wheel chair to get off. These attacks came on very fast and furiously.

It took 4 years for the rheumy to see this. By the time I would get to the rheumy it was gone and I could just tell him what had happened. When he finally saw it, it was in my wrist - he could tell by looking that the wrist was very inflammed. Hips are tough the joint is too deep for them to see much by looking/feeling.

He diagnosed me with palindromic rheumatism. In this case he said 60% of people just have it go away and 40% progress to chronic RA. I ended up with the chronic RA.
But if this is the case, odds are in your favor it will go away.

Mine traveled to different joints. One attack in shoulder, then knee, then ankle, etc. It would be weeks or months between attacks. At this point I was RF neg., but that has now changed. You have only mentioned one joint - so that is very different.

I would suggest you see a rheumy when the attack occurs. Just call up and tell them that you need to come over now. That is what I needed to do. At first they said I could come in 3 weeks. It would be gone by then. So, I needed to push. I said the rheumy has been waiting for 4 years to see this and I needed to come now. They got me in.

If the rheumy can't tell by looking, I would think a sed rate might confirm the presense of inflammation. Although, that doesn't confirm exactly what is inflammed.

There are many other causes of what you are describing - so don't think that this means you are going to get RA. A rheumy should be able to help sort things out.  Mine was great. He never doubted my stories and just said it would either go away or it would get worse and we would figure it out. He kept working with me for 4 years and didn't give up or treat me like a nut (which is what I sounded like telling him that yesterday I couldn't walk - now I'm fine and he saw nothing).

I hope you find your answer quickly or it just goes away. Many times that is the case. Enjoy those beautiful babies.

Best wishes.

[CCF Neuro[P] MD, RPS]

Dear Susan:

It is alttle far out to likely be due to the delivery.  However, that is not to say that the initial damage might not be aggreviated by another trumatic event.  It is difficult to say much without examining you because nerves have specific areas that they control the feeling of and the exam can give a good look at the distribution of the the symptom.  I would suggest that you see a neurologist to have him/her give you an opinion.

Sincerely,

CCF Neuro MD