[Ferg26]

#7890

Dear Dr. Corenman:

13 months ago, I traversed a heavily snowpacked gulley in order to render aid at a terrible traffic crash. As I was walking back to my car, I encountered a severe pain in my hip area such that I literally had to just lay down on the ice covered road and wait for it to ease.

In the ensuing months, I have had continual pain in my hip area, radiating down my leg. I’ve had radiology including MRIs of the hip and spine. Only a tiny spec of something was found in the hip joint and a sacralized L5. Nothing else abnormal. A year of PT with stretches, ultrasound, and ionto, as well as prescribed chiropractic, and I still can’t walk more than 80 feet, or make it up more than one floor of stairs, without breaking. 13 months of hydrocodone have made it barely tolerable.

One Dr. did an injection of the SI joint, but it was not under fluoroscopy. It did provide fairly significant relief for about three weeks, during which time I continued having pain in my knee when using stairs. I assume that’s due to over/undercompensation from the hip issues.

Any suggestions? One PA suggested that there’s not much to be done with SI, until I suggested in exasperation that I guess I need to go to Mayo clinic. “For SI pain?!?!?” was the incredulous response. This is REAL pain, but I don’t think my medical group really gets it or cares.

[Donald Corenman, MD, DC]

#7899

Pain in this region can originate from the hip, sacroiliac joint or from a nerve root in the lumbar spine. MRIs are helpful to diagnose root compression and hip disorders but are not helpful to diagnose a sacroiliac disorder.

Hip and sacroiliac disorders are more difficult to diagnose but the diagnostic injection is a good tool to differentiate these pain generators. I assume that the lumbar MRI was thoroughly screened to make sure there were no disc herniations, especially in the far lateral position which are sometimes missed by radiologists.

A sacroiliac injection needs to be performed using fluoroscopy and relief for three hours diagnoses this disorder. Same with the hip injection but this joint can be injected under ultrasound guidance which is an office procedure and not a hospital procedure.

The sacroiliac joint can be fused if it is a pain generator but there are other treatments available such as rhizotomy and prolotherapy. Each treatment has its advantages and problems.

If a hip disorder is diagnosed, it can most likely be remedied by an arthroscopic procedure in your case.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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