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  • Avatarniki
    Participant
    Post count: 7

    Happy holidays and thank you so much for replying once more!

    I was in a wheel chair for one year from hip pain, but it seemed to magically resolve. At that time I when to a rhuem and I’m scheduled to see one this week. I seem to fall through the cracks of many specialities.

    I did have a recent hip MRI, (my lumbar MRI came out “normal”) would that show the SI joints or is this something I’d need to ask for?

    In case this would help, here is the report:
    MRI HIP: 11/7/2019

    CLINICAL HISTORY: 33 years of age, Female, chronic right hip pain.

    PROCEDURE COMMENTS: Multiplanar, multisequence imaging of the right hip was performed at 3T without contrast.

    FINDINGS:

    Fluid: No significant joint effusion is present within the hip.

    Cartilage, bones and marrow: Minimal chondral thinning along the superior hip joint space. Bone marrow signal is within normal limits for age.

    Labrum: Degenerative signal and mild blunting of the anterosuperior labrum (701/16-18) with mild irregularity of the superior labrum (501/22-23).

    Tendons: The iliopsoas tendon appears normal with no surrounding fluid. Minimal gluteus medius tendinopathy and peritendinitis. No substantial trochanteric bursitis. The hamstrings and adductor compartment muscles are within normal limits.

    Additional findings: Increased signal within the sciatic nerve, most pronounced in the tibial portion (301/24), which is otherwise normal in caliber. Normal surrounding fat planes. Normal muscle bulk within the pelvic girdle musculature without edema.

    Thanks again for everything, this is really helping me advocate for myself as a patient who has been in such pain for half my life!

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7288

    An MRI of the lumbar spine can “catch” the SI joints but it really depends upon the sequences performed. I would expect that SI joint problems would have been seen by the radiologist and reported.

    You do have labrum issues in your hip which can cause hip pain (“Labrum: Degenerative signal and mild blunting of the anterosuperior labrum (701/16-18) with mild irregularity of the superior labrum”). Many individuals with age have labral disorders without significant symptoms so if you continued to have hip symptoms, a diagnostic hip injection would be in order.

    One finding is unusual, “Additional findings: Increased signal within the sciatic nerve, most pronounced in the tibial portion”. This is a neuritis or inflammation of this nerve which could indicate a neuropathy. Have a good rheumatologist or neurologist explain these findings to you.

    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.
    Avatarniki
    Participant
    Post count: 7

    I have an appointment Friday, thanks again.. With your help I’m more informed and can ask better questions.

    Lastly before I go, may I ask what a “diagnostic hip injection” is?

    Kind regards

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7288

    A diagnostic hip injection simply is an injection of a numbing agent (and sometimes steroid) into the hip joint itself. The fluid distributes just like the lubricating synovial fluid and “numbs” everything in the joint capsule. Good temporary relief of hip and referral pain is an indication that the hip joint is causing that pain.

    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.
    Avatarniki
    Participant
    Post count: 7

    My rheum is consulting with his radiology colleagues regarding the SI joints and possible ossification.

    If there’s not much risk, it may be worth getting a shot in the meantime..
    Thanks to this forum I’m on my way to feeling better. Thanks again for taking the time.

    Avatarniki
    Participant
    Post count: 7

    I got the MRI of the hip and good news I suppose, no sacroiliitis.

    I drove 2 hours to a Rhuem and he said he didn’t think it was AS but I’m still having some very serious pains, pelvic floor issues, burning and pain in my hands and feet and the dizziness and back spasms.

    He didn’t want to run any other tests but here are the SI findings. He also said I had “osteoarthritis of the cspine?” Which I don’t know where to turn next…

    Impression
    IMPRESSION:

    1. Normal MRI appearance of the sacroiliac joints without significant joint space narrowing, cartilage loss, or erosive change.

    2. Abnormal high T2 signal in the bilateral sciatic nerves proximally. Correlation with sciatica type symptoms is recommended. A lumbosacral plexus neurogram could be considered to further evaluate if clinically warranted.

    I have personally reviewed the images for this examination and agree
    with the report transcribed above.

    Signed”Final report”

    Narrative
    MR SI Joints wo: 2/8/2020 12:30

    CLINICAL HISTORY: 33 years of age, Female, Possible axial spondyloarthropathy..

    COMPARISON: MRI lumbar spine 11/14/2019, MR hip 11/7/2019

    PROCEDURE COMMENTS: Multiplanar, multisequence imaging of the sacroiliac joints was performed at 3T without contrast.

    FINDINGS:

    Fluid: No visible joint effusion. Small volume of fluid in the pelvic cul-de-sac, likely physiologic.

    Bones and cartilage: The sacroiliac joint spaces appear symmetric, and the cartilage appears intact. No significant erosive change. No significant joint space narrowing. No significant degenerative change of the lumbosacral junction or visualized lower lumbar spine.

    Mild degenerative changes of the right hip.

    Bone marrow signal is within normal limits for age.

    Ligaments and tendons: No significant abnormality within the field of view.

    Nerves and vessels: Symmetric abnormal high T2 signal within the bilateral sciatic nerves.

    Additional findings: 2.6 x 3.6 x 2.8 cm right adnexal cystic structure most likely a dominant follicle arising from the right ovary. Retroflexed uterus with a 0.8 x 0.6 x 0.3 cm oval-shaped T2 dark structure adjacent to or arising from the uterus anteriorly. This appearance and the location suggests either a small uterine fibroid or possibly a small endometrial implant.

    0.9 cm sized left-sided Tarlov’s cyst at the S3 level is incidentally noted.

    Best and Happy Valentines Day!

    Niki

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