What could be the reason for uncontrollable pelvic movements and difficulty walking?

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

I saw your attached photos and the MRI (magnetic resonance imaging) of the pelvis (attachments removed to protect the patient's identity). MRI shows that your pelvic joints are in perfect order of structure and outline, and there is no dislocation or deformity. In addition, the muscles in the pelvis and lower spine are normal in size, which means there is no muscle wasting.

The MRI also shows the lower part of the spine and that the spinal nerves are not compressed or deformed. However, we also need to know the condition of the spinal cord itself (which is not seen here). There is also a tiny Tarlov cyst on the left side at the S2 level, which is most likely insignificant. Overall, we see a normal MRI pelvis. Thus the cause of your problems is not present in the pelvis.

Thank you.

Hello,

Welcome back to icliniq.com.

I will check the reports and get back to you.

Thank you.

Hello,

Welcome back to icliniq.com.

I have reviewed your MRI (magnetic resonance imaging) of cervical, thoracic and lumbar spines (attachments removed to protect the patient's identity). No finding can be related to the problems you have been having.

The spinal cord and nerve roots are perfect and intact. There is only some dilatation of the central canal in the cervical spinal cord, but that is not a significant point in this context. If the bones and nerves are discounted, then the point of muscles connecting the ribs or thorax to the pelvis is reached. The main muscles in this group are the rectus abdominis, latissimus dorsi, abdominal obliques and transverses, and the erector spinae at the back. From your MRIs, all of these groups are seen as intact, symmetrical, and in proper shape and size.

So, the matter is quite peculiar and confusing, and I feel sorry that I cannot give you a perfect answer immediately. I can only make an assumption (similar to yours) that some fibers of any of these above muscle groups got injured (or paralyzed), so now there is an imbalance of muscle support on the left side. But then, the injury should have been recovered over all these years with proper treatment and rehabilitation. Therefore, I perceive that your assumption is reasonable, that the ribs stick out due to focal injury or paralysis of some muscle fibers. Perhaps there is little hope of getting those muscles back in that case. So, in that context, I think you can consult a thoracic surgeon (or sports medicine specialist, whichever is appropriate in your country) and discuss with them whether they consider removing the protruding part.

Thank you.

Hello,

Welcome back to icliniq.com.

I have seen some photographs of what you mention of slipping rib syndrome, and compared with your photographs (attachments removed to protect the patient's identity), it seems reasonable. However, I have rechecked your MRIs, and those look normal. Now, please note evaluation of bones on MRI is limited in some ways, so a CT of the chest with volume reconstruction of the bone window would demonstrate the slip (if any) right away. So, you can discuss this with your thoracic doctor and proceed to CT if they consider it appropriate.

Thank you.

Hello,

Welcome back to icliniq.com.

I have seen the X-rays you have attached (attachments removed to protect the patient's identity) and reviewed my comments from your previous images, and I do not think a pars defect is the case here. The pain you mention with every movement or posture change, or what you mention as joints rubbing each other, may be explained by some muscle tone or posture imbalance due to the "slipped rib" (or whatever). You may remember that the rib slipping was not evident on the MRIs, nor was any pars defect.

Thank you.