From the start of this month, I have been suffering hip pain and some tightness around the lumbar region. I had a steriod injection and thereafter the pain reduced to 80 %. I was on Aceclofenac 100 mg two times a day after 15 days. I had an MRI and the report is attached. I have a major complaint of hip pain. There is no thigh or back pain and no tingling, no numbness. I am able to walk after taking painkillers and I am able to do physiotherapy. Kindly guide as I am still with pain and on painkillers. I am attaching MRI images and report. Also, see remarks about L3. Is it serious? What do I need to do? My current medications include a steroid injection 1000 mg Methylprednisolone, Aceclofenac 100 mg twice a day, Pantoprazole twice a day, and Etodolac 400 mg twice a day.
I have gone through the attachments (attachment removed to protect patient identity). Your MRI (magnetic resonance imaging) report suggests disc changes at L5-S1 and hemangioma of L3 body. You should understand that MRI is a very sensitive investigation and picks up many features whether they are the cause of a problem or not. Hemangioma is picked up very commonly during the MRI of the spine or abdomen. These are benign lesions from birth and are not operated unless they are the cause of symptoms, which is in very few number of cases. Disc changes too can be seen in a number of individuals as it is a sign of aging. Only those disc lesions which cause a backache or neurological symptoms need to be addressed. In your case, you only have hip pain with no backache or neurological symptoms so you do not need to be concerned of any of the findings reported on the MRI. Only when you have neurological symptoms of tingling, numbness, muscle weakness, backache radiating to then legs then repeat clinical examination and MRI might be required. I have a few questions for you.
Are you able to sit in cross-legged position?
Which side of leg or hip is painful, the outer side, the back side, front side, groin or the inner thigh?
How long have you been suffering from hip pain?
In your past summary diagnosis of meralgia, paresthetica and radiculitis is mentioned, what medication was mentioned or no treatment has taken?
Is the current hip pain same as the previous one or new features have appeared?
What time of the day pain is severe, morning or night?
Do you have any other joint pain?
Which activities aggravate and relieve pain?
Do you eat non-vegetarian foods?
Any blood workup/investigations have been done?
Have you taken steroids or muscle gaining products in the past?
Do you drink alcohol? If yes then country liquor or branded?. What is the quantity consumed and how frequently?
Have you taken any local drugs or unprescribed medication for a long duration?
The answers to your questions are as below:
Yes, I can sit in a cross-legged position with no pain or pain noticeable. Sitting to getting up and standing to sit gives pain to hip to leg with bearable pain.
On the right side, there is a hip pain; on the back side only there is mild pain, no thigh pain, and I have mild pain in calves. The MRI shows L5-S1 disk herniation as per report which terrifies me.
The pain started a month ago. It triggered up while car washing which I ignored and two days later, the right hip pain locked me to walk but there was no back pain on that day until date. There is only hip pain and some lower hip and calf pain. The doctor gave me steroids, Methylprednisolone IV and I had relief 70 % around with bearable pain. I am able to walk, drive, sit, stand up with the bearable pain of course with painkillers.
I have radiculitis on the right side and on the left side I have meralgia paresthetica which has been treated with pregabalin, B12 and suitable clothing which is now only 10 % noticeable on the left side knee thigh area but nothing on the right side. I had right toe pain with mild numbness before one month. But, right now nothing in the right leg. There is no numbness, tingling, or shock pain.
Hip pain severity has slightly decreased and roughly 70 % bearable with painkillers.
Pain is more when getting up and sitting down from bed or chair. No significant pain while sleeping but while sitting more than 20 minutes, when trying to get up I need to slowly get up and warm up to get up to avoid more pain. Once I get up, I am able to walk with pain.
Sitting down and getting up from the chair and walking more than normal give more pain. I had started one physiotherapy exercise for a week. After one week, it started to hurt.
I rarely eat eggs and chicken.
I had LFT and TMT and both are normal before this pain.
I have not taken any steroids.
I drink alcohol rarely. Currently nothing.
I had depression two years ago. I was on Escitalopram, SSRI 10 mg, Amitriptyline HCL 10 mg for a tension headache which has been cured completely. These were prescribed by a neurologist.
From the history and the relief, you have got with analgesics, it suggests the pain to be of mechanical origin that means exertional pain. It is best to take analgesics (prescribed by your doctor) for a couple of weeks and start lower back strengthening exercises and the condition should resolve or decrease in intensity. If the pain remains of the same intensity or increase then clinical examination will be required. Your pain does not have any red flag signs to alarm you. Your pain can also be increased by stress.
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