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HomeAnswersRadiologyrib painMy pelvic joints hit each other while walking after trauma. Why?

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

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At September 29, 2022
Reviewed AtJanuary 19, 2024

Patient's Query

Hello doctor,

I tore something from my ribs and pelvis five years back; since then, my entire torso has been falling apart, and no doctor can pinpoint exactly what it is. Since the injury, my left ribs are floating around, and I can no longer control my pelvic movements, causing my pelvic joints to hit each other upon every walking movement.

Kindly help.

Thank you.

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.

Patient's Query

Hello doctor,

Thank you for your response.

I am attaching my spine and thorax MRI as well. Could you please help me find out the reason?

Five years back, I had torn something from my ribs, some kind of a ligament; I do not know what it was, but since the injury, my ribs have been hanging out, and I can no longer compress the left side of my ribs, it is causing me a lot of pain during movement and also with deep breathing.

Kindly help.

Thank you.

Hello,

Welcome back to icliniq.com.

I will check the reports and get back to you.

Thank you.

Patient's Query

Hello doctor,

Thank you for your response.

No problem. Since this injury is something I have been struggling with for years, I would appreciate your help, even if it takes a longer time. I have uploaded three MRIs and four images of my left ribs.

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.

Regarding follow up

Thoracic surgeon or sports medicine.

Patient's Query

Hello doctor,

Despite already consulting a thoracic surgeon and a sports doctor, I am still struggling with this injury. Is the cause of my symptoms maybe a slipping rib syndrome? Or something of that sort? Maybe I tore something in the spine that has healed but not healed properly. In general, I am doing my best to make this injury bearable.

I hope to hear from you.

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.

Regarding follow up

CT (computed tomography) chest with bone window volume reconstructions.

Patient's Query

Hello doctor,

Unfortunately, I am not allowed to schedule a CT scan. About my case, is it possible that I have a pars defect or some sort of spondylolysis in my lower back? My connective tissue keeps snapping around my lower back with every movement, and moving my torso backward or forward is extremely painful because some joints, bones, or cartilage is painfully rubbing with each other; it feels like my entire spine is falling downwards. Attached are additional x-rays of my lumbar spine I take for my lower back pain.

I hope to hear from you.

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.

Regarding follow up

CT chest with bone window volume reconstructions.

Patient's Query

Hi Dr Muhammed, Are you sure there isnt any sign of muscle, ligament or tendon injury in any of my MRIs? At this point I dont know what to do. Im still struggeling with this injury. Im trying physiotherapy with no improvement, I am losing hope. I am also trying fasings. so far I lost a lot of weight with no improvement. I do not know what to do. I need your help with this. I dont know what to do... To answer your question, in the Netherlands CT is only offered in emergancy situations, which unfortunately isnt my case
Hello there. I apologise for the delay due to our holidays. And I'm also sorry to hear about your continued suffering. Pls be reassured that I've check your MRIs & xrays meticulously and found no anatomic fault / fracture / dislocation etc. From your photograph and descriptions, however, I considered that "slipped rib" could be a possibility. Well, since CT is not easily available, I suggest you could discuss with your orthopaedic dr to have lateral & oblique view xrays, so that we could try to see whether the ribs are in proper alignment or dislocated / slipped. I earnestly hope that you get a proper solution to your problems soon. Best regards.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Muhammad Shoyab
Dr. Muhammad Shoyab

Radiodiagnosis

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