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Old 04-21-2012, 07:19 PM   #1
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Chronic groin/pelvic pain... so confused!

Hi...hoping for some input. Short history...bilateral total hip replacements, colon re-section (all within the last 10 years). Now dealing with fairly moderate spinal stenosis and DDD. Doc recommended a double level fusion. I've done PT, had a series of ESI's and recently had 4 selective nerve root injections (big ouch!). I have had chronic groin pain since my left hip was replaced 5 years ago and since my colon re-section 4 years ago (left side). Last year, had a hip aspiration and bone scan done to rule out infection/loosening of my hip because of the groin pain symptoms. Also ruled out a hernia. Still live with this maddening groin pain...it wakes me as I move my leg. A burning, pinching pain. It hurts constantly and almost feels like something's impinged in there. I've read the symptoms of an impinged psoas muscle and that pretty much describes it. HOWEVER, I understand that nerve root compression in the lumbar spine can cause the same sort of pain. What confuses me (and is, frankly, driving me nuts) is why would it hurt so much worse when flexing in a certain way? This seems more like muscle/ligament pain. Arrrggghhh......
My hip doc did suggest the pain could be referred from the back or be muscle-related. Soooo...have any of you experienced groin pain from your spinal stenosis/nerve compression? I see an ortho doc for my back, but am thinking it's time to consult with a neurosurgeon. Most of my leg pain/tingling is on the left side...altho I'm starting to have right leg pain also.
Any input is greatly appreciated. Thanks for reading...
Linda

 
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Old 04-21-2012, 10:12 PM   #2
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Re: Chronic groin/pelvic pain... so confused!

At what levels are your degenerative disc disease and spinal stenosis? Most common is L4-L5 followed by L5-S1. Are you familiar with a dermatome map? It is very helpful in seeing which spinal nerves innervate which area of the body and limbs...

With disc herniations and/or stenosis at both those levels, it is fairly common to have groin pain, "hip" pain, buttocks pain and pain that radiates down the leg...any or all locations, and it can move around.

If you are seeing an orthopedic spine surgeon, he should be able to provide the same level of care to you as a neurosurgeon -- assuming the pain is being caused by nerve compression of a spinal nerve.

Speaking from experience, it can be very difficult to determine where pain is coming from -- the dysfunction of nerves in this small area can cause pain in the pelvic area, sexual organs, hip, sacroiliac, buttocks, etc. But you could try having diagnostic nerve blocks to see if they can pinpoint which nerve is causing the issue.

Have you had an EMG to check for nerve damage or dysfunction? I assume you have had lumbar MRIs to check for various issues....SI joint dysfunction is another issue that can cause symptoms that are similar to those caused by lower lumbar disc herniations and stenosis...and again, it can be difficult to tease out which issue is causing which problem.

If you aren't getting any satisfactory answers from your current ortho, it is worthwhile consulting with another fellowship trained orthopedic spine surgeon or neurosurgeon who limit their practice to issues of the neck and back. It often pays to get several opinions because some doctors are better diagnosticians than others.

 
Old 04-22-2012, 10:12 AM   #3
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Re: Chronic groin/pelvic pain... so confused!

Thanks for your response. Yes, my stenosis and compression is at L4-5 and L5-S1. I've not had an EMG...yet. My confusion is trying to differentiate what could possibly (and is probably) referred pain into the groin/pelvic area from the back...from a possible complication from my hip surgery. I just find it hard to believe that what feels like a muscle injury could be nerve pain. I forgot to mention that it hurts to cough. I brace myself! (as mentioned, we ruled out a hernia). After having gone thru the big time tests to rule out infection and loosening of the hip prosthesis, I think it's time to head back to my hip surgeon and request further testing and, obviously, get another opinion on the back. I'm blessed to live in a great medical community with lots of brilliant docs.

 
Old 04-22-2012, 08:38 PM   #4
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Re: Chronic groin/pelvic pain... so confused!

I guess you'll just have to rule things in or out as you go...I've never had a hip problem although I thought I did, but it turned out to be caused by my SI joint on the left side. I had lots of groin pain and it was due to instability in my lumbar spine.

Looks like you'll be keeping the medical community in business for a while longer while you figure out what is causing your pain issues.

 
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