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Old 09-30-2012, 04:10 PM   #1
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Question L5-S1 root compression or gluteus maximus tear?

I have had pain in my left lower back area for the past 5 years. It started after walking uphill on a treadmill daily set to a steep incline. Based on the location, I'm not sure if it's referred nerve pain caused by disc degeneration, or a tear in the gluteus maximus near the insertion to the bone.

The area near the top of the gluteus maximus is where the pain is the most sharp, particularly after activity such as tennis (which I may have to give up shortly.) The pain is to the left of the lower spinal column by about an inch. Sometimes, after activity, it hurts to put weight on my left leg.

An MRI done several years ago showed disc degeneration at L5-S1 with potential deformity thickening left L5 nerve root. I am wondering if anyone has had a similar diagnosis, and if the pain was referred outwards and down due to the compression of the nerve root.

If anyone has had a similar pain and knows of the best tests to identify it, I'd appreciate the feedback. Thanks!

Last edited by CT06405; 09-30-2012 at 05:06 PM. Reason: misspelling

 
Old 09-30-2012, 04:44 PM   #2
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Re: L5-S1 root compression or gluteus maximus tear?

Do you have any pain below the buttock area? Anything going down the back of the leg?

Another possibility is an issue with the piriformis muscle....

Since this has been going on for quite awhile, my guess would be that the degenerating disc is responsible for the continued pain. Once a nerve becomes irritated, and you continue to aggravate it by activity, it stays riled up. One thing we know is that disc degeneration does not improve as time goes by....

A simple way to determine if the nerve is causing the pain is to have a diagnostic nerve block. This is similar to an epidural steroid injection. You will lie on your stomach, and the doctor, using live x-ray (fluoroscopy) to guide him as he places the needle, will inject a numbing agent around the nerve. You will then be asked to go about normal activities, especially the ones that usually cause you pain. If you can do these things without pain, it is generally a good indication that the pain is coming from that particular nerve. As the medication wears off, the pain will return.

 
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Old 09-30-2012, 05:27 PM   #3
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Re: L5-S1 root compression or gluteus maximus tear?

[QUOTE=teteri66;5064828]
A simple way to determine if the nerve is causing the pain is to have a diagnostic nerve block. This is similar to an epidural steroid injection. You will lie on your stomach, and the doctor, using live x-ray (fluoroscopy) to guide him as he places the needle, will inject a numbing agent around the nerve. You will then be asked to go about normal activities, especially the ones that usually cause you pain. If you can do these things without pain, it is generally a good indication that the pain is coming from that particular nerve. As the medication wears off, the pain will return.[/QUOTE]

Thanks for your post. I agree with your advice, and I've had several injections such as you describe, done at 3 different times; one into the facet joint so that it bathed the sciatic nerve, one into the soft tissue, one into the SI joint. They all relieved the pain temporarily, which meant to me that all the nerve blocks had spread into the soft tissue and numbed the surrounding areas, still not giving me much of an answer. I may have to go back and try again, then do the aggravating activity.

The pain does not run down the buttocks or into the leg, so is probably not sciatica, but it could be a nerve root other than the sciatic nerve that is irritated, I suppose. I have thought of piriformis syndrome, but doctors tell me that would be a slightly different location.

I also get a lot of lower back muscle guarding and locking up when the pain starts; I'm not sure if a disc or nerve would cause that, or if that means it is more likely an inflamed tendon or muscle and the muscles are tightening up to slow down movement and protect it.

I'm thinking of finding a hip or back doctor who would do an ultrasound if that would show muscle tears better than an MRI; this way I could rule that in or out.

 
Old 09-30-2012, 10:43 PM   #4
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Re: L5-S1 root compression or gluteus maximus tear?

What type of doctor is currently treating you?

 
Old 09-30-2012, 11:03 PM   #5
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Re: L5-S1 root compression or gluteus maximus tear?

I don't think an ultrasound is going to be helpful. I think a repeat MRI would be best and then an epidural steroid injection with anesthetic injected with it doubles as a nerve block (for 1-3 hrs depending on the anesthetic they use), and gives you the benefit of the steroid to reduce the nerve root irritation. Nerve root irritation commonly causes spasm of the back muscles on the affected side. The injections you have had in past are not really at the nerve root. The facet and SI joints are more to the side and the ESI will be aimed right at the nerve as it comes our of the spinal foramen. If the pain is gone for a bit afterward, you know they've injected the right spot. The steroid affect can last a few weeks, and some people even get months of relief.

 
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Old 10-01-2012, 05:19 AM   #6
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Re: L5-S1 root compression or gluteus maximus tear?

Thanks Ladybug - I've been thinking of doing exactly as you suggest, primarily for diagnostic reasons. I am thinking that the possibility of it being a nerve root irritation is higher than that of a muscle tear, which at least would leave out the complications of trying to heal a tendon that is used for almost every basic daily activity.

My only hesitation is that I've had several steroid injections in the area of the sciatic nerve before, so don't want to overdo these, and I've found it's not a permanent fix to take the irritating pressure off this nerve.

Teteri, as for doctors - I've consulted with both orthopedic and neurosurgeons, and have had the injections from a pain management specialist who works with the neurosurgeons. Injections are almost all he does all day, and he is very good. In a couple of weeks I have an appointment with the head of a university hospital's spine center who specializes in minimially invasive back surgery. I hope to get some updated tests through him. If there is a way he could reduce the size of what is pressing on this nerve without it being a big, risky operation, I'd strongly consider it.

 
Old 10-01-2012, 07:25 PM   #7
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Re: L5-S1 root compression or gluteus maximus tear?

Hi I had what you are describing. Turns out I had the smallest of a slip disc at my L4-5. All my pain would go into left butt, not down my leg. I could not sit. Lots of pain meds. 12,weeks ago I had a XLIF/ PLIF. They went in thru my side, cleared out the disc, but one in with bone growth, flipped me over on my back cut a three inch incision and on one side of my disc they attached a rod and screws. I HAVE KNOW PAIN. They did not correct the slip, they stabilized it. Stopped all of my lower and upper pain. One level fusion. It has taken 12 weeks to be able to sit a hour with out pain. I started with aquatic PT, light excise. I am starting land PT next week. I am still a little weak in my left leg for strength but its getting better. I can do 40 labs in the pool. First day I almost drowned doing 50 meters... LOL ice is my new best friend. Takes and discomfort away. I had all the things and them some done to me before I finale got surgery. I posted all my info doctor name here on the board. Good luck. Great PPL here, they helped me a lot

 
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