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Mystery Diagnosis Needed: Unexplained groin, pelvic, and bone pain. Please Help!!?

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Mystery Diagnosis Needed: Unexplained groin, pelvic, and bone pain. Please Help!!?

Postby brodrik » Mon Aug 08, 2011 10:24 pm

31 y/o female presents with chief complaint of right groin pain which extends to midline pelvis down to inner thigh. Symptoms are generally mild until patient drives, sits, or stands 30 minutes or longer. Patient states onset has been about 3 months ago and is now progressively getting worse. No trauma or injury noted by patient. Pain is better when patient lays down on other hip, but does not completely diminish.

Patient past surgical history: Complete hysterectomy, appendectomy, cholecystectomy

Patient medical history: mild Fibromyalgia, chronic sinusitis, appendicitis, Gall bladder EF=14%, "malfunctioning uterus", superficial blood clot (pregnancy)

Patient family medical history: Cancer (bone, blood, lung, kidney, breast), Heart attack, DVT's, anemia, HTN, hernia

1st office visit: Dr. ordered venous duplex and x-ray of right hip after ruling out hernia.

After both tests came back normal, Dr. ordered CT scan with contrast of abdomen/pelvis...results were pseudo finding of transverse ascending colon inflammation consistent with colitis.

After reviewing results of CT, physician had patient trial an oral steroid (Medrol Dose Pack) Patient's symptoms became intensley worse on this medication. Initially, the upper groin/pelvic pain got better, but entire right hip "was on fire" where the patient stated that she couldn't even stand having anything touch it including her underwear. As the medication gradually decreased the original symptoms returned at a gradual pace and the "fire" in her hip lessened as the medication dosage lessened.

2nd office visit: Due to the worsening effect from the Medrol, physician did pelvic exam and noted severe bone pain located at the top right of patients vaginal wall. Patient stated that there has been a dull ache there at all times since Feb 2009 and was made worse with sexual intercourse but hadn't thought of that earlier. (no history of STD's)

Pysician ordered full pelvic x-ray, basic lab workup, and MRI's of hip and pelvis...all were negative.

Patient was sent to have a nerve conduction test and EMG...both negative.

Patient's pain is presently worsening and she is now unable to drive longer than 10 minutes if pain was previously aggrivated and 20 minutes if not. Dull pain is continuously present but is made excrutiating when putting pressure on the pelvic bone itself. Pain seems to be worst in groin, vaginal, and bottom of the buttocks areas.


Things ruled out already: DVT, Hernia, bone infection, visible tumor, nerve entrapment, spinal and/or disc problems, arthritis, and referred pain


Does anyone have any suggestions as to what this odd presentation of symptoms could be? How about a next step suggestion? We are running out of options and we are 100% positive this is not "in the patient's head". Any further insight and ideas are greatly appreciated! Thanks.
brodrik
 
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Joined: Thu Mar 31, 2011 5:38 pm

Mystery Diagnosis Needed: Unexplained groin, pelvic, and bone pain. Please Help!!?

Postby nykko65 » Mon Aug 08, 2011 10:38 pm

31 y/o female presents with chief complaint of right groin pain which extends to midline pelvis down to inner thigh. Symptoms are generally mild until patient drives, sits, or stands 30 minutes or longer. Patient states onset has been about 3 months ago and is now progressively getting worse. No trauma or injury noted by patient. Pain is better when patient lays down on other hip, but does not completely diminish.

Patient past surgical history: Complete hysterectomy, appendectomy, cholecystectomy

Patient medical history: mild Fibromyalgia, chronic sinusitis, appendicitis, Gall bladder EF=14%, "malfunctioning uterus", superficial blood clot (pregnancy)

Patient family medical history: Cancer (bone, blood, lung, kidney, breast), Heart attack, DVT's, anemia, HTN, hernia

1st office visit: Dr. ordered venous duplex and x-ray of right hip after ruling out hernia.

After both tests came back normal, Dr. ordered CT scan with contrast of abdomen/pelvis...results were pseudo finding of transverse ascending colon inflammation consistent with colitis.

After reviewing results of CT, physician had patient trial an oral steroid (Medrol Dose Pack) Patient's symptoms became intensley worse on this medication. Initially, the upper groin/pelvic pain got better, but entire right hip "was on fire" where the patient stated that she couldn't even stand having anything touch it including her underwear. As the medication gradually decreased the original symptoms returned at a gradual pace and the "fire" in her hip lessened as the medication dosage lessened.

2nd office visit: Due to the worsening effect from the Medrol, physician did pelvic exam and noted severe bone pain located at the top right of patients vaginal wall. Patient stated that there has been a dull ache there at all times since Feb 2009 and was made worse with sexual intercourse but hadn't thought of that earlier. (no history of STD's)

Pysician ordered full pelvic x-ray, basic lab workup, and MRI's of hip and pelvis...all were negative.

Patient was sent to have a nerve conduction test and EMG...both negative.

Patient's pain is presently worsening and she is now unable to drive longer than 10 minutes if pain was previously aggrivated and 20 minutes if not. Dull pain is continuously present but is made excrutiating when putting pressure on the pelvic bone itself. Pain seems to be worst in groin, vaginal, and bottom of the buttocks areas.


Things ruled out already: DVT, Hernia, bone infection, visible tumor, nerve entrapment, spinal and/or disc problems, arthritis, and referred pain


Does anyone have any suggestions as to what this odd presentation of symptoms could be? How about a next step suggestion? We are running out of options and we are 100% positive this is not "in the patient's head". Any further insight and ideas are greatly appreciated! Thanks.
have you looked further up the spine at the thoracolumbar junction? just my 2 cents worth given you're looking for suggestions given the odd presentation.
nykko65
 
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Joined: Thu Mar 31, 2011 3:28 am

Mystery Diagnosis Needed: Unexplained groin, pelvic, and bone pain. Please Help!!?

Postby brant » Mon Aug 08, 2011 10:40 pm

It's not really a mystery or even hard to fix. Crazy part is if the dr. I had tried taking this type of information to six months ago had listened it might have been somewhere out there for you instead of me having to pass it around on the net. Here is what has happened to her. The tendon that attaches her thigh to her body has shortened, like all tendons have the capability to do. It is now pulling her thigh into her hip and the more it tightens the harder it is to sit, or anything for any period of time. She needs her tendon released so that her hip will once again glide as it was meant to do instead of being pulled tight into her body. The release is fairly simple also and is as follows:
Pelvic tendon
With only shorts on lay on a bed and pull your legs up and bend them at the knee so your feet are flat on the bed. Take your hand and run it down the crease between your thigh and body. When you reach the area of your pelvis you will feel a bump in that crease. That is the tendon to work on. Take it between your fingers and thumb and press and hold a good amount of pressure on it. Then relax, take a deep breath and exhale and don’t tense up any part of your body. After 30 seconds slowly lower your leg outward until it has gone as far as it will. Then release the pressure but rest your leg there for one minute longer. As a side note, if you cannot get a grip on the tendon, press on it near the pelvis with as much pressure as you can. Don’t let it slip out from under that pressure. Then use the rest of the exercise to finish up.
If you run into any problems or have questions please let me know. This woman has suffered long enough.
brant
 
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Joined: Fri Apr 01, 2011 5:12 pm


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