Lower right abdominal pain - groin and hip area.

by Gail
(Worcestershire UK)

lumbar spine with L5 - pars defect

lumbar spine with L5 - pars defect

I had a suspected appendicitis 10 months ago with bleeding in bowel. No cause has been found despite extensive investigations (CT, MRI, Ultrasound). Findings have been - 3cm ovarian cyst & Pars defect in spine. I had serious bowel obstruction problems (mainly fluid diet only) until the ovarian cyst was removed in April, at same time surgeon found adhesions around appendix and caecum, which he released. My pain then lessened by 50%. Continued below...

Hello Gail,
Thank you for a very full report.

It seems highly likely that there are different things going on here; what's uncertain is whether the proven bowel and ovarian conditions could cause this level of hip cum groin pain.

Let's focus on that hip for the moment. I agree no real arthritis, but I think I see what's known as a pincer deformity. Either google, or at Chiropractic Help type "Femoro Acetabular Impingement Syndrome Pincer" into the search engine. It's not an xray so difficult to be sure. Has a pelvic radiograph been taken?

Three tests for me. Lie on your back and pull the other knee to your chest, and then rotate the hip. Repeat with the naughty hip. What's the difference?

Secondly, place your heel on the opposite knee, and drop the involved knee outwards. The lotus position. This is called Patrick's Fabere test if you want to search for it. What's the difference between the two hips?

Thirdly, sitting, put some oil on your thumb and starting at what's called the ASIS run your thumb through the groin area, close to the pubes, and down the inner thigh towards the knee. First, look at an anatomy text: lighten up as you cross the femoral artery. Is the groin, pubes and adductor magnus muscle very tender? Compare with the opposite side.

Although you probably have some lower back issues with that pars defect, but no forward slip called a spondylolysthesis, I suspect this is all unrelated to your back. To test for a sciatica, the nerve from the L5 area, sit in a kitchen chair and straighten first the good leg, and then the naughty leg parallel to the ground. Is there a significant difference?

The sacroiliac joint is almost certainly involved, but again I suspect not the primary cause. But correcting any SIJ fixation will bring significant relief.

If this is FAIS Pincer, then there's significant relief to be had from chiropractic care of the hip; having said that, it took me years to learn how to treat FAIS. It's a diagnosis that wasn't recognised when I did my training.

This is all very complex and I can understand that you are tearing your hair out; give me some answers to the above queries, and perhaps we can take this further.

Dr B

I have had unusually high BP since this all started due to pain (average 160/100+). No internal GI cause for problems found. Pain seems to be in lower right abdo, hip and groin, so colon surgeon referred me to hip specialist. He said hip was OK, slight degeneration, but inflammation in 'greater trochanter' due to altered gait because of pain from elsewhere.

Referred to spinal surgeon - Pars defect L5? (see pic). Seems relatively stable, but wants to do nerve block/spinal injection into the pars to check. In the meantime, recently sat forward to pick something up off floor and had sudden severe 'burst/pop' in lower right groin area - great pain for about 1 hour after. Then right hip seemed to move more freely and less pain than before. Next day, better too. Then pain getting worse again over the following days. Now on max painkillers 8 x cocodamol 8/500 and 3 x diclofenac daily, but pain in groin.

Ultrasounds over the months have noted 'very tender over inguinal canal' but no hernia has been found, tho the GP said he could feel some 'popping'. Sitting, bending, climbing stairs/slope, lying down / night - all make this worse. Any ideas appreciated! 10 months on.

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti-inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He is doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost pain-free. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily stroll has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift; he has a short leg.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. X-rays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65-year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88-year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done. 

10. Mr X is a 71-year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a few months ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he could not sleep on that shoulder.

13. Mr D, a 71-year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors should not be treating the elderly most medical sites state but that is so much bunkum.

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