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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