undiagnosed right pubic ramus pain

by Rebecca
(Michigan)

I had a femoral neck fracture repair in 2014 that resulted in necrosis. I then had a total hip replacement in April of 2015. I had severe atrophy from wheelchair and extensive physical therapy that is still ongoing. After Si injections in May 2016 to stabilize my sacroiliac joint I began to have pinching pain in right groin area.

After inguinal ligament injection and psoas tendon injection that provided no relief I underwent diagnostic laparoscopy yesterday that indicated no inguinal hernia. X-rays done in Sept show no abnormalities. Bone scan in October is normal. MRI done in Oct shows no skeletal abnormalities but glare from metal hip prevented any diagnosis of soft tissue. Pain at right pubic ramus is severe. Do you have any helpful input? I'm tired of not getting any diagnosis after all I've been put through and willing to reach out to any source for help. Thank you.

Hello Rebecca,
Yes, it is tiresome and I understand your frustration.

Do a few things for me.

Starting at the ASIS, using a little oil, run your right thumb down through the groin, lighten up as you cross the femoral artery and nerve, feel the pubic bones and continue down the inner thigh muscles towards the knee. Is it exceptionally tender? How does it compare with the left?

What do you feel when raising your knee to get into the car?

Do you have any significant lower back pain? Where? Does bending forwards, backwards and to the side provoke any pain? In the thigh?

Lying on your back gently pull your knee to your chest and then to the opposite shoulder and then make a circle using the knee as your contact point. Is it particularly stiff and sore? Where?

My experience is that failed hip surgery frequently has to do with a fixation in the sacroiliac joint; it's difficult for you to test. If you place your heel on the opposite knee and drop your thigh into the lotus position do you get SI pain? In the groin?

Using some oil run the heel of your hand down the side of the thigh. Is it very tender?

Obviously Rebecca it's very difficult for me, from a distance to make a diagnosis when the best in town have failed to do so. These may give some answers and they may not.

Have you seen a local chiropractor who specialises in hip pain?

Are you doing any daily exercises for your hip? That would be a good place to start.

If you want to continue this conversation, give me detailed answers to the above. As specific as you can.

I hope this contributes.

Dr B


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