undiagnosed right pubic ramus pain

by Rebecca

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

» undiagnosed right pubic ramus pain

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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've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's 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's 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 painfree. 

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's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's 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 walk 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.

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. Xrays 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 year 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's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 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 couldn't 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 shouldn't be treating the elderly most medical sites state but that's so much bunkum.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

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Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

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