hip/leg 1 yr. post op fusion L3-4-5

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1Philfan

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Hey folks,
You've heard the "pull my finger " joke ? Well , Pull my leg. Hip pain is nasty.
11 Mnths Post op fusion L3-4-5. Back is bearable. Hip is not. Leg spazes(sic) from about l-5 to small toes when prone. Seated erect, primarally in the glute area/top of femur. Pressure of walking/clirabing steps/standing up Not good. It feels like the hip is out of place, hence the pull my leg. Been thru PT and aqua pt. Surgeon wants me to try another round of injections in l-5
I'm thinking it's the Bursa. Strength seems to be ok in evals but the pain is non-stop. No sleep etc. Cold and snow do not help. Ideas welcome.
Thanks!
 
Might it be worth it to get that hip X-rayed at this point? When we have lurabar surgery we always assume any pain in the hip/buttock/groin is related to the surgery, but you could have developed a hip problem.

I assume the pain is down the BACK of the leg?
 
Hello,

I agree, you might want to get the hip x-ray'd and MRI'd. Several yrs ago I had a multi-level laminectomy (and foramenotomies & discectomies) from L3 thru L3. After the surgery I started feeling pain in what seemed like my hips/pelvic girdle. Since I wasn't long out from surgery, my spine surgeon sent me to his group's hip specialist & I had both MRI'd & xray'd. He mainly wanted to check for osteonecrosis, but it turned out I only had mild arthritis. My surgeon thought it was hip related, the hip doc thought after the tests that it was spine related. A month or two later I had problem at L4/L5, had an MRI, and that noted mild disc bulging and mild narrowing at L1/L2. Nothing was ever mentioned about it because it didn't appear that it could have been causing me any problems. Over time, this pain has worsened, though, and normally feels like it's in both hips, my groin, and across my entire pelvic girdle on both sides. I also get bad spasms as well as muscle cramps. For myself, Soma has helped control these quite a bit. Anyway, my Rheum kept telling me Fibromyalgia and hip bursitis. I saw bursitis as diagnoses on my med recorRAB, but strangely he never me actually told me that or offered any suggestion as to how to treat bursitis. I told my last PM about it, he did some physical tests like moving my legs in different directions and thought it might be my sacral area. (I have been diagnosed w/ sacroilitis as well by another doc and I do believe I probably do have this)

Then we get to now (well since this past October) I had to go to a new PM due to insurance. He sent me for all brand new x-rays and MRI's (oh what fun that was :::eyeroll:::) Anyway, my lurabar MRI's showed a few disc herniations with a massive one at L1/L2. My pain doc thought the dermatome for that ran to the hips/groin region. So we did some ESI's at L1/L2 and what do you know.....suddenly almost all of the nerve pain and spasms I had in my hips/pelvic/groin areas was gone. The ESI's along with my meRAB I had almost no pain. This is since late '06. The only problem is, the ESI's don't give me any lasting pain relief. They last about 2 weeks, then I'm back to where I started. At it's worst, I was also getting stabs of sharp nerve pains in the front of my left thigh down to about my knee.

I also know exactly what you mean about you hip feeling "out of place". Boy i can relate to that as I get that on and off with my left shoulder. I have literally asked people to pull my arm and push onto my shoulder. Now I know it was due to severe muscle spasms. I've also felt like that in my hips from time to time. I don't know if this is normal or not, but my hip joints (used to anyway) be able to move alot, not sure if they were actually coming out of place, but I could make then do it. When I have all this pain, I find myself trying to do that thinking that it will get "unstuck" or something.
 
back of leg is correct. Just off center, from the side view. calf and rear thigh. into ankle.
 
Have you had a MRI recently? Also, I wondered if this pain has been with you ever since surgery, or was there a period, after you got over the initial healing of surgical pain, when you were not bothered by it? Does it run into the foot or stop at the ankle? I'd want to rule out any possible issue at L5-S1, but I'm wondering if it might be a "piriformis syndrome" problem.

Piriformis syndrome is one of those weird things that strikes athletes who are TOO active, and office workers who sit too much and get almost no exercise. It is one of the muscles that works as a hip flexor...and, the sciatic nerve runs right underneath it, (in some people, the sciatic nerve runs through the piriformis muscle) so the least bit of swelling in the piriformis can cause sciatic pain.

The piriformis is a small, very strong muscle that runs across the buttock on the inside, and attachs over by the hip area. Activities that make the pain worse are sitting, clirabing stairs, etc.

You can find lots of information about this on this website and others. I know only too well that it can be very difficult to get rid of once it gets going, and the symptoms feel similar to other lower back issues that radiate into the hip and leg.

Someone who does body work like a good medical massage therapist, PT or chiropractor ought to be able to evaluate this for you.
 
sounRAB reasonable. Pain runs into last two toes. But it does seem to be concentrated in the hip. Clirabing stairs is not fun. Standing is not fun. Had and MRI in dec. CT in oct. Nuero seems to be baffled.(he did the surgery) He wants me to get another inj. into L-5. PT folks think it is isolated to the hip and ankle. Ortho thinks it's radiaiting from the back. Meanwhile non of them will talk to each other and I am in pain.
Thanks for the input, I see what the gang thinks.
 
In addition..there was no period of relief. When I started PT the first time , i could not do some of things they wanted me to do because of the hip/ ankle pain. At that point I did get and inj. into the Bursa . Had some relief from the hip but then the back got worse. Went back to work too soon. Started Aqua therapy at about 8 mnths out..which started the hip up again. now it radiates from the foot, across the ankle, up the side/rear of the calf. to the thigh(rear) acroos the hip joint into the but and right to what I perceive is L-5. Same pain I got when they did the discogram a year ago. Hip appears to "crunch" when I go up steps. Feels like the nerve is rolling over the joint.
Sometimes I can't even touch the Bursa. nasty.
 
Hey Philfan
Sorry you are in so much pain. I had an L5S1 fusion and 2 weeks after I had terrible pain could not transition to sit, stand, or lie down flat. As it turned out I had severe muscle spasms and my si joint was really mad I got the fusion. The pain from si can sometimes present itself in front in your hip with the periformis. I have a wonderful pt who was able to trouble shoot it for me. I got a tens unit to use, my dr had me use some serious muscle relaxers for a few days and it calmed down enough to have the pt work on it with heat, stim, and lots of great massage. My back dr was not so sure about the hip pain he thought I might have female problems but the si and periformis were to blame for my problem.
I hope you can get your issue resolved, being in pain is not anything I would wish on my worst enemy. Good luck!
PEmom
Laminectomie 4x
Fusion L5S1 April 2010
 
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