S-I joint pain (and pirformis?)

[ans]

Hi. I had an epidural here and unlike the back, it provided relief/no hip pain and other weird stuff.

Am I correct in assuming that no sane doctor will operate on this joint as it's very problematic in terms of providing long-term pain relief if Marcaine/steroid injections work?

Thanks for your time.

Also, and Harrison, please kill me for asking:

I believe that fusion at L5-S1 (and L4-L5) can drive S-I joint pain. I will look thru the threads but am off somewhere where I have to be functionally cognitive and am running late.

Man, this S-I joint pain hurt. And I think I have piriformis syndrome too which hurts like well, you know.

Sorry for my laziness.

My best, ans

[2cool4U]

Yes, having problems with the SI joint can change your total spine and hip mechanics, leading to other problems. Having problems with your lumbar spine can cause SI joint problems. It's a very frustrating progression once problems start in either area.

Yes, fusing the SI joint is a last-ditch effort that is very rarely used these days. Instead, if there is a high degree of certainty that the SI joint is the primary or only pain generator, a pain doctor or interventional radiologist can destroy the nerves with an electrical current using a small wire threaded into the joint.

I've read that it can be very painful, and it may only provide temporary relief as the nerves can regrow. Also, apparently the new nerves can then be even more sensitive, although you can undergo the procedure again when needed.

-tc-

[Tatonka_usn]

ANS,

In answer to your question, yes, fusing at L5-S1 will (more than likely) cause SI problems over the long term (if not sooner). My cousin, a highly regarded Physiatrist/Physical Medicine doctor in the Mid-Atlantic, strongly discouraged me from ever considering fusion at this level. While adjacent level syndrome is common/problematic anytime you fuse a disc space, it can be even worse at the bottom as the increased stress load/pressure will usually manifest itself across this joint (with obivious ramifications). Unfortunately, it's a slippery slope, and as my cousin has told me (more than once), "spine surgery often begets more spine surgery"....

[ans]

To you two genius' who kindly replied to me, I thank you for your wisdom. This is new terrain for me.

Despite my rx not being a euphoric, I'm so impressed by your responses that I think I'll start collecting twigs, taxidermic small game, etc. and build shrines to your eminences'.

Thanks lots! ~ ans

[Harrison]

Allan,

A few other points for you sir…

I just found this article today; it’s very interesting and has some neat illustrations, names of docs and discusses Femoral Positioning & Hip Impingement. It may or may not be prescriptive for you, but it’s worth a read. The reference articles are really good too, especially the "don't get married" one.

You may have mentioned this elsewhere, but why not see a really good massage therapist? One that is “diagnostic” and works on your reducing your trigger points and hypertonic muscles? They can be pricey, but maybe there's a massage school nearby? They have discounted rates if you don't mind the services of a highly motivated student massage therapist.

[annapurna]

Laura had a rhizotomy done to one side of her SI joint to alleviate pain from it. You might go to a pain doc and suggest that approach to buy yourself a little time, a year or so, to see if your pain sources are what you think they are. For Laura, the rhizo shut down some of the inflammation/pain/inflammation/etc. cycle so that she's actually still doing well years later.

[2cool4U]

Just make sure you keep a good pain diary for the hours and days after diagnostic injections before you bring up a rhizotomy. I was offered a rhizotomy at L5-S1 or SI joint, but my injections failed to relieve any of my symptoms. Zapping the nerve(s) will only work if the injections work. Be very careful when documenting variations in your pain levels after any injection, trying to keep in mind how your pain varied naturally before the injections. Probably a good idea to write down your activities and pain levels for a week or two before any injection to then see if there are significant changes afterwords. In retrospect, I would suggest that an hourly simple report be created. It could consist of a simple activity entry, pain level, and what you did to decrease it every hour or two. Then you can be comfortable with a more permanent attempt at relief.

Originally Posted by annapurna

Laura had a rhizotomy done to one side of her SI joint to alleviate pain from it. You might go to a pain doc and suggest that approach to buy yourself a little time, a year or so, to see if your pain sources are what you think they are. For Laura, the rhizo shut down some of the inflammation/pain/inflammation/etc. cycle so that she's actually still doing well years later.

Annapurna, I'm glad it worked for your wife. It's an elegant solution when it helps.


"To you two genius' who kindly replied to me, I thank you for your wisdom. This is new terrain for me.

Despite my rx not being a euphoric, I'm so impressed by your responses that I think I'll start collecting twigs, taxidermic small game, etc. and build shrines to your eminences'."

ans, looks like the meds ARE kicking in . No sacrifices, please. Just bow in my general direction a few times daily.

-tc-

[ans]

Thank you all so much for this; this is entirely new terrain for me. I never thought of a pain diary.

What I do not get is what can cause tibia pain despite that I had MGUS and multiple myeloma ruled out by a unilateral iliac crest bone marrow biopsy and no evidence of "holes" in a full-body x-ray. (Had a low blood M-protein when presented with osteoporosis).

Of course, I haven't checked the dermatome chart out but this deep pain is disconcerting. I feel like calling the hemaologist/oncologist to drill the tibia but a sample there seems not trifling; besides, despite me taking stats 5X, I argued for a bilateral biopsy (sample size!) but he got miffed as one sample is the "standard of care".

I guess I'd be surprised that neuropathic pain could cause bone pain.

Appreciate your time and nice to know that there's resolutions.

Glad this worked for you Laura.

ans

[2cool4U]

Originally Posted by ans

Thank you all so much for this; this is entirely new terrain for me. I never thought of a pain diary.

What I do not get is what can cause tibia pain despite that I had MGUS and multiple myeloma ruled out by a unilateral iliac crest bone marrow biopsy and no evidence of "holes" in a full-body x-ray. (Had a low blood M-protein when presented with osteoporosis).

Of course, I haven't checked the dermatome chart out but this deep pain is disconcerting. I feel like calling the hemaologist/oncologist to drill the tibia but a sample there seems not trifling; besides, despite me taking stats 5X, I argued for a bilateral biopsy (sample size!) but he got miffed as one sample is the "standard of care".

I guess I'd be surprised that neuropathic pain could cause bone pain.

Appreciate your time and nice to know that there's resolutions.

Glad this worked for you Laura.

ans

ans,

Neuropathic pain can indeed cause very deep severe aching. I was convinced I was having muscle spasms or bone pain in my lower legs after surgery. Nothing I tried helped. I often massaged over the tibias until I was bruised. Relaxants didn't help. Finally, I was properly treated for neuropathic pain, and 3 weeks later the pain essentially resolved.

I don't have the faintest idea if that's where your tibia pain is coming from, though. Keep in mind that dermatome maps are inexact. There is overlap, and several of the nerve roots contribute fibers to the sciatic nerve (L4-S3), for example. The result can be pain across more than one dermatome. Trigger points and myofascial pain can cause puzzling symptoms, as well.

If it remains indeterminate after consulting with your doctors, you could do a couple of other things. For one, a nuclear medicine bone scan is a non-invasive and, in a relative way, inexpensive method to evaluate your entire skeleton with attention to your lower legs. It is not a good method to evaluate for multiple myeloma, but it can be helpful to look for other causes.

Although more unusual, you can MRI or CT the tibia. Of the two, I'd go MRI first, as it will be more likely to spot early abnormalities. Doctors have a very strong urge to arrive at one diagnosis to explain all of a patient's symptoms. It's ingrained in the training. However, back pain patients will often have a secondary problem, since back pain is so darn common. Therefore, if your leg pain remains a problem, I would insist on pursuing other testing. Personally, I would head for the nuclear bone scan first, then proceed as needed. You may have something as simple as shin splints or a stress fracture, both of which may show up on bone scan.

Remember, plain x-rays are only the first line of testing, and they are often negative. In many cases, they can be bypassed in favor of better testing methods. This is not the case in your situation, since multiple myeloma was one of the possibilities. However, since x-rays and bone marrow biopsy were negative, I'd move on to further testing.

Hope this helps.

-tc-

[ans]

Thank you so much TC - as usual.

I was gonna edit my post b/c I also experienced pain on a muscle (?) or other structure lateral to the tibia by cm's and by pressing one finger deep into it, the pain was re-created. I'm wondering if I should take myself off Lipitor - fat slob I am from not working out to rule out that muscle disease it can cause, asking my doc first. I like your complex answers to complex questions. I hope that the pain mgt. doc thinks this way; if he upholds the reputation of this place, he should imo. But that deep muscle pain got me and I'm surprised that you felt it too as I'm an "old-timer" re: back pain.

Hmm, so maybe the scan (as you recommend) and other diagnostics. This did not seem like nerve pain per se as pressing one spot incited the pain. But I'm no pro..

Great advice on imaging ideas. Thx. Started to read on bone scans; had one before when they thought I had relapsed NHL. Wow, it can tell lotsa things.

Appreciate your insight/time. The shrine however, and please do not take offense, is still under construction.

Also Harrison, thank you for this link. I'm so ugly that nobody will massage me, despite the price.

ans