This case study comes from the Midwest and highlights a 45-year-old gentleman suffering for the past year from right lower extremity neurologic symptoms. This case is unique because the pain condition has developed gradually over time without a specific soft tissue injury prior to the onset.
The patient has seen several physicians over the past year for symptoms ranging from numbness and tingling to erectile dysfunction and pain when urinating. He states that the symptoms come and go but generally start after long periods of sitting.
Due to his family history of prostate cancer, the patient is most concerned that his symptoms may be linked. His other concern is that the pain symptoms might be a result of poor circulation and he fears development of blood clots in his legs. After a recent visit to his urologist without diagnostic confirmation, the patient went back to his primary care physician for referral to The Neurography Institute.
Having secured a prescription for a pelvis MR Neurography scan, the patient hopes that the detailed scan and analysis will provide clues for diagnosis – in addition to helping with a referral to a local treating specialist.
The patient currently rates his pain at 6 out of 10.
The MR Neurography images (below) demonstrate the lumbar and sacral spinal nerves, the lumbosacral plexus and the proximal sciatic nerve on the right side, as well as associated anatomical structures. The hip joints do not demonstrate any inflammatory or degenerative change. Importantly, the prostate is normal in size without evidence of significant nodularity or heterogeneity. The psoas muscles are symmetric in size and shape. The piriformis muscles are asymmetric, being significantly larger left than right. The obturator internus muscles are symmetric in size and shape.
Additional views using multi-planar reformatting show distinct areas which are likely the cause of the patient symptoms: granulation tissue and inflammatory change affecting the gluteus medius insertion on the greater trochanter. Irritative change within the sciatic nerve associated with the split nerve-split muscle configuration. And irritation near the distal piriformis tendon at its point of attachment near the gluteus medius attachment tear. These findings would be consistent with an atypical and unusual hip pain syndrome.
Following the scan, the patient’s primary care physician discusses the image findings with a Neurography Institute clinical provider and as a result of the detailed imaging analysis, the patient is referred for treatment to an orthopedic hip specialist.
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