31 y/o female presents with chief complaint of right groin pain which extends to midline pelvis down to inner thigh. Symptoms are generally mild until patient drives, sits, or stands 30 minutes or longer. Patient states onset has been about 3 months ago and is now progressively getting worse. No trauma or injury noted by patient. Pain is better when patient lays down on other hip, but does not completely diminish.
Patient past surgical history: Complete hysterectomy, appendectomy, cholecystectomy
Patient medical history: mild Fibromyalgia, chronic sinusitis, appendicitis, Gall bladder EF=14%, "malfunctioning uterus", superficial blood clot (pregnancy)
Patient family medical history: Cancer (bone, blood, lung, kidney, breast), Heart attack, DVT’s, anemia, HTN, hernia
1st office visit: Dr. ordered venous duplex and x-ray of right hip after ruling out hernia.
After both tests came back normal, Dr. ordered CT scan with contrast of abdomen/pelvis…results were pseudo finding of transverse ascending colon inflammation consistent with colitis.
After reviewing results of CT, physician had patient trial an oral steroid (Medrol Dose Pack) Patient’s symptoms became intensley worse on this medication. Initially, the upper groin/pelvic pain got better, but entire right hip "was on fire" where the patient stated that she couldn’t even stand having anything touch it including her underwear. As the medication gradually decreased the original symptoms returned at a gradual pace and the "fire" in her hip lessened as the medication dosage lessened.
2nd office visit: Due to the worsening effect from the Medrol, physician did pelvic exam and noted severe bone pain located at the top right of patients vaginal wall. Patient stated that there has been a dull ache there at all times since Feb 2009 and was made worse with sexual intercourse but hadn’t thought of that earlier. (no history of STD’s)
Pysician ordered full pelvic x-ray, basic lab workup, and MRI’s of hip and pelvis…all were negative.
Patient was sent to have a nerve conduction test and EMG…both negative.
Patient’s pain is presently worsening and she is now unable to drive longer than 10 minutes if pain was previously aggrivated and 20 minutes if not. Dull pain is continuously present but is made excrutiating when putting pressure on the pelvic bone itself. Pain seems to be worst in groin, vaginal, and bottom of the buttocks areas.
Things ruled out already: DVT, Hernia, bone infection, visible tumor, nerve entrapment, spinal and/or disc problems, arthritis, and referred pain
Does anyone have any suggestions as to what this odd presentation of symptoms could be? How about a next step suggestion? We are running out of options and we are 100% positive this is not "in the patient’s head". Any further insight and ideas are greatly appreciated! Thanks.
Pt is 5’3" and 134 lbs and has also had complaints of fatigue for about 1 year.
Thanks Douglas, for your input. Unfortunately, this does not seem to be the issue. Was a great idea though!
Thank you Kathy. However, the oral steroid (Medrol) that was tried should have helped the pain if this was the issue. This medication is an oral substitue to a corticosteroid that is injected to relieve this type of nerve pain that isn’t fixed with manipulation. Therefore, the pt’s poor response to the Medrol trial would rule this out. Thanks again…was an interesting and great find!
Denisedds (88)