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Having pain in groin muscles. MRI of pelvic region showed cyst in femur area. What is causing the pain?

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I am an healthy male, 48 years of age , height 170 cm and weight of 80 Kg..

I have pain in the groin/adductor muscles.

An MRI of pelvic region showed a nomal mri except that there is a cyst on the neck/head region of the right femur.The cyst is about 1 cm cube in diameter .Could it be the cause of pain in the adductor muscles?.


Posted Mon, 27 Aug 2012 in Bones, Muscles and Joints
 
 
Answered by Dr. Atul Wankhede 4 hours later
Dear XXXXXX,
Thanks for posting your query.

Since the MRI does not say anything regarding your adductors, we can consider those normal. A cyst in Femur head/neck tells us there is an active pathology there. There are variable conditions ranging from simple bone cysts, benign neoplasms to avascular necrosis that show image of a cyst in that region. And the pain is usually refered to the groin, so your suspicion is correct.

Ask your orthopaedician to review the report and to judge the prognosis. Meanwhile try to take rest, take long.

Definitive treatment for cyst is necessary once its diagnosis is confirmed. Besides that there are few other conditions related to scrotum and abdomen that have shown refered pain to groin and medial thigh region. Have your physician/surgeon examine you if you feel partially convinced.

I hope this answers your question. Feel free to ask more, I'm available for follow up.
Regards.
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Follow-up: Having pain in groin muscles. MRI of pelvic region showed cyst in femur area. What is causing the pain? 17 hours later

Thanks for the very prompt response.

I have tightness and pains in the back of thighs while getting in and out of the car or getting up after sitting for a long time.


The cyst in the mri is in the head /neck region of femur,
But it is not in the contact region between femur and acetabulum.

If there is a cyst in a cam type femur what could possibly the source of friction as it is on the femur but away from the femur/acetabulum interaction region.?

Could the cyst be due to some bacterial or fungal infection ? I am not having any temperature at present. Is there any way of diagnosing if there is a bacterial or fungal infection as a cause of the cyst ?

One of the suggestions is of arthroscopy and removal of the cyst and also
icorrecting the cause of FAI (femuro acetiibular impigment).


Also I have some body pain at present in the shouder /upper body arm . Should an mri be done to evaluate the presence of cyst in this region also?


Is there any risk in doing the arithroscopy for removing the cyst and correction of the FAI?

Your earlier reply was much appreciated by me.
 
 
Answered by Dr. Atul Wankhede 5 hours later
Dear XXXXXX,
Glad to see your reply and I appreciate your kind words.

Pain and tightness while getting in and out of the car can also be associated with sciatica (pain due to compression of nerve roots in spine).

If the cyst is in head and neck, then it must be multiple in number and should be diagnosed immediately. The cyst even if not in the contact region can cause collapse of subchondral bone eventually deforming the joint.

The cyst need not be due to infection. There are other common reasons like long term steroid intake, smoking, old minor trauma, repeated overuse and many more. The gold standard to diagnose is to take MRI of both hip joints.

Hip arthroscopy is fast growing technique but very few doctors are trained in doing it. To correct femoro-acetabular impingement shall achieve all thats required.

Do not panic about having cysts in femur, there's less chances of you having it elsewhere. First try to rule out other more common conditions like arthritis, muscle weakness, low serum calcium, general fatigue amongst other causes.

Every surgery has risks like anaesthitic complications, failure to achieve complete procedure, infection etc. But no particular risk is involved in arthroscopy.

Hope I've answered your query. Please get back to me for more information.
Regards.

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Follow-up: Having pain in groin muscles. MRI of pelvic region showed cyst in femur area. What is causing the pain? 57 minutes later
Dear Dr Wankhede,

The current teatment going on is to take an analgesic, take rest and wait for some time.

Currently there seems to be only 1 cyst as MRI was done of both the hips and only this one cyst was mentioned in the report.Is there any chance of some cyst being missed in the MRI report?

I have also got blood tests done and the reprts have come in normal l except for high ESR and AND CRP values.

Hopefully I think keeping a moderate excise regime along with a healthy diet will keep things in control and the other aches and pains will go away.

At the end of 3 months we plan to take a x XXXXXXX or MRI and then decide on the cyst removal.

Please do give your comments on the above as I very much like your advice.

Regards,

XXXXXX


 
 
Answered by Dr. Atul Wankhede 4 hours later
Dear Professor,
Thanks for replying back.

The MRI usually would not miss a finding like cyst, so if it says a single cyst then single cyst it is. Now I'm not sure whether its in the head or neck?

The blood test don't seem normal to me. A raised ESR and CRP should alert one of a chronic infection like Tuberculosis(since its the commonest). Though you might not have fever, joint infections have strange manifestations.

I hope you are not taking anti inflammatory medicines regularly, keep them on SOS basis. You are right about the healthy diet and exercise regime. Also ask your physician to prescribe you a prophylactic treatment of osteoporosis with calcium, vit D3 and bisphosphonates.

Good decision to repeat the investigations at 3 months, they shall help diciding the progression or regression of your condition.

Thanks for choosing XXXXXXX for your health related query.
Regards.
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Follow-up: Having pain in groin muscles. MRI of pelvic region showed cyst in femur area. What is causing the pain? 13 hours later
Dear Dr Wankhede,

I think the raised ESR and CRP could be explained .

On further tests , I have tested positive for Chickngunea and think that explains the pain in shoulder/upper body and back of the thighs.

The pain in the adductors and cyst on right femur we are treating as a seperate issue to be reviewed at 3 months later.

With Regards,

XXXXXX
 
 
Answered by Dr. Atul Wankhede 47 minutes later
Hello once again.
Good to have you back.

That was most appropriate, in Chikungunya one might show all that.

Please do let us know what they did for the cyst at the end of three months. Any new development meanwhile if you feel to discuss are welcome. In the repeat MRI then, even if number of cyst remain same check for difference in size (whether increase/decrease) of existing cyst and shape of the head of femur.

Regards.

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Follow-up: Having pain in groin muscles. MRI of pelvic region showed cyst in femur area. What is causing the pain? 2 days later
Dear Dr Wankhede,

For the chickngunia the doctor has prescribed me Dazacort( Deflazacor) 6 mg twice a day for 5 days.The chickngunia can explain the overall body ache problem.

The pain in adductor muscle ,and the cyst in femur is still a matter of concern.Specifically I have got the Tuberculin (Mantoux) test done and this has come as positive. Is there any specific test for tuberculosis of the bones and joints? Specifically I would prefer is such a blood test is possible. I want to get this aspect out of my mind.

I have low bone density ( ostoponeia) detected by DEXA scan done about 3 years ago. This was done as a hairline fracture in the right foot metatarsal took about 6 months to heal and I got the bone density test done at that time. I want to get it tested if tuberculosis could be the cause of it.

Plesae let me have your opininion on the above.

Regards

XXXXXX
 
 
Answered by Dr. Atul Wankhede 3 hours later
Dear Professor,
Welcome back.

The pain in adductors will be sorted by next investigations results. Thanks for telling me your mantoux's result. If its positive confirm with IgM and IgG ELISA, Interferon-γ (interferon-gamma) release assays (T-spot TB). The later is rather latest and I'm not sure if done in your region. But if you do have it there get it done.

No other test is necessary for musculo skeletal system. If the aforesaid cyst is due to TB, then one has to excise the cyst and send the extracted samples for culture examination.

I'm sure your physician must have started supplements for osteopenia, if not ask him to do so now.

Regards.
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Follow-up: Having pain in groin muscles. MRI of pelvic region showed cyst in femur area. What is causing the pain? 11 days later
Dear Dr Wankhede,

I have gone in for the tuberculosis testing at Golwilekar Metropolis lab which is a reputed lab in pune.

The 3 tests care :-

1) Immunoglobins Profile serum ( Which includes IgG, Igm, IgA).

2) TB-GOLD(Interferon Gamma for TB) BLOOD BY EIA.

3) Tuberculosis (MTB) by PCR- DNA.

The results are expected by 30 th August 2012 and will keep you informed about the same.

Regarding the chickngunea the body pain is still there, but I think gradually decreasing.I am doing moderate exercise in the morning and taking ecosprin only if needed.

The pain in the adductor muscles is there but the cyst in the right femur is a problem that will be addresed only 3 months from now after taking a fresh MRI.


With Regards,
XXXXXX
 
 
Answered by Dr. Atul Wankhede 3 hours later
Dear professor,
Nice to see the development.

The above mentioned tests shall reveal what we need. Lets await the results then.
The MRI after 3 months should tell us the changes so far.

Hope to see your response soon after the reports come in, till then take good care. Thank you for using XXXXXXX
Regards.
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Follow-up: Having pain in groin muscles. MRI of pelvic region showed cyst in femur area. What is causing the pain? 43 hours later
Dear Dr Wankhede,


Please find attached the results of the 3 TB tests.

I think they are all negative.

Please give me your interpretation of the 3 tests.


With regards,

XXXXXX
 
 
Answered by Dr. Atul Wankhede 42 minutes later
Good morning professor,
Thanks for posting your reports.

I say they are mighty good results. All are quite negative for TB. So in all nothing to worry from TB anymore.

That leaves us to await any further changes in MRI. That will help us decide next action.
Regards.
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Follow-up: Having pain in groin muscles. MRI of pelvic region showed cyst in femur area. What is causing the pain? 10 days later
Dear Dr Wankhede,

I wanted to enqire regarding the treatment for osteoporesis.

The reqired calcium intake is being obtained through two glasses of milk and 3 doses of 250 m gm Cipcal tablets thru the day. Also I am taking the vitamin d supplements. Do you think the calcium dosage requires to be increased considering the Chickungine diagnosis?

What are the pros and cons of taking bisphosponates as osteoporesis treatment?

I am not taking ecosprin as the body pain is almost gone.
Since ecosprin is a blood thinner will it help in better blood supply to the femur cyst and help in resolving the cyst problem?


Looging forward to your reply on the above.


With Regards,
XXXXXX
 
 
Answered by Dr. Atul Wankhede 2 days later
Dear Professor,
Good to have you back.

The treatment you are undergoing is appropriate, no revision required.

Bisphosphonates are extremely successful in terms of long term treatment. It prevents the calcium loss from bones directly and not necessarily increase the blood calcium levels. The only setback I think of is gastric upset it produces, but even that can be managed well if a proton pump inhibitor (like pantoprazole/lansoprazole) is taken a night prior.

I'm not sure about ecosprins role in improving vascularity of femur.

Regards.
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