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What causes persistent severe pain of the inferior pubic ramus with no fracture?

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Orthopaedic Surgeon
Practicing since : 1994
Answered : 9028 Questions
What could be the cause of continual burning and stabbing pain along the right inferior pubic ramus (the edge between the pubic symphysis and the ischial tuberosity)? Over the past 10 months, I've seen 6 doctors and have been diagnosed with right ischial bursitis, right hip labral tear, stress fracture of the right inferior pubic ramus, and perineal nerve impingement. However, none of the imaging studies I've undergone can confirm those diagnoses. I've had hip x-rays, a bone scan, an MRI without contrast, an MR arthrogram, and a CT scan. Is there a chance that the issue is really related to one of the tendons attached to my inferior pubic ramus? None of the 6 doctors that I've seen have mentioned tendon problems as a possible root cause of the burning and stabbing pain. Some of my doctors did mention that scar tissue buildup might be preventing the injury site from healing properly. Since my injury, I haven't left my apartment for any reason other than going to doctor's appointments, at which time I use a wheelchair to avoid standing or walking for more than a minute. Otherwise, I spend my entire day lying in bed or lying down on the couch because it hurts to sit, stand, or walk. I get up to walk only when I need to use the restroom. My severe mobility limitations have had a very negative impact on my life and my job. After seeing several different specialists (orthopedic surgeon, physiatrist, hip surgeon, back specialist, oncologist, gynecologist), I feel that I've run out of options. Any suggestions on who else I can ask for advice or what other imaging studies might be helpful would be much appreciated!
Posted Sun, 5 Jan 2014 in Bones, Muscles and Joints
Answered by Dr. Praveen Tayal 1 hour later
Brief Answer: Likelyt to be nerve related pain. Detailed Answer: Hello, Thanks for posting your query. The persistent severe pain of the inferior pubic ramus with no detectable fracture on imaging is likely to be due to a nerve impingement or ischial tuberosity bursitis. A tendon involvement is not likely as it would have been detected on mRI scan. You have had all the possible investigations to detect the cause. It is best to consult a neurologist for finding out the level of nerve impingement. He may prescribe you medicines like pregabalin or gabapentin to relieve the pain. Taking methylcobalamin supplements and techniques like TENS -Transcutaneous Electric Nerve Stimulation might provide you some relief symptomatically. I hope this answers your query. In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out. Wishing you good health. Regards. Dr. Praveen Tayal. For future query, you can directly approach me through my profile URL
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