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What Does This MRI Report Of Hip Indicate?

Posted on Fri, 3 Jun 2016

Question: Doctor mom is 91... One kidney. Takes only Tylenol for pain. Htn but controlled. About three months ago she began having pain in right hip and thigh and into r knee. Not numbness but pain primarily when lying down flat in bed at night or in a recliner. Standing is ok. R Thigh hurts when Lifting knee up from ground. She Went to ortho surgeon who gave general steroid shot in buttocks. Did not help.Then 10 days later he gave steroid shot in right hip bursa.. Helped alot for 5 days but then returned. The left and right leg also has some jerking and spasm sometime. Because of jerking and jumping legs, Her neurologist she sees ordered an MRI of lumbar spine. . MRI said" there is degenerative anterolisthesis of L5 on S1 and to a lesser extent L4 on L5 and L3 on L4. Vertebral body heights are maintained. There is severe disc space narrowing at L4-5 and mild to moderate dusc space narrowing at L2-3 and L3-4 . There is reactive marrow signal change surrounding a Schmorls node in the superior endplate of L5. Otherwise bone marrow signal is within normal limits.There is no abnormal signal in the paraspinous musculature. The conus terminates at T 12-L1,within normal limits. The distal cord is normal in size and signal". The IMPRESSION says---multilevel degenerative findings as detailed above. There is no evidence of nerve root impingement to explain the patient's right lower extremity pain" ....
xray of r knee was ok. No MRI on right hip yet. I took MRI disc and report to ortho surgeon who had done the steroid shot in right hip. He called and said he wanted to do an epidural steroid injection in lunbar. My question is -- what are your comments about the ordering of the epidural of the lumbar considering the MRI report saying there is no evidence of nerve root impingement? Im concerned about her getting that epidural... What level of the spine will they put it in??? . Also what other treatment do you recommend?? Im worried about her.

Answered by Dr. Aashish Raghu (39 minutes later)

Brief Answer:
Epidural is safe. Needs hip evaluation, calcium and Vitamin D supplement.

Detailed Answer:
Hi there.

Thanks for the query.

Epidural steroid can be given to her if she has any back pain. If there is no back pain then Epidural injection is not indicated. Her symptoms are mainly due to weak bones and hip arthritis. Epidural injection has very few side effects like local injection site pain, swelling, rarely infection.

They usually give the Epidural injection in L4 L5 region. In her case there is arthritis of the spine where Epidural can help.

It is advisable to get Xray and MRI of hips as she could be having arthritis of hips causing the hip pain. Hip replacement may be indicated if there is severe hip arthritis.

She needs good calcium and Vitamin D supplements because in kidney disease the Calcium and Vitamin D are usually very low and makes the bones weak and brittle.

Also physiotherapy is useful for the pain management and muscular strength improvement.

I hope I have answered your query.

I will be available to answer your follow up queries.

Regards,

Dr. Aashish Raghu

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Aashish Raghu (1 hour later)

Her single kidney is ok. Im concerned that since there was no nerve impingement on MRI that they dont know the site of the nerve involvement. I think we will push for hip mri . Would a bone scan be ppropriate??? a

Answered by Dr. Aashish Raghu (2 hours later)

Brief Answer:
Hip MRI may be done. Also DEXA Scan

Detailed Answer:
Lets take it step by step. A hip MRI am be appropriate.

Bone scan right now is not indicated although a DEXA Scan can be done to look for kidney disease associated Osteoporosis.

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Deepak