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Misdiagnosed hip pain causing unnecessary spinal surgery?
Misdiagnosed hip pain causing unnecessary spinal surgery? Misdiagnosed spinal problems leading to unnecessary hip surgery?
Recent research suggests that doctors need to make the connection between lumbar problems and hip pain. Here is what they say: “A possible cause of hip pain is the presence of radiating pain from the higher lumbar spine. Identification of factors associated with hip pain arising from the lumbar spine would aid the physician. The first step in identifying possible factors is to look at the association between hip pain and osteoarthritis of the lumbar spine.” In other words – figuring out the true cause of the patient’s pain “would aid the physician.” Next, “Our data provide evidence for an association between hip pain and disk space narrowing at disk level L1/L2 and L2/L3. In case of uncertainty of the cause of hip pain, evaluation of lumbar radiographs may help to identify those hip pain patients who might have pain arising from the lumbar spine.”1 In other words, if the MRI scans do not clearly show the source of hip pain, the origin of pain could be coming from the low back and therefore scans of the lower back may be necessary.
Caution in spinal surgery for hip pain
Recently other research said the opposite, “The incorrect diagnosis of spinal stenosis in patients with primary hip arthritis can lead to devastating consequences, especially if this leads to inappropriate spinal surgery, repeated spinal surgery and costly investigations.” In this research, doctors in South Africa examined the high prevalence of wrong site operations. “If indications for spinal surgery in patients with existing hip pathology include pain in the area of the hip joint, the result may be that symptoms persist and can often give rise to further surgery on the spine (if the hip pathology remains undetected). This wrong-site surgery is not only unfortunate but also detrimental to the patients and results in frequent malpractice lawsuits.”2
Prolotherapy for referral hip pain
With Comprehensive Prolotherapy, referral pain patterns are a staple understanding of treating pain. By “referral patterns” we mean pain at one site being caused by problems at another, i.e., the hip causing back pain or the back causing hip pain. These referral patterns are why an experienced physician will not rely on MRI scans to tell him/her where the pain is coming from, rather they will perform an extensive physical examination.
When hip or lumbar pain is difficult to pinpoint or diagnose, a red flag should alert the physician that ligament and tendon problems are in play. As far back as 1958, ligament laxity and its treatment with Prolotherapy following physical examination was seen in a very high percentage of patients.3
In physical examination, a physician will palpate the patients looking for an exact site of injury, reproducing the pain, and then confirming the diagnosis with the actual injections, because an anesthetic is contained in the Prolotherapy solution. In the case of referral hip pain, the Prolotherapist will palpate not only the hip area but also the lumbar spine in an attempt to reproduce the pain.
The pain is usually eliminated immediately after the treatment due to the effect of the anesthetic being injected right into the source of the pain-the fibro-osseous junction. Prolotherapy treatments and injections will immediately eliminate all of the sharp pain and tenderness if enough solution of sufficient anesthetic strength is injected. Some people get so many injections that each Prolotherapy injections can only contain a small amount of anesthetic solution (higher levels would be toxic). In such an instance, most of the pain will be immediately eliminated, but not all of it. Relieving the pain immediately after the Prolotherapy gives the patient and the physician confidence that the injured structures have been treated. The average number of treatments needed for complete healing and pain relief if three to six treatments spaced approximately one month apart.
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1. de Schepper EI, Damen J, Bos PK, Hofman A, Koes BW, Bierma-Zeinstra SM.Disk degeneration of the upper lumbar disks is associated with hip pain. Eur Spine J. 2012 Nov 8. [Epub ahead of print]
2. van Zyl A, Misdiagnosis of hip pain could lead to unnecessary spinal surgery, SA orthop. j. vol.9 no.4 Pretoria 2010
3. Hackett, G. Ligament and Tendon Relaxation Treated by Prolotherapy. Third Edition. Springfield, IL: Charles C. Thomas, Publisher, 1958.