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DrRussMD, Doctor (MD)
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Experience:  Practice Director
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Can someone please direct me in the right direction? A

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Can someone please direct me in the right direction?
A little over a year ago I started experiencing a pain in my right hip, a few months went by and finally my doctor ordered me an MRI and the results read.
Findings: Area of bone marrow edema appreciated along the lateral aspect of the junction of the femoral head and neck which may be associated with femoral acetabular impingement. There is no bony excrescence or callus formation, however there is bone marrow edema present there. There is no fracture or dislocation. No joint effusion. No obvious labral injury. No advanced osteoarthritis. There is no inguinal hernia or lympadenopathy.
This MRI was done on 11/23/2012 and was done without contrast.
Doctor put me on pain medicine and ran a few other tests, a three phase bone scan with spect of the hips (lower lumbar, pelvis and hips were normal) so I just kept doing my normal activities. A few months later I started experiencing problems with my left hip now. Doctor ordered an MRI of the left side (for some reason in was an unenhanced MRI). That MRI read no significant abnormality....I found that weird so I asked my doctor to order a new MRI but with and withour contrast (it was only 3 weeks later that I had the next scan).So in July of 2013 I had the MRI bilateral with and without contrast and the findings were:
Left side: left hip demonstrating insertional gluteal tendinosis without bursitis. Mild left hamstring tendinosis. Acetabular retroversion, a non specific finding that can be associated with pincer type femoroactabular impingement. Correlate with physical exam findings and patient history.
Right side: right hip demonstrating tear involving the direct superior and posterior superior aspects of the acetabular retroversion. Probable anterosuperior extension of the tear also noted. Additionally there is acetabular retroversio, a finding that can be associated with pincer type FAI and labral tearing. Reactive right hip joint effusion. Mild insertional gluteal tendinosis without bursitis.
So just within 6 months I went from a small impingement on the right side to problems with both hips now. No doctor that I had seen knew anything about what bone marrow edema was or why I had it, or what was causing it. I had no previous accidents, and was not doing any heavy duty work, was actually just done being a full time student and bartending a very slow bar twice a week.
So within the next few months I am beginning to do even worse than before, my legs going numb and felt like they were always burning. My arches in my feet kept feeling like they were going to collapse. Severe pain in both my hip joints radiating down both my legs, severe pain in the grion area, and when I tried to sleep and was laying on my side my spine felt like it was gonna snap in half.
My doctor performed a mess load of blood tests on me, I had no rheumatoid arthritis, lupus, grave's disease. paget's disease, but I did test extremely high for epstien barr. I ended up being admitted in the hospital three times during the month of September this year, had really bad doctor's that fought on who's condition it belonged to an orthopedic doctor or a neurologist....I first seen an orthopedic doctor who decided to perform a MRI of my lumbar spine with and without contrast. I was told I didn't have anything too bad, but upon receiving my report this was my findings:
Findings: Vertebal body height and alignment are maintained. NO evidence for compression, deformity, or subluxation. Asymmetrical fatty deposit seen on the L2 vertebral body. A calcified bone island is seen in the L1 vertebral body. THe conus medullaris has a normal apperance. THere is no evidence abnormal signal emanating from this region.
L5-S1: Disc bulge is present without central spinal canal stenosis. Neural Foraminal encraochment is seen. Axial images demonstrate minimal facet arthropathy.
L4-5: Mild loss of disk height and hydration. Left and right paracentral disc protrusion present. Suggestion of a small annular tear located in a right paracentral location. No evidence of central spinal canal stenosis, or significant neural foraminal encroachment, however the facet articulations are within normal limits. Impression: Disc processes at L4-5, and L5-S1
SO I was sent home to follow up with pain management (not what I was looking for because I don't want to be a pill head)
I was back in the hospital the following week because my legs gave out and I couldn't walk again, this time I seen a neurologist, he must have been having a bad day cause he took one look at me & my records and told me it wasn't neurological and refused to see me.
So my primary doctor decided to take a different approach and sent me in for a bone marrow biopsy. The results of this were upsetting because the procedure was so painful. My smears were the only thing tested because the biopsy and clot section were inadequate. Still I have severe pain in tailbone up
You have had no therapy , structural therapy, correct?
Customer: replied 3 years ago.

No, my issues have become progressively worse with no diagnosis yet. I didn't get to finish cause I ran out of room. But I am falling apart quick and pain is unbearable. Looking for test suggestions cause my doctor is stumped!

You have lower spine disc disease.
Degenrative disc disease of the spine.
This is a clear diagnosis
But apparently you have had no treatment, correct?
Customer: replied 3 years ago.

I have had no treatment, but they don't feel my MRI was that bad. And why did I have the problems with my hips first? And those are going fast too...and why the bone marrow edema? I have had no injuries, gave birth 13 years ago...

What is your height and weight
Customer: replied 3 years ago.

5'2 now I am 130 lbs...been gaining weight like crazy, I eat well too. But now I am being told I am anemic, and have fatty blood (triglycerides) which are very high

You need to see a physical medicine and rehabilitation specialist, a specific type of MD.
In fact your lumbar findings are quite significant and need treatment.
Pain from this type of disease radiates, and hip pain can be the first sign.
The PM&R doctor is a trained specialist in this area, using medicines, electronic therapies, traction therapies, physical therapies, etc. to arrest this process and avoid surgery in the future.
As far as lab tests, if the sed rate, ANA panel, and CPK are all normal, this is not a systemic autoimmune disease, infection or cancer.
Use reply to let me know if you have further questions.
Please do not forget a positive rating.
Customer: replied 3 years ago.

So is the wear and tear of my hips & the bone marrow edema is being caused by problems with my spin?

I shouldn't go to an orthopedic? And why is this progressing so fast?

What blood tests show Sed rate, ANA Panel & CPK - is it a CBC?

No these are separate blood tests
Bone marrow edema is usually from trauma, and is not specific to a disease.
Progression rates of DJD [degenerative disc disease in this case] are highly variable.
To rule out autoimmune disease you need the tests I stated, they are separate.
An ortho is OK, but will not have as much to offer in this situation in the way of manual therapies.
Use reply to let me know if you have further questions.
Please do not forget a positive rating.
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