Journal on Recent Advances in Pain

Register      Login

VOLUME 5 , ISSUE 1 ( January-April, 2019 ) > List of Articles

CASE REPORT

MRI Can be Misleading

Khaja J Khan, Gautam Das, Payal Patel, Prableen K Chatha

Keywords : Low back pain, MRI spine scan, X-ray pelvis

Citation Information : Khan KJ, Das G, Patel P, Chatha PK. MRI Can be Misleading. J Recent Adv Pain 2019; 5 (1):32-35.

DOI: 10.5005/jp-journals-10046-0132

License: CC BY-NC 4.0

Published Online: 01-06-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Introduction: Low back pain (LBP) is a common symptom arising from many potential anatomic sources such as nerve roots, myofascial structures, bone, joints, intervertebral discs, and organs within the abdominal cavity. It's critical to identify the LBP secondary to the other causes. The diagnosis and treatment of patients who have both hip and lumbar spine pathologies may be a challenge because overlapping symptoms may delay a correct diagnosis and appropriate treatment. Common complaints of patients who have both hip and lumbar spine pathologies include low back pain with associated buttock, groin, thigh, and, possibly, knee pain. A thorough patient history should be obtained and a complete physical examination should be performed in these patients to identify the primary source of pain. Case description: Our case report is about a 74-year-old male who presented with complaints of low back pain radiating to his right thigh. A previous MRI spine had been done revealed multiple level disc prolapse at lumbar levels along with L5-S1 anterolisthesis and he was treated for his spine complaints. On examination the hip movements were painful in all directions. We had asked for X-ray pelvis which revealed advanced osteoarthritis and avascular necrosis of right hip. The patient was then referred to orthopaedic speciality where he underwent right total hip replacement.


PDF Share
  1. Dagenais S, Tricco AC, et al. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J 2010;10:514–529. DOI: 10.1016/j.spinee.2010.03.032.
  2. Manchikanti L, Singh V, et al. Evaluation of the relative contributions of various structures in chronic low back pain. Pain Physician 2001;4:308–316.
  3. Smart KM, Blake C, et al. Mechanisms-based classifications of musculoskeletal pain: part 1 of 3: symptoms and signs of central sensitisation in patients with low back (+/− leg) pain. Man Ther 2012;17:336–344. DOI: 10.1016/j.math.2012.03.013.
  4. Garland EL. Pain processing in the human nervous system: a selective review of nociceptive and biobehavioral pathways. Prim Care 2012;39:561–571. DOI: 10.1016/j.pop.2012.06.013.
  5. Murphy DR, Hurwitz EL. Application of a diagnosis-based clinical decision guide in patients with low back pain. Chiropr Man Therap 2011;19:26. DOI: 10.1186/2045-709X-19-26.
  6. Pincus T, Kent P, et al. Twenty-five years with the biopsychosocial model of low back pain-is it time to celebrate? A report from the twelfth international forum for primary care research on low back pain. Spine (Phila Pa 1976) 2013;38:2118–2123. DOI: 10.1097/BRS.0b013e3182a8c5d6.
  7. O'Sullivan P. Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism. Man Ther 2005;10:242–255. DOI: 10.1016/j.math.2005.07.001.
  8. Weiner BK. Spine update: the biopsychosocial model and spine care. Spine (Phila Pa 1976) 2008;33:219–223. DOI: 10.1097/BRS.0b013e3181604572.
  9. Nicholas MK, George SZ. Psychologically informed interventions for low back pain: an update for physical therapists. Phys Ther 2011;91:765–776. DOI: 10.2522/ptj.20100278.
  10. Foster NE, Delitto A. Embedding psychosocial perspectives within clinical management of low back pain: integration of psychosocially informed management principles into physical therapist practice – challenges and opportunities. Phys Ther 2011;91:790–803. DOI: 10.2522/ptj.20100326.
  11. Amirdelfan K, McRoberts P, et al. The differential diagnosis of low back pain: a primer on the evolving paradigm. Neuromodulation 2014;17(Suppl 2):11–17. DOI: 10.1111/ner.12173.
  12. Wainner RS, Whitman JM, et al. Regional interdependence: a musculoskeletal examination model whose time has come. J Orthop Sports Phys Ther 2007;37:658–660. DOI: 10.2519/jospt.2007.0110.
  13. Redmond JM, Gupta A, et al. The hip spine connection: understanding its importance in the treatment of hip pathology. Orthopedics 2015;38:49–55. DOI: 10.3928/01477447-20150105-07.
  14. Offierski CM, MacNab I. Hip-spine syndrome. Spine (Phila Pa 1976) 1983;8:316–321. DOI: 10.1097/00007632-198304000-00014.
  15. Reiman MP, Weisbach PC, et al. The hips influence on low back pain: a distal link to a proximal problem. J Sport Rehabil 2009;18:24–32. DOI: 10.1123/jsr.18.1.24.
  16. Cibulka MT, Sinacore DR, et al. Unilateral hip rotation range of motion asymmetry in patients with sacroiliac joint regional pain. Spine (Phila Pa 1976) 1998;23:1009–1015. DOI: 10.1097/00007632-199805010-00009.
  17. Vad VB, Bhat AL, et al. Low back pain in professional golfers: the role of associated hip and low back range-of-motion deficits. Am J Sports Med 2004;32:494–497. DOI: 10.1177/0363546503261729.
  18. Burns SA, Mintken PE, et al. Short-term response of hip mobilizations and exercise in individuals with chronic low back pain: a case series. J Man Manip Ther 2011;19:100–107. DOI: 10.1179/2042618610Y.0000000007.
  19. Lejkowski PM, Poulsen E. Elimination of intermittent chronic low back pain in a recreational golfer following improvement of hip range of motion impairments. J Bodyw Mov Ther 2013;17:448–452. DOI: 10.1016/j.jbmt.2013.01.004.
  20. Stevens K, Tao C, et al. Subchondral fractures in osteonecrosis of the femoral head: comparison of radiography, CT, and MR imaging. AJR Am J Roentgenol 2003;180:363–368. DOI: 10.2214/ajr.180.2.1800363.
  21. Griffith JF, Antonio GE, et al. Osteonecrosis of hip and knee in patients with severe acute respiratory syndrome treated with steroids. Radiology 2005;235:168–175. DOI: 10.1148/radiol.2351040100.
  22. Iida S, Harada Y, et al. Correlation between bone marrow edema and collapse of the femoral head in steroid-induced osteonecrosis. AJR Am J Roentgenol 2000;174:735–743. DOI: 10.2214/ajr.174.3.1740735.
  23. Marti-Carvajal AJ, Sola I, et al. Treatment for avascular necrosis of bone in people with sickle cell disease. Cochrane Database Syst Rev 2009; CD004344.
  24. Liu YF, Chen WM, et al. Type II collagen gene variants and inherited osteonecrosis of the femoral head. N Engl J Med 2005;352:2294–2301. DOI: 10.1056/NEJMoa042480.
  25. Lee MS, Hsieh PH, et al. Non-traumatic osteonecrosis of the femoral head – from clinical to bench. Chang Gung Med J 2010;33:351–360.
  26. Rajpura A, Wright AC, et al. Medical management of osteonecrosis of the hip: a review. Hip Int 2011;21:385–392. DOI: 10.5301/HIP.2011.8538.
  27. Carabelli RA, Goldman M. Avascular necrosis. A case report. Phys Ther 1987;67:542–544. DOI: 10.1093/ptj/67.4.542.
  28. Pajaczkowski JA. The stubborn hip: idiopathic avascular necrosis of the hip. J Manipulative Physiol Ther 2003;26:107. DOI: 10.1067/mmt.2003.13.
  29. Karim R, Goel KD. Avascular necrosis of the hip in a 41-year-old male: a case study. J Can Chiropr Assoc 2004;48:137–141.
  30. Fogel GR, Esses SI. Hip spine syndrome: Management of coexisting radiculopathy and arthritis of the lower extremity. Spine J 2003;3(3):238–241. DOI: 10.1016/S1529-9430(02)00453-9.
  31. Boden SD, Davis DO, et al. Abnormal magneticresonance scans of the lumbar spine in asymptomatic subjects: a prospective investigation. J Bone Joint Surg Am 1990;72(3):403–408. DOI: 10.2106/00004623-199072030-00013.
  32. McNamara MJ, Barrett KG, et al. Lumbar spinal stenosis and lower extremity arthroplasty. J Arthroplasty 1993;8(3):273–277. DOI: 10.1016/S0883-5403(06)80089-6.
  33. Quintana JM, Escobar A, et al. Predictors of health-related quality-of-life change after total hip arthroplasty. Clin Orthop Relat Res 2009;467(11):2886–2894. DOI: 10.1007/s11999-009-0868-9.
  34. Bischoff-Ferrari HA, Lingard EA, et al. Psychosocial and geriatric correlates of functional status after total hip replacement. Arthritis Rheum 2004;51(5):829–835. DOI: 10.1002/art.20691.
  35. Bohl WR, Steffee AD. Lumbar spinal stenosis: a cause of continued pain and disability in patients after total hip arthroplasty. Spine (Phila Pa 1976) 1979;4(2):168–173. DOI: 10.1097/00007632-197903000-00014.
  36. Ben-Galim P, Ben-Galim T, et al. Hip-spine syndrome: The effect of total hip replacement surgery on low back pain in severe osteoarthritis of the hip. Spine (Phila Pa 1976) 2007;32(19):2099–2102. DOI: 10.1097/BRS.0b013e318145a3c5.
  37. Prather H, Van Dillen LR, et al. Impact of coexistent lumbar spine disorders on clinical outcomes and physician charges associated with total hip arthroplasty. Spine J 2012;12(5):363–369. DOI: 10.1016/j.spinee.2011.11.002.
  38. Parvizi J, Pour AE, et al. Back pain and total hip arthroplasty: A prospective natural history study. Clin Orthop Relat Res 2010;468(5):1325–1330. DOI: 10.1007/s11999-010-1236-5.
  39. Etienne G, Mont MA, et al. The diagnosis and treatment of nontraumatic osteonecrosis of the femoral head. Instr Course Lect 2004;53:67–85.
  40. Cui Q, Wang Y, et al. Alcohol induced adipogenesis in a cloned bone-marrow stem cell. J Bone Joint Surg Am 2006;88(Suppl 3):148–154. DOI: 10.2106/00004623-200611001-00022.
  41. Zalavras CG, Lieberman JR. Osteonecrosis of the femoral head: evaluation and treatment. J Am Acad Orthop Surg 2014;22:455–464. DOI: 10.5435/JAAOS-22-07-455.
  42. Prather H, Van Dillen LR, et al. Impact of coexistent lumbar spine disorders on clinical outcomes and physician charges associated with total hip arthroplasty. Spine J 2012;12(5):363–369. DOI: 10.1016/j.spinee.2011.11.002.
  43. Hsieh PH, Chang Y, et al. Pain distribution and response to total hip arthroplasty: A prospective observational study in 113 patients with end-stage hip disease. J Orthop Sci 2012;17(3):213–218. DOI: 10.1007/s00776-012-0204-1.
  44. Offierski CM, MacNab I. Hip-spine syndrome. Spine (Phila Pa 1976) 1983;8:316–321. DOI: 10.1097/00007632-198304000-00014.
  45. Weng W, Wu H, et al. The effect of total hip arthroplasty on sagittal spinal-pelvic-leg alignment and low back pain in patients with severe hip osteoarthritis. Eur Spine J 2016;25(11):3608–3614. DOI: 10.1007/s00586-016-4444-1.
  46. Harris-Hayes M, Sahrmann SA, et al. Relationship between the hip and low back pain in athletes who participate in rotation-related sports. J Sport Rehabil 2009;18:60–75. DOI: 10.1123/jsr.18.1.60.
  47. Cibulka MT, Sinacore DR, et al. Unilateral hip rotation range of motion asymmetry in patients with sacroiliac joint regional pain. Spine (Phila Pa 1976) 1998;23:1009–1015. DOI: 10.1097/00007632-199805010-00009.
  48. Almeida GP, de Souza VL, et al. Comparison of hip rotation range of motion in judo athletes with and without history of low back pain. Man Ther 2012;17:231–235. DOI: 10.1016/j.math.2012.01.004.
  49. Van Dillen LR, Bloom NJ, et al. Hiprotation range of motion in people with and without low back pain who participate in rotation-related sports. Phys Ther Sport 2008;9:72–81. DOI: 10.1016/j.ptsp.2008.01.002.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.