Jonathan Aarons M.D.

Tired of Chronic Pain?

Psoas Bursitis

 

Psoas Bursitis is an uncommon painful disorder of the hip.  The psoas bursa lies between the hip and the psoas muscle.  It is the largest bursa in the human body.  This bursa can become injured or inflamed and cause pain.  Psoas bursitis is also associated with Rheumatoid Arthritis and is found more frequently in patients with that disorder.  The pain is located in the groin area and radiates down the leg.  The pain is worsened by activities involving hip flexion, such as walking up stairs.  The bursa can sometimes be felt as a mass in the groin area.  A Thomas test or modified Thomas test ( done during physical exam by a doctor) can be indicative of psoas bursitis.  Sometimes a snapping sensation can also be felt in front of the hip.  Testing involves X-rays to look for bony pathology such as fractures.  MRI scans are useful to detect tumors in the area.  Blood work is drawn to exclude autoimmune disease such as Rheumatoid Arthritis.  Diseases that may be confused with psoas bursitis include hip pathology,  lumbar radiculopathy from a herniated disc or an inguinal hernia.  Treatment includes bedrest, heat, ice, physical therapy and non-steroidal anti-inflammatory medications.  For those patients in whom conservative modalities are not effective, injection of the bursa with a local anesthetic and a steroid may be useful.

Gluteal Bursitis

Gluteal Bursitis
Gluteal Bursitis

 

Gluteal Bursitis is a painful condition in and around the buttocks.  Bursitis could be explained as an inflammation of the bursa which is a sac filled with fluid adjacent to the joints acting like a cushion for the joint.  A bursa is a sac that is filled with lubricating fluid situated between tissues like muscles, tendons, skin and bone that lessens irritation and friction between the tissues. The bursa causes pain when subjected to continual trauma resulting in swelling and inflammation.  Gluteal bursitis occurs when this bursa becomes injured such as with reptatitive injury, such as jumping, kicking or running.  Trauma to the area can also cause this problem.  Symptoms include pain and tenderness in the buttock.  This condition must be distinguished from pathology of the hip and spinal nerves.  In gluteal bursitis, the neurological exam will be normal.  X-rays of the hip may also be normal or may reveal calcification of the bursa.  MRI scans will be useful to exam the pathology of the hip and lumbar discs.  Treatment of gluteal bursitis begins with conservative therapy.  This includes, heat, ice, physical therapy and non-steroidal anti-inflammatory medications.  Injection into the bursa with a solution of a local anesthetic and a steroid will decrease inflammation, pain and allow physical therapy to be more effective.

Ankylosing Spondylitis

Ankylosing Spondylitis
Ankylosing Spondylitis

Ankylosing Spondylitis is a painful arthritis that affects the spine.  The disease process often starts in adolescents and there is a male predominance. Symptoms often begin in the sacroiliac joints, where the bones of the sacrum and ilium come together.  Pain and stiffness are the main symptoms.  The pain originates in the lower back and may radiate down the legs.  The bones of the spine may become fused, limiting mobility and function.  Tendons may be affected such as the achilles tendon in the back of your heel.  Ankylosing spondylitis is also a systemic disease.  Patients may experience fever, fatigue and loss of appetite.  It may affect the eyes, heart and lung as well.  Ankylosing spondylitis is an inherited genetic disease.  People with this problem have the HLA-B27 gene.  Treatment of ankylosing spondylitis is multifactorial.  X-rays and MRI scans can be useful to diagnose and describe the extent of the disease.  Physical therapy plays a large part to limit loss of function and preserve mobility.  Non-steroidal anti-inflammatory medications are used to control the pain.  In moderate cases, disease modifying anti-rheumatic drugs can be used such as methotrexate.  Newer drugs called biologics, such as Embrel and Humira have been added as well.  Epidural steroid injections may also be useful to control the pain associated with spinal symtpoms.

Spondylolisthesis

Spondylolisthesis is a slipping of one of the vertebral bodies of your spine on top of another one.  Sometimes this can be asymptomatic.  It can also be a source of back pain.  Pain from spondylolisthesis rarely occurs before the age of 40.  Disc degeneration and weakening of the joints and ligaments of the spine can allow the vertebral bodies to move.  This movement can narrow the spinal canal causing spinal stenosis as well.

Spondylolisthesis
Spondylolisthesis

Occasionally, there can be a fracture in one of the bones of the spine call the “pars”.  This fracture can allow the vertebral bodies to slip forward as well.

Pars Fracture
Pars Fracture

Patients with sponylolisthesis can have back pain.  The pain can radiate down the legs and be associated with numbness and tinging of the leg.  In severe cases, the patient may develop cauda equina sydrome, which may cause bowel or bladder symptoms. X-rays, MRIs and CT scans of the spine can delineate the cause of pain.  Electromyography (EMG) and nerve conduction studies (NCV) may be useful to delineate the nerve roots affected.  Treatment begins with conservative modalities including physical therapy, heat, ice and medications such as non-steroidal anti-inflammatories.  Injections, such as epidural steroids, can be useful to decrease pain and allow physical therapy to be more successful.  If conservative modalities are unsuccessful, surgery may become necessary.

Diffuse Idiopathic Skeletal Hyperostosis

 

 

Diffuse Idiopathic Skeletal Hyperostosis or DISH is a disease of the ligaments of the spine.  The ligaments that support the spine become ossified and turn to bone.  DISH occurs in 19% of men and 4% of women over 50 years old.  This syndrome is asymptomatic.  Occasionally, swallowing problems may occur due to nerve injury.  There mild be some mild discomfort in the back area.  Occasionally, compression of the spinal chord can occur, leading to nerve damage.  When this occurs, symptoms related to the bowels or bladder may appear.  The diagnosis of Diffuse Idiopathic Skeletal Hyperostosis is made by X-Rays.  When the bony overgrowth spans three vertebral segments, the diagnosis is made.  MRI scans may allow better visualization of the spine and nerve roots, looking for compression.  The pain of DISH syndrome can mimic may other diseases such as bursitis, arthritis, and radiculopathy.  Treatment is conservative and includes physical therapy and non-steroidal anti-inflammatory medications.  If compression of the nerve roots is an issue, an epidural nerve block may be useful as well.

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