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Spine and Back Health

Iliosacral pinching sensation s/p pubic ramus

02/17/2010

Question:

I am a 26 y.o. female with a history of coccyx fracture around age 12 which healed (I assumed) over time and has not limited my activities since other than occasional pain in coccyx region after sitting long periods. I played sports throughout my teens, and I am an avid runner, 6-7 miles/day 5-6 days/week, having run consistently for the past 2+ years. I ran prior to that for several years in my late teens & early 20`s as well, but then stopped for a period of about 4 years before recommencing. In May, 2009, while running downhill on dirt and rock, I slipped and caught myself enough that only my R. posterior thigh & butt skimmed the ground. I continued running with only slight soreness in my hips for the 2 days thereafter. 1 week after the fall while running my normal route on concrete, I began feeling like I had pulled a muscle in my posterior L. groin or pubic region. 1 day after the pain began, again while running my normal route, the pain became such that planting my foot was almost unbearably painful. Several physicians whom I saw in the weeks and months after the injury diagnosed a groin strain, with a similar dx from a pelvic floor PT I was sent to for rehab. During this time I began feeling a pinching sensation in my L. sacroiliac joint. This nagging sensation was constant, worse by the end of the day, and irritating more than painful. I was given an SI steroid injection which immediately alleviated the pinching sensation. Then, 2.5 mos after the L. groin pain began (and continued), I finally had my pelvis x-rayed & a nearly healed, vertical fracture going through the entire width of my L. inferior pubic ramus was noted. I have occasional pain in the are of the fracture still, but it is minimal in comparison to that I had for the 3 mos. after the injury. About 4 mos. after the steroid injection of my SI joint though, this nagging, pinching feeling in my L. SI joint returned and has worsened. It is most notable after sitting for long periods. I researched pelvic fractures on PubMed and read about some very preliminary studies showing malformations or misplacement of the sacrum or coccyx being prevalent in a number of athletes with pelvic stress fractures. I am a grad student currently, with less than stellar insurance, so I am trying to avoid expensive work-up. Nonetheless, I am wondering what diagnostic or therapeutic measures I should take to ultimately find the cause of this SI issue. Finally, since several mos. after the pelvis fracture, I began noticing frequent leg heaviness and fatigue, with no signs of edema or other changes to explain the leg symptoms. Is there an expert out there with insight into my symptoms, and or the physiological causes of my injury & resultant SI sx?

Answer:

Thank you for visiting NetWellness. On this site, we try to answer general questions about health but cannot diagnose or recommend treatment. You appear to have some very, very specific questions about your condition, which can only be answered properly by a physician who is familiar with your history, physical exam, and test results. Your questions about the testing results you've been given or the risks, benefits, and alternatives for proposed treatments of this condition need to be directed to your treating physician(s). You should insist that they answer these questions in a way that you are able to understand before consenting to any treatment. If your physician is unable to help you understand these issues, you should get a second opinion. Take care.

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Response by:

David J Hart, MD David J Hart, MD
Associate Professor of Neurosurgery
School of Medicine
Case Western Reserve University