Paper
The Perplexity of Posterior Pelvic Pain
Published Jun 28, 2022 · George M. Raum, Allison N. Schroeder
American Journal of Physical Medicine & Rehabilitation
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Abstract
HISTORY AND PHYSICAL EXAMINATION A 45-yr-old woman with a medical history of chronic low back pain and hypertension initially presented to her primary care and orthopedic physicians with right low back, buttock, and hip pain with radiation into the calf for 1 yr. Her pain was insidious in onset with a numbness and cramp-like quality. She rated the pain as a 9/10 in severity. Pain was worse with any activity, especially standing andwalking, and improvedwith rest. She stopped working as a housekeeper and refrained from her exercise regimen, which included workout videos, because of her symptoms. Because of lack of improvement of her symptoms, she presented to the physical medicine and rehabilitation (PM&R) sports medicine clinic. Previous treatment was attempted with various nonsteroidal anti-inflammatory drugs, gabapentin, physical therapy targeted at lumbopelvic strengthening, right intraarticular hip injection, and right L5 transforaminal epidural steroid injection. Her previous treatment did not provide significant relief from her symptoms, including during the anesthetic phase of the injections. On initial evaluation by PM&R, her symptoms were centered in the lateral right hip/ buttock with radiation down the leg to the great toe with concomitant numbness/tingling in the medial and lateral shin. On physical examination, strength, sensation, and reflexes were normal in the bilateral lower limbs. She had pain with hip adduction, external rotation, and was tender to palpation over the ischiofemoral space. Pain was also exacerbated by taking a long stride. She had a positive straight leg raise with a negative slump test. This study conforms to all American Journal of Physical Medicine and Rehabilitation Resident Fellow Section CARE guidelines and reports the required information accordingly (see Supplemental Digital Checklist, Supplemental Digital Content 1, http://links.lww.com/PHM/B738). Transitional Question: What is the differential diagnosis for posterior hip/gluteal pain with radiation into the lower extremity?
Case ReportPosterior hip/gluteal pain with radiation into the lower extremity can be a complex and challenging diagnosis, with potential causes including lumbar spine pathology, lumbar spinal stenosis, and lumbar spinal fusion.
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