Apparent lengthening..pain in legs, inflammation, neck pain ???

[cure4richa]

I am not able to post in Ask a Doctors forums, so apologies if I am posting in  wrong forum but please help me out

Please find my case history below:

Case History:

Pain started in the month of July 08 and I suddenly felt numbness and severe pain in

my right leg. I realized that my leg is not supporting my weight.I have consulted

few orthodpadecians who adviced some multi vitamin and pain killer tablets with 10

days physiotherapy treatment. I followed the same but it did not worked at all.

Then I changed my doctor who adviced me few tests. Details are as follows:

1) Tuberculin Test
Date: 13/10/2008
Results: Negative

2) RA Factor
Date: 13/10/2008
Results: Negative

3) X Ray for Pelvis with both Hips
Date: 11/10/2008
Results: Mild 'S' shaped scoliosis with convexity to left boneislan is seen in left

femoral head
Visualised bones and joints are normal

4) Mycobacterium TB PCR (Qualitative)
Date: 20/10/2008
Results: Not Detected

5) Haematology(ESR)
Date: 11/10/2008
Results: Normal

6) MRI Scan of both Hip Joints
Date: 12/10/2008
Results: On Right side - Altered marrow signals in the right acetabulun (roof,anterior and posterior)

* Moderate degree of Synovial effusions
7) Nuclear Bone Scan
Date: 17/10/2008
Results: * Mild hypermia with a peripheral rim of increased traces. Concentartion seen involving head of right femur,could represent synovitis

8) Gallium Scan
Date: 11/11/2008
Results: findings are compatible with the diagnosis of chronic infections in the right hip

9) ANCA
Date: 18/02/2009
Results: Negative

10) ANA
Date: 17/02/2009
Results: Negative

11) ACCP
Date: 17/02/2009
Results: Negative

Doctors mentioned that there is apparent lengthening deformity in right leg(3 cms difference).

At present, Doctors are giving treatment for Rheumatoid and Tuberculosis both.

Medicines for Tuberculosis(Completed 6 months)
- Cobadex
- AKT 3
- Zeof 400 /Ofloxacin 400 mg
- B-long

Medicines for Rheumatoid

- HCQS
- Lofecam 4
- Sa zo 500 mg

Pain is reduced but limping is still existing. I have neck pain as well. I feel stiffness in various joints.

Please suggest if the treatment is correct or if there is any alternative treatment which can solve my problem in a fast way.

I have inflammation prob in my legs. I cannot squatt my legs.I am 27 years old female and fighting with this for the last one year...

I need to get rid of this. Even I am not sure what caused this.

Please suggest what can be done here. If necessary, I can share the reports as well.

Thanks,
Richa

[cure4richa]

Thanks Tuck. I will discuss on these lines with the ortho surgeons and keep you posted on this.

Thanks a lot

Richa

[Tuckamore]

Hello Richa,

Welcome to the Pain Management Forum. I am glad that you found us. As you noted there are no physicians on this forum and I am far from one. I will do my best to help you understand some of your test results.

That said, as I read your medical reports I see no test that indicates you have Tuberculosis (TB).  # 1 indicates that you have a negative TB test. So I am confused as to why they are treating you for TB.

I also see that you have a bone marrow issues as noted in #6. This can be from several causes, several of which are serious and should be investigated.

And #8 indicated you have a chronic infection in your right hip. The medical term for that is Osteomyelitis. It is an infection of bone or bone marrow.  By definition Osteomyelitis is inflammation of the bone and marrow, but since it is always caused by an infection, it indirectly implies an infection. It generally encompasses all of the bone including the bone marrow. When it is chronic it can lead to bone sclerosis and deformity. It can be difficult to treat and generally requires a long course of IV antibiotics.


And #7 indicates you have synovitis. Synovitis may be caused by injury, medication, or viral infection. It means you have inflammation of the lining of the hip joint. This may be a result of the Osteomyelitis.

The length difference, though significant may or may not be related to your current symptoms. It's my guess it plays a part in it. Discrepancy in lower limb lengths alone can cause pain and issues with the alignment of the pelvic girdle which in turn can cause pain and problems with that structure. Pain in both lower limbs can be a result of the different lengths or could be an inflammatory process.

#9, ANCA and #10 ANA are lab tests that would indicate inflammation, more specifically  rheumatologic disorders or disease. Both your tests came back negative. So once again I am confused as to why they are treating you for  Rheumatoid (Arthritis) which if you had these tests should have been positive. Did you have a positive or elevated lab for RA or was a Sed rate done and that was elevated? However an elevated Sed rate could also be from the Osteomyelitis or the Synovitis.

In my humble opinion (I am not a physician) many of your symptoms may be related directly or indirectly to the infection noted in the hip bone (Osteomyelitis). Please discuss this with an orthopedic surgeon or infection specialist. They should be able to address your concerns and put all your tests together and compile a plan of care.

I may not be interpreting your results correctly, the above is only my personal opinion. I am not saying that your current physician is not treating your properly. Please let us know how you are doing. I will be very interested to hear what a new physician or specialist will conclude is your diagnosis and how he/she will proceed with treatment.

Best of luck to you. I will look forward to your updates with interest.
Tuck