Henry,

Pain (predominantly or worse) at night is thought to be a sign of a space
consuming process, such as an inflammation (or worse). In fact, it is
included in most "red flags" lists. If I couldn't find a clear (benign)
mechanical explanation, with a concurrent examination, I'd like to have
abdominal pathologies ruled out, such as an iliopsoas abscess, and while
they're at it, all sinister pathologies possible. David's theory is
certainly not impossible, but the pelvic provocation should be clearly
painful then.

Good luck,
Frank



----- Original Message -----
From: "Henry Tsao" <[log in to unmask]>
To: <[log in to unmask]>
Sent: dinsdag 5 juni 2001 23:52
Subject: strange case of sciatica


To all:

I had a 47 y.o. lady come in about 4 weeks ago complaining of right sided
low back pain which radiated down the buttock only. She had no associated
symptoms and complained that the pain was worse with prolonged positions,
and relieves with movement.

She turned out to have somatic pain originating from L4-5 right facet joint,
and this was easily treated in 4 sessions using mobilisation and exercise.

A week ago, she called me up stating that she was not getting anymore back
pain, but that she had pain from the right buttock radiating posteriorly
down into the heel. She had no other associated symptoms, and once again
complained that the pain was worse with prolonged positioning. The pain was
particularly bad at night, and would wake her up around 2-3 am. The strange
thing was this pain was LOCALIZED DEEP ANTERIOR PAIN IN THE "INGUINAL/HIP"
REGION.

Objective examination:
- SLR 20 degrees right, with reproduction of posterior pain
- Tight piriformis right more than left, and tender on palpation
- L3-5 right facet stiffness, tenderness, but no referral of pain
- Neurological NAD
- Hip Flexion/Adduction painful only with the adduction component, and
reproduced the anterior hip pain.

I did neural glides yesterday, and this improved the SLR to 60 degrees
(equal to left). When she stood up, she said the posterior pain was not as
severe, but the anterior hip pain was worse (perhaps from lying down for too
long??). I am due to see her by the end of the week.

My questions are:
1. what do you think is happening in this lady?
2. Do you think the anterior hip pain is associated with the other symptoms,
and if so, how?

Thank you in advance for your replies.

Henry***



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