Suggest Treatment For Severe Pain In Groin Area

Posted on Wed, 15 Jun 2016

Question: My husband, 59, has severe pain in his groin, right side. An x ray of his hip in December showed arthritis... but nothing severe. He also needs his left knee replaced but wants to wait until this pain can get figured out. He was told to give it 3 months and is now scheduled for a MRI next week. A shot of cortisone and a dose of prednisone over a month ago did nothing for the pain. He ices the area every night but still no pain relief. He is on Coumadin for DVT's so he is limited with what he can take for pain. He is in agony day and night. He's had several tick bites through the years and has been tested for Lyme disease. Any ideas what this pain could be?

Answered by Dr. Naval Mendiratta (52 minutes later)

Brief Answer:
Hip pain

Detailed Answer:
Good evening

Thank you for writing on health care magic

Well, it doesnt look like inflammatory arthritis since he did not benefit from Steroid injection.

I would like to know a few more details about the pain before guiding you further:

1. Is the pain more on weight bearing or is it present at night also?

2. Did he have his blood tests done to look for Calcium, Vitamin D and Alkaline phosphate?

3. Is the left hip affected as well??

Well, my differentials here would be Osteoarthritis of the Hip or Avascular necrosis of the Hip( AVN)> AVN is a known side effect in patients who are on anticoagulants for a long duration.

Do let me know these queries. If you could attach the X ray also, it would be helpful

Regards
Dr naval

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Naval Mendiratta (33 minutes later)

The pain is both weight bearing and at night while asleep, he frequently awakes in pain.
He has his INR done monthly but not sure on other blood tests but will check. And the pain is just on his right side.
I will try to send the X Ray tomorrow.
He has been on antocoagluants for about 3-4 years.

Answered by Dr. Naval Mendiratta (15 hours later)

Brief Answer:
Hip pain

Detailed Answer:
good evening

sorry for late reply. had a long duty

Well it sounds more like avascular necrosis of hip. A MRI would confirm the diagnosis. I think he may need a repair of the joint eventually. AVN is a common side effect of drugs/smoking/ Alchohol. my diagnosis goes more in favor of it

Do let me see the x Ray..It would give me a better clue

regards
dr naval

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Naval Mendiratta (29 hours later)

Attached is the x ray. If this is AVN will the hip replacement help? And as for reasons that this could happen.. He was a triathlete until about 3 years ago when he got his first blood clot. He is on medication for that, high blood pressure, and acid reflux. No other drugs, he doesn't smoke but he does drink..every day. Could it happen from alcohol alone?

Can I email you the x ray? This program will not allow me to upload the file.

Just uploaded back and front view

Answered by Dr. Naval Mendiratta (8 hours later)

Brief Answer:
? AVN

Detailed Answer:
Good evening

Well, it does look like early stages of AVAn. there is a Crescent Sign which can be seen, which indicated an early stage. however MRI is still the investigation of choice as it will give us a clear picture on it.

If it is AVN, He will have to stop Alchohol. Alchohol is a common cause for it. As per the drugs, the warfarin/Heparin class of drugs also cause this disease.

But never the less, I would suggest lets go for MRI and get the final conclusion, cause the joint is not so bad that osteoarthritis will cause that much pain. Yes, the replacement will work in AVN as well.

Do let me know for more queries

Regards
Dr naval

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar