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What Do My MRI Scan Test Reports Indicate?
Question: Hi Dr Mascarenhas,
I sent you a question a few weeks back to which you responded to regarding some neuropathy symptoms I was experiencing after a caudal epidural. At the time you said they would subside and they are gradually doing so. I found your advice very helpful as I have not had much luck getting too many answers from my consulting doctors here in Australia. Unfortunately no one has actually been able to give me a proper diagnosis for my chronic back pain which has worsened in the past month since having the epidural.
I wondered if you wouldn't mind reviewing my MRI's that I have had done, the most recent being only a few weeks ago. My symptoms continue and to recap are as follows:
1. lower back pain that feels at the bottom of my spine and sacrum area
2. Unable to sit for more than 5 minutes without pain
3. Previous muscle spasms in my gluteal muscles - primarily the minimus and medius muscles for over 4 months (has subsided recently)
4. Groin and hip aching - continued the whole time (10 months)
5. More recent (last 7-8 weeks) burning pain in lower back, now radiating slightly in the upper buttocks
6. Stiffness, and some aching in thoracic spine area
I have had blood tests to check for inflammation and menopause which were all normal and no imbalance in hormones. I have also been tested for folate and B12 deficiencies which were all clear.
A link to all three MRIs with dates is here on Google Drive:
https://drive.google.com/open?id=0BxXilJdODwQRdkNQcW8xU0YwZGc
I would greatly appreciate your thoughts on this.
Regards
XXXX
I sent you a question a few weeks back to which you responded to regarding some neuropathy symptoms I was experiencing after a caudal epidural. At the time you said they would subside and they are gradually doing so. I found your advice very helpful as I have not had much luck getting too many answers from my consulting doctors here in Australia. Unfortunately no one has actually been able to give me a proper diagnosis for my chronic back pain which has worsened in the past month since having the epidural.
I wondered if you wouldn't mind reviewing my MRI's that I have had done, the most recent being only a few weeks ago. My symptoms continue and to recap are as follows:
1. lower back pain that feels at the bottom of my spine and sacrum area
2. Unable to sit for more than 5 minutes without pain
3. Previous muscle spasms in my gluteal muscles - primarily the minimus and medius muscles for over 4 months (has subsided recently)
4. Groin and hip aching - continued the whole time (10 months)
5. More recent (last 7-8 weeks) burning pain in lower back, now radiating slightly in the upper buttocks
6. Stiffness, and some aching in thoracic spine area
I have had blood tests to check for inflammation and menopause which were all normal and no imbalance in hormones. I have also been tested for folate and B12 deficiencies which were all clear.
A link to all three MRIs with dates is here on Google Drive:
https://drive.google.com/open?id=0BxXilJdODwQRdkNQcW8xU0YwZGc
I would greatly appreciate your thoughts on this.
Regards
XXXX
Brief Answer:
Unable to Download the Folders. Please Upload each MRI as Single ZIP File
Detailed Answer:
Dear Madam,
Welcome to HealthCareMagic.com I am Dr.J XXXXXXX Anto Bruno Mascarenhas, and I am here to help you.
I am not able to download the Files to my Computer. I request you to please convert the Entire Folder of a MRI into a ZIP File and then Upload the 3 ZIP Files (one for each MRI) to Google Drive. I will download the ZIP Files, Unzip it and then view all the three MRIs and give my opinion
Waiting for the ZIP Files :) :)
Regards
Bruno Mascarenhas
Unable to Download the Folders. Please Upload each MRI as Single ZIP File
Detailed Answer:
Dear Madam,
Welcome to HealthCareMagic.com I am Dr.J XXXXXXX Anto Bruno Mascarenhas, and I am here to help you.
I am not able to download the Files to my Computer. I request you to please convert the Entire Folder of a MRI into a ZIP File and then Upload the 3 ZIP Files (one for each MRI) to Google Drive. I will download the ZIP Files, Unzip it and then view all the three MRIs and give my opinion
Waiting for the ZIP Files :) :)
Regards
Bruno Mascarenhas
Above answer was peer-reviewed by :
Dr. Sonia Raina
Hi Dr Mascarenhas,
I have zipped the files and a new link is here:
https://drive.google.com/open?id=00000000
Please let me know if you can't open them.
Many thanks
XXXX
Hi Dr Mascarenhas,
Just ensuring your can open my google drive files above?
XXXX
I have zipped the files and a new link is here:
https://drive.google.com/open?id=00000000
Please let me know if you can't open them.
Many thanks
XXXX
Hi Dr Mascarenhas,
Just ensuring your can open my google drive files above?
XXXX
Brief Answer:
No Surgical Intervention Needed at Present. Manage Muscle Spasms
Detailed Answer:
Dear Madam,
I apologize for the delay
You have narrated the following symptoms
1. lower back pain that feels at the bottom of my spine and sacrum area
2. Unable to sit for more than 5 minutes without pain
3. Previous muscle spasms in my gluteal muscles - primarily the minimus and medius muscles for over 4 months (has subsided recently)
4. Groin and hip aching - continued the whole time (10 months)
5. More recent (last 7-8 weeks) burning pain in lower back, now radiating slightly in the upper buttocks
6. Stiffness, and some aching in thoracic spine area
Of these 6
1, 3, 4, 6 are usually due to Muscle Spasm
2, 5 can be due to muscle spasm or nerve involvement
I thank you for converting the Files into a ZIP File and Uploading that.
I have downloaded the three Files and have unzipped and have gone through the Images
First and Foremost, I would like to reassure you that the MRIs do not reveal any reason for a surgical intervention
So, the short reply is that all the symptoms you have narrated are due to muscle spasm and hence there is nothing to worry
Muscle Spasms can be due to so many causes
1. Psychological Stress (may be your brother or sister is not well, may be your favourite team has lost, may be you have a deadline in your office, may be you have a huge loan etc).
2. Physical Stress (For example, you are working more, travelling more, walking more, lift is not working and hence you are climbing in stairs)
3. Wrong Furniture (The Sofa, Chair etc in which you are sitting is not alright for you)
4. Too Tight Dress
Just understanding the cause and taking proper remedial measures will solve the symptoms
Hope you found the answer helpful.
If you need any clarification / have doubts / have additional questions / have follow up questions, then please do not hesitate in asking again. I will be happy to answer your questions.
Best Wishes for Speedy Recovery
Let me know if I can assist you further.
Take care.
-oOo-
PS 1 : After all your doubts have been cleared, kindly (a) Close this Question (b) Rate my Replies and (c) Give your Feedback.
PS 2 : In the future, for continuity of care, I encourage you to contact me directly in HealthCareMagic at http://bit.ly/askdrbruno
No Surgical Intervention Needed at Present. Manage Muscle Spasms
Detailed Answer:
Dear Madam,
I apologize for the delay
You have narrated the following symptoms
1. lower back pain that feels at the bottom of my spine and sacrum area
2. Unable to sit for more than 5 minutes without pain
3. Previous muscle spasms in my gluteal muscles - primarily the minimus and medius muscles for over 4 months (has subsided recently)
4. Groin and hip aching - continued the whole time (10 months)
5. More recent (last 7-8 weeks) burning pain in lower back, now radiating slightly in the upper buttocks
6. Stiffness, and some aching in thoracic spine area
Of these 6
1, 3, 4, 6 are usually due to Muscle Spasm
2, 5 can be due to muscle spasm or nerve involvement
I thank you for converting the Files into a ZIP File and Uploading that.
I have downloaded the three Files and have unzipped and have gone through the Images
First and Foremost, I would like to reassure you that the MRIs do not reveal any reason for a surgical intervention
So, the short reply is that all the symptoms you have narrated are due to muscle spasm and hence there is nothing to worry
Muscle Spasms can be due to so many causes
1. Psychological Stress (may be your brother or sister is not well, may be your favourite team has lost, may be you have a deadline in your office, may be you have a huge loan etc).
2. Physical Stress (For example, you are working more, travelling more, walking more, lift is not working and hence you are climbing in stairs)
3. Wrong Furniture (The Sofa, Chair etc in which you are sitting is not alright for you)
4. Too Tight Dress
Just understanding the cause and taking proper remedial measures will solve the symptoms
Hope you found the answer helpful.
If you need any clarification / have doubts / have additional questions / have follow up questions, then please do not hesitate in asking again. I will be happy to answer your questions.
Best Wishes for Speedy Recovery
Let me know if I can assist you further.
Take care.
-oOo-
PS 1 : After all your doubts have been cleared, kindly (a) Close this Question (b) Rate my Replies and (c) Give your Feedback.
PS 2 : In the future, for continuity of care, I encourage you to contact me directly in HealthCareMagic at http://bit.ly/askdrbruno
Above answer was peer-reviewed by :
Dr. Prasad
Thank you Dr Mascarenhas for your reply. My back pain started straight after having a hysterectomy conducted vaginally last July. I awoke from the surgery with back pain which intensified for 4 weeks not allowing me to lay on my back flat ( which I still cannot do) nor sit upright (only in a reclined position with pillows under my legs) I am still like this 10 months on. The muscles spasms in my glutes and aching hip/groin started 3-4 months later after attending a pain clinic where light stretching and exercises were prescribed. Throughout the past 10 months I have tried to keep active walking each day and mostly up and doing things each day to avoid anymore muscle weakness etc. It was suggested there may be some signs of stenosis ( that was before I had the epidural). It would be good to hear your thoughts on that?
Also, all exercise and physiotherapy has made things worse with the epidural 4 weeks ago seeming to give me more pain. I was tested for Arachnoiditis also. This week I have sciatic pain down the back of my right leg and sharp pain at the bottom of my spine that feels more nerve-like.
I am glad the MRIs don't point to anything surgical, but I can say I am not psychologically stressed and am lucky to have a very supportive partner and be financially independent. Hence I can't see that stress would be a factor in causing this.
I am keen to get back to normal living, but unfortunately my pain and inability to sit or stand for more than 30 minutes plus the aching through my body by mid afternoon seems extreme given I was an active, healthy person and regular exerciser before my surgery last year.
Any other thoughts or opinions you may have would be greatly appreciated.
Regards
XXXXX
Also, all exercise and physiotherapy has made things worse with the epidural 4 weeks ago seeming to give me more pain. I was tested for Arachnoiditis also. This week I have sciatic pain down the back of my right leg and sharp pain at the bottom of my spine that feels more nerve-like.
I am glad the MRIs don't point to anything surgical, but I can say I am not psychologically stressed and am lucky to have a very supportive partner and be financially independent. Hence I can't see that stress would be a factor in causing this.
I am keen to get back to normal living, but unfortunately my pain and inability to sit or stand for more than 30 minutes plus the aching through my body by mid afternoon seems extreme given I was an active, healthy person and regular exerciser before my surgery last year.
Any other thoughts or opinions you may have would be greatly appreciated.
Regards
XXXXX
Brief Answer:
Anterior Abdominal Wall Weakness is the cause. Physiotherapy is solution
Detailed Answer:
Dear Madam,
Thanks for Telling me about your Surgery. It has enabled me to find the cause of Muscle Spasm
Please permit me to explain a bit about your problem
Your Back is essentially a series of Bones (Called vertebral Bodies) which are kept straight by two forces
1. The Contraction of Muscles attached to the spine
2. The Pressure inside your Abdominal Cavity (called Intra Abdominal Pressure)
Now,
If the Intra Abdominal Pressure is low due to some reason, then the muscles of your back have to work more to maintain your spine in erect posture
If the Intra Abdominal Pressure is normal, then there is less work needed by the muscles of back
This diagram may help you understand this http://www.hanslindgren.com/assets/Images/Core/_resampled/resizedimage208300-flexion-over-IAP.png
How is Intra Abdominal Pressure increased --> By Contraction of the Muscles of your Pelvis + Contraction of Muscles of your Abdominal Wall
So
If your muscles of Anterior Abdominal Wall and Muscles of Pelvis are working properly, then your muscles of back have to work normally to make you straight
But
If your muscles of Anterior Abdominal Wall and Muscles of Pelvis are not working properly, then your muscles of back have to work more to make you straight
After your Hysterectomy, your pelvic muscles and abdominal muscles would have worked less
So
Your Back Muscles had to work more to compensate.
This over work has caused Muscle Spasm in your back.
Now
The ideal way to treat is to REDUCE THE WORKLOAD TO YOUR BACK MUSCLES and INCREASE THE WORKLOAD TO YOUR ABDOMINAL MUSCLES and PELVIC MUSCLES
But
Since this diagnosis has not been made, you have had treatments concentrating on your back muscles like stretching and walking routine, which has increased the workload MORE and caused MORE Spasm and it has become a vicious cycle
Now
Instead of stressing your back muscles further, if you give them rest and concentrate on workouts to improve your abdominal muscles and pelvic muscles (your physiotherapist will tell you what exercises, routines are needed for this) the stress on your back muscles will reduce and the spasm will reduce and you will be alright in 12 to 16 weeks
In Short, Treat your Abdomen and Pelvis :)
Hope you found the answer helpful.
If you need any clarification / have doubts / have additional questions / have follow up questions, then please do not hesitate in asking again. I will be happy to answer your questions.
Best Wishes for Speedy Recovery
Let me know if I can assist you further.
Take care.
-oOo-
PS 1 : After all your doubts have been cleared, kindly (a) Close this Question (b) Rate my Replies and (c) Give your Feedback.
PS 2 : In the future, for continuity of care, I encourage you to contact me directly in HealthCareMagic at http://bit.ly/askdrbruno
Anterior Abdominal Wall Weakness is the cause. Physiotherapy is solution
Detailed Answer:
Dear Madam,
Thanks for Telling me about your Surgery. It has enabled me to find the cause of Muscle Spasm
Please permit me to explain a bit about your problem
Your Back is essentially a series of Bones (Called vertebral Bodies) which are kept straight by two forces
1. The Contraction of Muscles attached to the spine
2. The Pressure inside your Abdominal Cavity (called Intra Abdominal Pressure)
Now,
If the Intra Abdominal Pressure is low due to some reason, then the muscles of your back have to work more to maintain your spine in erect posture
If the Intra Abdominal Pressure is normal, then there is less work needed by the muscles of back
This diagram may help you understand this http://www.hanslindgren.com/assets/Images/Core/_resampled/resizedimage208300-flexion-over-IAP.png
How is Intra Abdominal Pressure increased --> By Contraction of the Muscles of your Pelvis + Contraction of Muscles of your Abdominal Wall
So
If your muscles of Anterior Abdominal Wall and Muscles of Pelvis are working properly, then your muscles of back have to work normally to make you straight
But
If your muscles of Anterior Abdominal Wall and Muscles of Pelvis are not working properly, then your muscles of back have to work more to make you straight
After your Hysterectomy, your pelvic muscles and abdominal muscles would have worked less
So
Your Back Muscles had to work more to compensate.
This over work has caused Muscle Spasm in your back.
Now
The ideal way to treat is to REDUCE THE WORKLOAD TO YOUR BACK MUSCLES and INCREASE THE WORKLOAD TO YOUR ABDOMINAL MUSCLES and PELVIC MUSCLES
But
Since this diagnosis has not been made, you have had treatments concentrating on your back muscles like stretching and walking routine, which has increased the workload MORE and caused MORE Spasm and it has become a vicious cycle
Now
Instead of stressing your back muscles further, if you give them rest and concentrate on workouts to improve your abdominal muscles and pelvic muscles (your physiotherapist will tell you what exercises, routines are needed for this) the stress on your back muscles will reduce and the spasm will reduce and you will be alright in 12 to 16 weeks
In Short, Treat your Abdomen and Pelvis :)
Hope you found the answer helpful.
If you need any clarification / have doubts / have additional questions / have follow up questions, then please do not hesitate in asking again. I will be happy to answer your questions.
Best Wishes for Speedy Recovery
Let me know if I can assist you further.
Take care.
-oOo-
PS 1 : After all your doubts have been cleared, kindly (a) Close this Question (b) Rate my Replies and (c) Give your Feedback.
PS 2 : In the future, for continuity of care, I encourage you to contact me directly in HealthCareMagic at http://bit.ly/askdrbruno
Above answer was peer-reviewed by :
Dr. Prasad
Thank you for the detailed response Dr Mascarenhas. I had been consulting a women's physiotherapist prior to my hysterectomy for tight pelvic floor muscles and had been told to work on relaxing them as well as not doing any abdominal exercises after the hysterectomy. This advice was given to me post-surgery also. So you are right in that all the exercises I have done to date along with my walking have concentrated on my back, not my pelvic floor or abdominal muscles. I will consult a physiotherapist on looking at the best exercises to improve these areas.
Thank you again for your time and for providing such an informative response. The thought of being better in 12-16 weeks would be amazing to have my life back!
Thank you again for your time and for providing such an informative response. The thought of being better in 12-16 weeks would be amazing to have my life back!
Brief Answer:
We Need Balance in Life ! Strengthen All Your Muscles Equally :)
Detailed Answer:
Dear Madam,
You were asked to relax your pelvic muscles and not do abdominal exercises to enable to wound heal better. That is a normal precaution for the surgery you had undergone. But, once the wound has healed, we have to come back to the routine. Since this was not mentioned to you, you had over stressed your back and We find that it has produced a problem with your back muscles.
Also, the surgical wound would have healed by now and so, under the guidance of your physiotherapist, you can restart your abdominal and pelvic exercises so that you reduce the load on your back
But
I would suggest you to start slowly and increase gradually so that all the muscles get optimal workload
Since we have found the exact problem
and
Also Since we know the correct treatment, it will be a matter of time before you are back to your normal life
All the best :) :)
-oOo-
PS 1 : After all your doubts have been cleared, kindly (a) Close this Question (b) Rate my Replies and (c) Give your Feedback.
PS 2 : In the future, for continuity of care, I encourage you to contact me directly in HealthCareMagic at http://bit.ly/askdrbruno
We Need Balance in Life ! Strengthen All Your Muscles Equally :)
Detailed Answer:
Dear Madam,
You were asked to relax your pelvic muscles and not do abdominal exercises to enable to wound heal better. That is a normal precaution for the surgery you had undergone. But, once the wound has healed, we have to come back to the routine. Since this was not mentioned to you, you had over stressed your back and We find that it has produced a problem with your back muscles.
Also, the surgical wound would have healed by now and so, under the guidance of your physiotherapist, you can restart your abdominal and pelvic exercises so that you reduce the load on your back
But
I would suggest you to start slowly and increase gradually so that all the muscles get optimal workload
Since we have found the exact problem
and
Also Since we know the correct treatment, it will be a matter of time before you are back to your normal life
All the best :) :)
-oOo-
PS 1 : After all your doubts have been cleared, kindly (a) Close this Question (b) Rate my Replies and (c) Give your Feedback.
PS 2 : In the future, for continuity of care, I encourage you to contact me directly in HealthCareMagic at http://bit.ly/askdrbruno
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Yogesh D
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