Severe Buttock Pain after A Fall: A Story of Two Physicians
POSTED ON 4/21/2014 IN Research BY Christopher Centeno
RP is an elderly physician who I met in the most unlikely of circumstances. He was performing a life insurance physical on me and I noticed he had a cane. We struck up a conversation about his severe buttock pain after a fall. The next thing you know I had him on my exam table and our roles reversed-the patient was examining the doctor. His story might be helpful to other patients with buttock pain after falling, as his case was one of a bright, shiny object which looked like the cause of his pain and a more subtle problem which turned out to be the cause.
RP is an ex-military doctor who now makes a living in retirement performing life insurance physicals. He looks nothing like an ex-military guy, instead he has an earring and wears wild Hawaiian shirts. Perhaps he's making up for all of those years in fatigues. He fell a few months before I first met him and as a result he had severe pain in his right buttocks. After a stay in the ER where x-rays showed no fractures, his family doctor followed the religion of "take NSAID drugs and stay off it". However, after several visits to his family doctor produced no results other than a refusal to perform an MRI, he was frustrated. In addition, during this time he went from an active elderly man to becoming dependent on a cane to hobble around.
When I first examined him during my own insurance exam, I immediately noticed a large lump in the gluteal muscles of his buttocks. A quick in office ultrasound revealed a hematoma the size of a small egg from the fall. This seemed to be tender so I attempted to remove the blood under ultrasound guidance. That usually doesn't work because the blood has long since turned to sludge that won't budge and it didn't work here either. However, while this was the "low hanging fruit", he also had evidence on exam of a rip roaring sciatica (pinched S1 nerve in his back). A low back MRI revealed a large herniated disc (his back hurt some, but most of his attention was on the butt pain). He underwent the Regenexx-PL disc procedure for his irritated low back nerve and I saw him today, without his cane! He now no longer limps and is grateful.
What's interesting about RP is it illustrates what happens to a lot of patients with buttocks pain after a fall. They see their family doctors who prescribe anti-inflammatory drugs and maybe some PT, but when the pain doesn't get better, there's often a reluctance to really dig deeper. Some of these patients have injured muscles, tendons, nerves, or ligaments-but all too often they get blown off. To figure out the cause and treat the problem often takes just someone who is willing to look for the problem.
The upshot? RP's "pain in the butt" was quite real. While he had a massive collection of blood from his fall that nobody found until an ultrasound revealed the issue, that turned out to be "window dressing". The real cause of his severe butt pain and inability to walk was a pinched nerve in his low back. A quick injection of the growth factors from his own blood platelets quickly helped him recover!
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