14 doctors weighed in:

37 y/o m localized pain/tenderness r psis area. Immediate onset c sitting, hip flexion & cervical flexion. Lesi, facet block & si injection no help!

14 doctors weighed in
Dr. Qamar Khan
Pain Management
6 doctors agree

In brief: Piriformis?

Could be piriformis syndrome.
Also consider the superior cluneal nerve entrapment or even iliolumbar spasm. Consider injections to these areas to evaluate. Otherwise, you may want to consider an emg/ncs to eval further.

In brief: Piriformis?

Could be piriformis syndrome.
Also consider the superior cluneal nerve entrapment or even iliolumbar spasm. Consider injections to these areas to evaluate. Otherwise, you may want to consider an emg/ncs to eval further.
Thank
3 comments
Dr. Jan Lei Iwata
Also, can get a 2nd opinion from an osteopathic physician, who will do a complete neuromusculoskeletal examination, who can treat this area osteopathically, and see what residual spasms remain. It would provide another perspective.
Dr. Martin Raff
Dr. Iwata's suggestion is excellent if you can find a D.O. who still manipulates.
Dr. Jose Barreto
Physical & Rehabilitation Medicine
4 doctors agree

In brief: Ligament vs nerve

Dr. Omrani, pain on the psis could be due to cluneal neuritis or neuromata and iliolumbar ligament enthesopathy.
Check posture for lumbar lordosis, core strength, hamstring flexibility, etc which stress this area. Consider injecting the psis area c local anesthetic to block the cluneal nerve, follow c steroid injection if DX block is positive. If no improvement consider prolotherapy for ill.

In brief: Ligament vs nerve

Dr. Omrani, pain on the psis could be due to cluneal neuritis or neuromata and iliolumbar ligament enthesopathy.
Check posture for lumbar lordosis, core strength, hamstring flexibility, etc which stress this area. Consider injecting the psis area c local anesthetic to block the cluneal nerve, follow c steroid injection if DX block is positive. If no improvement consider prolotherapy for ill.
Thank
3 comments
Dr. Bahman Omrani
Thank you for the great answer Dr. Barreto. Patient is a physician, recently came under care after2 LESI (pain only localized to R PSIS!!!), facet block, R SI joint inj & TPI, all with 0-10% benefit. PT/DC have been more beneficial. He was recommended a microdiscectomy for MRI finding of a 3-mm disc bulge w/ pain only localized to R PSIS!. R PSIS inj w/ lido+kenalog performed by ortho x2 for diagnosis of "PSIS bursitis" was 100% effective but short lived. Another Dr performed PRP inj 10 days ago w/ zero help thus far, but sounds like diagnosis was unknown to by Dr performing PRP. Will be doing us guided Prolo in about 10 days. Only concern is how to account for pain in PSIS with C/S flexion. Thanks for your insight.
Dr. Chris Faubel
Run from that surgeon that offered microdiscectomy for PSIS pain. Iliolumbar and cluneal neuroma pain is underdiagnosed and treated. It may bear repeating the PSIS steroid and lidocaine injection with more volume. Oh, the other pain in that area is Bertolotti's syndrome.
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