Low back pain below the beltline

She is having significant low back pain below the beltline. This sudden pain began when she was moving on to the operating room table and Dr. was set to do prognostic medial branch blocks in the lumbar spine. She is having left greater than right pain below the beltline with radiation to the buttock and proximal thigh to the knee, but not beyond it. She also has a squeezing type pain in the lateral groin and hip area.

IMPRESSION:
1. History of renal cell carcinoma.
2. History of gamma knife therapy for cranial meningioma.
3. Severe and acute left superomedial buttock pain and lateral hip pain; highly consisted with hip joint pathology in addition to sacroiliitis.

PLAN:
Due to this patient’s history of renal cell carcinoma and meningoma and the acuteness of this pain, we will need to obtain an MRI with and without contrast of the pelvis with hips as well as the MR arthrogram of the left hip. We will order that immediately. This was the best way of assessing for possible osteoporotic fracture versus tumor versus possible hip joint labral tear. She understood my rationale for moving forward with this testing. We will see her back in the practice for follow-up as soon as possible.

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