Expert: Gerald Anzalone, D.C. - 1/18/2010

Question
My 91 yr old mother had a recent fall, went to ED, x-rays and CT of left hip and also head were negative but her pain is severe in her lower back and left leg and hip area with difficulty in movement.
If nothing is fractured, why is she having such acute pain and what other treatment and relief should we adult children seek for her?

Answer
I can't provide you with a precise diagnosis over the Internet, but in general, assuming that there are no hip or pelvic fractures, I would be concerned about the possibility of a lumbar spine fracture or disc herniation following her fall. When low back pain and sciatica persist (pain lasting 6-12 weeks), appropriate consultation and diagnostic imaging should be considered. Referring the patient to a physician with expertise in spinal disorders may be the most appropriate procedure for initial evaluation rather than relying on expensive diagnostic testing. Appropriate spine specialists could include a chiropractor (DC), osteopathic physician (DO), orthopedic surgeon, neurosurgeon, or neurologist. I would start first with a medical specialist (MD or DO), because Medicare does not allow DCs to order x-rays, MRI, or CT scans.

CT scanning is an effective diagnostic study when the spinal and neurologic levels are clear and bony pathology is suspected.

MRI is most useful when exact spinal and neurologic levels are unclear, when a pathologic condition of the spinal cord, discs, or soft tissues is suspected.

Also, contusions (bruises), sprains, and strains may occur as a result of trauma, and even though there is no broken bone, these injuries can still be very painful. Sprains are due to ligament injuries, while strains occur because of damage to muscles and tendons. The muscles, bursas (fluid-filled sacs between muscles/tendons), and ligaments are designed to shield the joint from weight-bearing forces. When these structures are inflamed, the hip cannot function and pain will occur.

Persistent disabling symptoms and degenerative spinal changes should prompt discussion and shared decision-making regarding surgery or interdisciplinary rehabilitation (that is, involving a team of practitioners from different specialties).

For patients with herniated disks, the use of epidural steroid injection should be discussed.

For patients with herniated disks and disabling leg pain from spinal stenosis (narrowing of the spinal canal, due to arthritis or disc herniations), surgical options should be discussed if conservative therapy fails.

I hope that this helps to answer your question.