Expert: Dr. J. Shawn Leatherman - 5/22/2007

Question
QUESTION: I fractured my sacrum from falling on my back about 30 years ago and most of the time I don't have a problem  I walk 6 days out of the week but my problem started last fall when my hip at the top of my leg, in the front seemed to ketch me than started to hurt.  It then went to the side and down my leg.  I wonder if this could be caused by my fractured sacrum..I just started going to the doctor and he did not take x-rays but told me it was the ball and socket of my hip that was out of order.  He is trying to manipulate it back together.  Does this sound reasonable?   What should he be doing and what should I ask him. Thank you for you answer.

ANSWER: Dear Joan, NO this does not sound reasonable!!

If your ball and socket was out of position, then you would have a dislocation, and you would not be doing anything...especially walking or standing upright, you would be in serous pain, and on your way to the emergency room for a reduction which is very painful and many times done under anesthesia.

What kind of doctor are you seeing?  You should ask him what he means by "out of order"...ask for a proper diagnosis, one that can be explained by any other medical professionals you know.  Is this a ligamentous problem, cartilaginous problem, bone problem, muscle problem, joint mechanics problem or all of the above...make the doctor explain it to you fully and write it down if need be...he had better of documented it in his notes...ask for a copy!!

It is a doctor's duty, by law, to provide you with the most accurate diagnosis possible and explain it fully to you.  Then a rational treatment program should follow.  

Did this doctor actually examine your area of complaint, or did he only take a history of your symptoms?  He should have checked your range of motion and performed provocative tests to stress the joint space and surrounding tissues.  If the joint was truly , "out of order", then he should have taken x-rays to evaluate it!!

My opinion...ask those questions, expect logical answers, or get another opinion.   Maybe the doctor is right on track, but with para-medical terminology and explanations, I doubt it.  

Good luck Joan, follow-up with me if you need to.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net

---------- FOLLOW-UP ----------

QUESTION: Thank you so much for your quick and excellent reply!  

I went back to my Chiropractor for the second time and he asked me if the first manipulation had made a difference and I told him no.  He than said that the ball and socket was not the problem.. He did something else but I still had pain when I walked this morning.  I have pain in my buttock and leg and when I climb a step with that leg it hurts to put the pressure on it.  I guess I will go back to him and ask a few questions as you suggested.  I had a problem two years ago with inflamed ligament in that same leg just below the knee so I stopped walking for a few months and it healed.  Now I am having this problem with the same leg.  I will ask him about this.  Do you have any ideas about this problem, what it could be?
Thank you so much, again..

Answer
Dear Joan,

Unfortunately, I do not, without a proper examination it would be remiss for me to offer you any specific diagnostic advise, but I can point out some structures.

With the locations of the pain and the fact that it is worse with walking etc... it is likely that you have some derangement in the sacroilliac joint (SI) of the pelvis which may or may not be complicated by muscular imbalances or spasms.  The SI joint has pain patterns that match your areas of location and mechanism of provocation.  The ligaments that hold this joint together can be extremely painful when inflamed.

Additional areas to be suspected, lumbar/sacral junction of the spine, piriformis muscle, myofascial system of the lumbar spine, gluteal muscles, lumbar nerve roots that give rise to the sciatic nerve, and possible lumbar degenerative conditions.  There are so many structures that could be the problem...the physical examination really gives the doctor more information about the possible diagnosis and effective treatment.

Wish I could be more exact on this, but the possibilities are many.  Good luck, follow-up with your treating doctor and make him explain his findings to you or get a second opinion.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net