Hip Pain After a Fall: When to Seek Further Evaluation

Fell and hit the buttocks?

Hello Doctor,
In early April, I accidentally slipped and fell, hitting my buttocks.
Initially, I thought it was nothing serious, but the pain persisted, so I went to the emergency room on April 21 for an X-ray.
The emergency physician assessed that there were no fractures or cracks and prescribed a week’s worth of muscle relaxants and anti-inflammatory pain medication.
On April 26, I visited a chiropractor, who mentioned that my bones were misaligned and shifted to the right, even pointing it out to my mother.

On May 17, due to ongoing severe pain and the onset of soreness and numbness in my right lower back and leg, I returned to the orthopedic clinic.
However, this time, no X-rays or additional tests were performed.
I informed the doctor of my symptoms, and he noted that the X-ray from April 21 appeared somewhat abnormal, suggesting a possible fracture but he could not confirm it.
He mentioned that the pain might be due to my discontinuation of the anti-inflammatory medication and that it should be improving after a month.
He prescribed muscle relaxants and pain medication again.

After taking the medication, my symptoms did not improve.
Regardless of whether I am sitting, standing, or lying down, there is a specific point in my groin and right lower back that hurts.
Pressing on the groin area causes excruciating pain, making it difficult to lie down or move.
The pain is localized and does not shift, particularly in the groin area.

Could this situation indicate a fracture, crack, or displacement of a bone? I have been receiving treatment at the same facility; should I consider switching to another medical institution or undergo further examinations? I am concerned because my cousin had a car accident where an X-ray did not reveal a pelvic fracture, but a CT scan later identified it.
Is it possible that I could have a similar situation? Thank you for taking the time to respond, Doctor.

Yu, 20~29 year old female. Ask Date: 2018/05/21

Dr. Wang Shouji reply Orthopedics

Coccyx contusions and fractures can affect the recovery period.
However, coccyx fractures typically do not require surgery.
Treatment involves rest and minimizing irritation to the area, such as avoiding prolonged sitting or cycling.
Most cases will gradually improve within a few weeks to three months.

Reply Date: 2018/05/21

More Info

Dear Patient,
Thank you for sharing your detailed medical history regarding your hip pain following your fall in early April. It sounds like you have been through quite a challenging experience, and I appreciate your patience in seeking further evaluation and treatment.

From your description, it appears that you initially sustained a fall that resulted in significant pain, which has persisted despite treatment. The X-ray taken in the emergency department indicated no fractures, but your ongoing symptoms, including pain in the groin area and radiating sensations down your leg, suggest that there may be more to your injury than what was initially diagnosed.

Hip pain after a fall can arise from various causes, including soft tissue injuries, joint issues, or even subtle fractures that may not be visible on standard X-rays. Given that you are experiencing localized pain in the groin area and radiating symptoms, it is essential to consider the possibility of a hip labral tear, hip impingement, or even a stress fracture, particularly if the pain is persistent and worsening.

The fact that your symptoms have not improved with conservative treatment, including muscle relaxants and anti-inflammatory medications, raises a red flag. It is crucial to seek further evaluation, especially since you are experiencing new symptoms such as numbness and tingling in your leg, which could indicate nerve involvement or referred pain from the hip joint.

In your case, I recommend the following steps:
1. Seek a Second Opinion: If you feel that your current healthcare provider is not addressing your concerns adequately, it may be beneficial to seek a second opinion from another orthopedic specialist. A fresh perspective can often lead to a more accurate diagnosis and treatment plan.

2. Advanced Imaging: Given your ongoing symptoms and the potential for undiagnosed injuries, I would strongly recommend obtaining advanced imaging studies, such as an MRI or a CT scan. These imaging modalities can provide a more detailed view of the soft tissues, cartilage, and any subtle fractures that may not be visible on X-rays.

3. Physical Examination: A thorough physical examination by a qualified orthopedic specialist is essential. They can assess your range of motion, strength, and any specific areas of tenderness that may help pinpoint the source of your pain.

4. Consider Physical Therapy: If no significant structural issues are found, physical therapy may be beneficial in addressing muscle imbalances and improving your hip function. A physical therapist can design a tailored rehabilitation program to help strengthen the surrounding muscles and improve flexibility.

5. Monitor Symptoms: Keep a close eye on your symptoms. If you experience increased pain, swelling, or changes in mobility, it is essential to communicate these changes to your healthcare provider promptly.

In summary, while your initial X-ray did not show any fractures, the persistence of your symptoms and the development of new ones warrant further investigation. It is entirely possible for subtle injuries to be missed on initial imaging, and your concerns about a potential fracture or displacement should be taken seriously. Seeking a second opinion and advanced imaging will be crucial in determining the appropriate next steps for your recovery.

Thank you for reaching out, and I wish you the best in your journey towards healing. Please do not hesitate to follow up with any further questions or concerns.

Best regards.

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