Disc Herniation and Hip Joint Issues: A Patient's Journey

Herniated Disc and Left Hip Joint

Dear Doctor,
I am currently working in a rural area of Shizuoka, Japan.
Due to prolonged standing, walking, and lifting heavy objects, I have experienced a recurrence of 1.
herniated discs.
Currently, I am experiencing pain in my lower body.
During my last visit to Taiwan, I was diagnosed at Taipei Veterans General Hospital with 2.
varicose veins and 3.
plantar fasciitis (I have already changed my work shoes).
Due to the long hours of standing, I underwent an MRI at a local hospital last week, where the doctor informed me of 4.
developmental dysplasia of the left acetabulum (hip joint), which was quite unexpected, and 5.
bilateral hip joint pain.
The doctor suggested that I consider undergoing hip replacement surgery while I am still young.
For now, the doctor has recommended that I take medication to treat the herniated discs and will advise whether surgery is necessary in two weeks.
I have had experiences of misdiagnosis at other local hospitals, and the equipment at the rural hospital is not the latest.
Although I would like to return to Taiwan for treatment (due to language ease), I am concerned about the risk of infection during travel that could affect others.
Currently, when I open and close my legs, I hear a clicking sound in my hip joint, but the pain from the herniated discs (muscle soreness) is greater than the pain in my thighs and calves.

I would like to ask the doctor if not undergoing surgery will result in an inability to walk in the future.
(I have started a month of rest.) I sincerely appreciate your guidance.
Thank you very much.

Gu Ding, 30~39 year old female. Ask Date: 2020/12/02

Dr. Shi Guozheng reply Orthopedics

If a herniated disc improves with conservative treatment, surgery may not be necessary.
As for the hip joint, if there are indeed degenerative changes and the joint space is significantly narrowed, surgery should be performed as soon as possible.
However, if there is not much pain, observation can continue.

Reply Date: 2020/12/02

More Info

Understanding the complexities of disc herniation and hip joint issues is crucial for anyone experiencing related symptoms, especially in the context of a patient’s journey through diagnosis and treatment. In your case, it appears that you are dealing with multiple musculoskeletal issues stemming from your work environment, which involves prolonged standing and heavy lifting.

Disc Herniation and Its Implications
Disc herniation occurs when the soft inner gel of a spinal disc bulges out through a tear in the tougher exterior. This can lead to nerve compression, resulting in pain, numbness, or weakness in the lower back and legs. Your symptoms of lower body pain, particularly in the legs, may indeed be linked to the herniated disc. The fact that you are experiencing significant discomfort in your lower extremities suggests that the herniation may be affecting the nerves that supply these areas.

In your case, the recommendation to initially manage the herniation with medication is standard practice. Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce inflammation and alleviate pain. Physical therapy is also a critical component of treatment, focusing on strengthening the muscles that support the spine and improving flexibility. If conservative treatments fail to provide relief, surgical options may be considered, but this is typically a last resort.

Hip Joint Issues
You mentioned that an MRI revealed an issue with the left hip joint, specifically that the acetabulum (hip socket) is underdeveloped. This condition can lead to hip pain and may contribute to the clicking or popping sounds you hear when moving your hip. The recommendation for a potential hip replacement at a young age is concerning, but it may be warranted if the joint is severely degenerated and causing significant pain or functional limitations.

The clicking sound in your hip, especially if it is not accompanied by pain, is often benign and can be a result of tendons or ligaments moving over bony structures. However, if it is associated with pain, further evaluation is necessary.

Interrelationship Between Conditions
The relationship between your disc herniation and hip joint issues is significant. Pain from the lumbar spine can often radiate down to the hips and legs, complicating the clinical picture. Conversely, hip joint problems can lead to altered gait mechanics, which may exacerbate or contribute to lower back pain.

Recommendations
1. Follow-Up Care: It is essential to maintain regular follow-up appointments with your healthcare providers. Given your history of misdiagnosis, consider seeking a second opinion from a specialist in spinal disorders or orthopedic surgery, particularly one experienced in treating hip conditions.

2. Physical Therapy: Engage in a structured physical therapy program that addresses both your lumbar spine and hip joint. A physical therapist can provide exercises tailored to your specific needs, focusing on strengthening and flexibility.

3. Lifestyle Modifications: Given your work environment, consider ergonomic adjustments to reduce strain on your back and hips. This may include using supportive footwear, taking regular breaks to stretch, and employing proper lifting techniques.

4. Surgical Considerations: If conservative management does not yield improvement, discuss the potential benefits and risks of surgery with your doctor. It is crucial to weigh the long-term implications of surgery against the potential for recovery with non-invasive treatments.

5. Monitoring Symptoms: Keep a detailed log of your symptoms, noting any changes in pain levels, mobility, or functionality. This information can be invaluable for your healthcare team in making informed decisions about your treatment plan.

Conclusion
In summary, your journey through the complexities of disc herniation and hip joint issues requires a comprehensive approach that includes medical management, physical therapy, and possibly surgical intervention. It is vital to remain proactive in your treatment and to communicate openly with your healthcare providers about your symptoms and concerns. With the right approach, many patients can achieve significant improvements in their quality of life and functional abilities.

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