Why does one experience upper glute pain despite treatment?

Question

Hello doctor,

I have been experiencing upper glute pain on the right side for two years, which hurts while sitting or lying down facing upwards. I had an magnetic resonance imaging (MRI) scan done in the past. Also, I have taken multiple treatments like Botox injection in the right piriformis muscle, Sacroiliac (SI) steroid injection, L4-L5, and L5-S1 facet joint steroid injection, and radiofrequency ablation of these facet nerves. Also, I have used analgesics, steroids, and pregabalin in the past, but nothing has improved my condition. I am sharing an attachment of my MRI scan.

Can you please advise on what can be the reason for my upper glute pain?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for addressing your queries to us. I understand your concern and would be happy to help.

I have seen the MRI (magnetic resonance imaging) scan (attachments removed to protect the patient's identity). Unfortunately, you have an old fracture at the right-sided inferior articular process of L4 and left-sided nerve root compressions at L4/L5 & L5/S1 levels due to disc herniation and facet arthropathy at multiple levels. However, in the recent MRI scan report, the sacroiliac (SI) joints and hip joints on both sides look perfect, with no widening or loss of joint space and no fluid collection.

So, in that context, I believe that your gluteal pains arise from the nerve root compression detected earlier. Since different injections and therapies have not worked, your next viable option may be disc surgery, subject to the opinion of a spine surgeon. Surgery is often successful in relieving the pain; however, it can be less effective with the "chronic S1 nerve dysfunction" found on EMG (electromyogram) earlier. Therefore I suggest you consult a surgeon.

I hope this helps.

Kindly revert in case of further queries. I wish you all the best.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

Your soft tissues (muscles, tendons, and ligaments) do not show any abnormalities in the magnetic resonance imaging (MRI) scan. However, there could still be some muscle strain due to mechanical stress causing muscle spasms. As your symptoms cannot be correlated with MRI findings, we can consider muscle pain a possibility. I suggest you consult a physiotherapist for pain relief.

I hope this helps.

Feel free to revert in case of further questions.

Thank you.