Question
My 9 year old daughter complained of tailbone,heel and outside right ankle pain after a dance audition. Everything looked o.k. but the pain did not go away in the heel and ankle for a few weeks so we went to the pediatrician. She was diagnosed w/Severs disease and sent tp PT. The pain increased and swelling became evident in her ankle.MRI of ankle was normal.Went to see an ortho sports medicine specialist and he diagnosed her as Si hip dysunction and sent for more PT. The pain increased and spread to knee and lower back. MRI results were:Segmental dysunction of L4,L5,S1 w/slight bulging disc at L5,S1. Again more PT,told to wear an SI belt and Tylenol,Motrin and ice as needed for pain.Don't worry about the spine and disc it isn't really significant is what M.D. stated. Fix the hip and the rest will come he says. Pain and swelling has continued at times severe and debilitating(22 months have now passed and she has stoped all dance and self limits activities due to pain). I took her to a chiropractor recently and he said she has spina bifida occulta. He wants to see MRI before talking any further. I asked M.D for copy of MRI 4 times and he has not produced it so now put in a request to the hospital and will hopefully have in a week or two.She also has burning in her leg at times and will sometimes feel as if something is pinching her at the spot where her femur meets her pelvis.The doctors have done nothing but tell me to ice and give the Tylenol or Motrin and have her use crutches if pain is severe. I am concerned that the new finding of spina bifida occulta is significant and coul this mean she has a tethered spinal cord. and What does segmental dysfunction of her vertenrae mean? Are they talking about the spina bifida but just didn't call it that? or something else? Please help

Answer
Kristin,

I know this is a frustrating situation for you and your daughter.  Given the information you gave me, I'll do my best with this.  I'd surely like to know more about this, because it is obvious that something is being missed.  First, get the MRI from the MRI facility and not the orthopedist.  You should be able to walk in and get a CD right on the spot, and then drop it off to the chiropractor.   Did the MRI report state anything about "spondylolysis" or "spondylolisthesis?"  If she had pelvic joint instability, then the SI belt would provide immediate pain reduction, otherwise, it is not likely the cause of her pain.  Has anyone considered a growth plate slip in the hip? Slipped femoral capital epiphysis is seen in pre-adolescent kids and it will cause pain anywhere from the lower back to the knee.   If this was missed by the ortho' then you have a malpractice case.  Is there any tenderness to press on her bones, hip, knee, lower back?  The chiropractor should be able to determine if there is tenderness of the bone, ligament, tendon, or fascia (connective tissue).  Is there any chance she has an infection in the bone (osteomyelitis)?  It is a rare event, clearly a long-shot, but it has happened without having a puncture wound to cause the infections.  Segmental dysfunction means that the joints are not working smoothly.  It is a subjective assessment and not a valid assessment for your daughter.  You will get different opinions of what is dysfunctioning from different providers.  It is an assessment that is used to guide manual therapists or chiropractors in determining where to provide treatment.  In other words, if her lumbar vertebra feels stuff/stuck on one side it is called segmental dysfunction and that is where the mobilization, manipulation, or other therapy is targeted.  You cannot determine dysfunction (3-D dynamic) from an MRI (2-D static).  As for spina bifida occulta, it is not the cause of the kind of pain you daughter is experiencing.  If she had a teathered cord or other cord abnormality, that would show up on the lumbar MRI.  She also would likely have neurologic symptoms if she had a teathered cord, e.g. sciatica, numbness, possibly altered reflexes as well, and not joint swelling.   My concluding thought is that the hip needs to be looked at more closely, with x-ray or, better, MRI.  I hope this was helpful.  Please feel free to ask more questions.   I would also be happy to consult with the chiropractor on this case.  Otherwise, feel free to fax me the chiropractor's report on your daughter (#'s on my web site).   

'Good luck with this.

Dr. G

www.drgillman.com