THIS week I am very pleased to answer three readers’ questions regarding muscle and joint issues.

My advice is given in good faith, according to current guidelines, but cannot be a substitute for consulting with your own doctor.

Question – I’ve had lower back problems for years. The pain has got worse and now shoots down my left leg all the way to my foot. Why am I only getting a scan of my lower back, and not my entire leg?

Paul, 67

Answer – From your description you have a disc in your lumbar (lower) spine, pressing on a nerve root. The nerves come off the spinal cord and pass through an opening between two consecutive vertebrae (the bones which make up your spine), called the foramen.

Where the nerve leaves the spinal cord is referred to as the nerve root.

Magnetic Resonance Imaging (MRI) is the most commonly used tool to look at the state of the spinal canal, and if a nerve root is being compromised. This may be due to a disc pressing on it, or the foramen becoming narrowed. This is known as stenosis.

When the nerve runs in your leg, it is less likely to be compressed by anything surrounding it. Hence scanning the leg will not add any useful information.

The degree of compression of the nerve, as well as the severity of your symptoms, will guide those treating you as to what to do next.

Question – I thought I had hip pain, but even though my x-rays show arthritis, the physiotherapist advised it was coming from my lower back. Please can you explain?

Sandra, 60

Answer – Hip and low back pain are often confused. If your pain is in the lower back, or indeed the side of your leg, it is less likely to be coming from your hips. If you feel pain on the outside of your leg at the top, this is most likely to be trochanteric bursitis. This is an area on the top of your femur (thigh bone), similar to the knee cap. Like the knee cap, it can become inflamed and pain may go down the outside of the leg as far as the knee.

The hip joint itself is a ball and socket joint and sits deep in the groin. The pain from hip arthritis is felt in the groins, or in the middle of the buttocks. Because of its closeness to the genitals, hip pain may be confused with discomfort in these.

While x-rays may show arthritis, if the pain is not coming from this region when you are examined, it is likely that this is not the cause of your symptoms. The majority of people over the age of 40 will have some degree of arthritis on x-rays, whether they have symptoms or not.

Question – I have pain in my shoulder but because I’ve been a smoker, the GP requested a chest x-ray as well as my shoulder, and marked it as urgent. I’m extremely worried.

Martin, 65

Answer – shoulder pain may be caused by problems other than shoulder arthritis. If you are a smoker, or have a long smoking history and have recently stopped, your doctor may be concerned about the possibility of a lung cancer in the top of your lung on the side where you are reporting shoulder pain.

This is known as a Pancoast tumour. It is a relatively rare form of lung cancer, making up less than one in twenty lung cancers.

The pain is caused because the tumour presses against the brachial plexus, a set of nerves that run from the upper chest and into your arm and neck.

Pain may be felt in the shoulder, between the shoulder blades, or down the arm. Pancoast tumours are also less likely to produce typical symptoms associated with lung cancer such as chest pain, cough and shortness of breath.

Hopefully your chest x-ray will come back as not showing anything suspicious.

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