I recently had an MRI at a hospital here in my home state. I asked them to use the Potter protocol and brought all the paperwork with me but the radiologist told me that what they use is very similar to the Potter protocol. I guess she talked to Dr. Potter on the phone that morning.
So although the MRIs took 4 hours (!!!) I'm still unsure if the official Potter protocol was actually used...
Anyway, I thought I might post the results here to see if anyone has any ideas or suggestions.
Pelvic MRI
CLINICAL HISTORY: Lumbosacral plexopathy seen on EMG.
Impression
1. Temporal evolution of findings suggestive of either multifocal muscular myositis or denervation injuries to scattered muscle groups by the bilateral lumbosacral plexuses. On today's examination, there is prominent edema of the left obturator internus
and worsening atrophy of the right obturator internus.
2. No abnormality is seen in either the bilateral lumbosacral nerve roots, lumbosacral plexuses, or expected locations of the pudendal nerves. In particular, there is no evidence of nerve enlargement or edema. No obvious focal masses.
CLINICAL HISTORY: Lumbosacral plexopathy seen on EMG.
COMPARISON: MRI lumbar spine from today, MRI pelvis 09/04/2019 MRI hip 06/04/2019 MRI sacrum 11/14/2018
TECHNIQUE: Multiplanar, multisequence T1-weighted and fluid-sensitive oblique sequences of the lumbosacral plexus and proximal sciatic nerves from L3 to the lesser trochanters before and after administration of intravenous contrast.
Other: Imaging was performed in a 3 Tesla magnet using lumbosacral plexus protocol as well as pudendal nerve protocol. Protocols were similar to that used by the hospital for special surgery, as requested by the patient. (Actually, I requested the original protocol but ok.....)
FINDINGS:
Sacroiliac Joints: Small bilateral SI joint effusions are present. No erosions.
Hips: Trace osteophyte formation is in the right hip joint. No effusions.
Musculature: Similar to the prior examinations, there is mild edema and fatty atrophy in the multifidus muscles in the region of the sacral spine. The obturator internus has progressive moderate edema and mild enhancement as it swings around the pubic
bone posteriorly. This is best visualized on series 6, image 19 and series 3, images 9 through 60. This is just inferior to the expected locations of the sciatic nerve and the pudendal nerve on the left. No fatty atrophy of this muscle. The muscle is
expanded compared to the contralateral side and prior MRIs. The right obturator internus demonstrates moderate non-fatty atrophy compared to prior MRIs. The previously seen edema in some of the bilateral gluteus muscles is not visualized on today's
examination.
Lumbar MRI
Impression:
Unremarkable lumbar spine MRI. No abnormal enhancement. No evidence for infection, no diskitis or osteomyelitis. Benign-appearing levoscoliosis.
FINDINGS:
Neurologic Structures: The conus terminates at T12-L1. The conus medullaris and cauda equina are unremarkable.
Alignment: No listhesis. 13.0 degrees of levoscoliosis between T12-L1 and L5-S1.
Disk Levels/Facets:
T12-L1: Unremarkable.
L1-L2: Unremarkable.
L2-L3: Unremarkable.
L3-L4: Unremarkable.
L4-L5: Unremarkable.
L5-S1: Mild bulge. Normal disk hydration. Normal facets. No central or foraminal stenosis.
The left side (maybe my obturator internus?) feels twisted no matter which way I lie (on my side with knees slightly bent or on back with knees bent and angled to the right because I can't sleep completely flat on my back).
I've read of some people who have the obturator internus ligament cut during surgery to make more room for the sciatic nerve. (I also have sciatic pain on the left). Is this procedure something people on this site are familiar with?
It feels like both SI joints are twisted at really odd angles and pulling my muscles in weird directions. And of course the SI issues are then cascading to my pelvic and hip muscles too. Honestly, I wouldn't be surprised if my whole body is malaligned because I have scoliosis and am bedridden 90% of the time but even lying down is never completely comfortable, maybe 30-50% comfortable. My left side of my pelvis also looks visibly smaller than my right side.