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Tug lesion- any ideas?

immyaliimmyali Posts: 399
edited 06/11/2012 - 8:36 AM in Back Surgery and Neck Surgery
Hi all,

I had xrays of the lumbar spine and both hips yesterday due to persisting spine and right hip pain post ALIF surgery L5/S1.

The lumbar xray came back fine other than minor endplate osteophytes throughout the remainder of the spine.

But the Hip xray reads "There are no significant features of either an erosive or degenerative arthropathy and no protusion acetabuli. Tug lesions of the anterosuperior iliac spines bilaterally as well as the anteroinferior iliac spine on the left side noted related to muscle insertions"

Any ideas on what tug lesions are? The only things I can find on line about it doesn't sound too good to me.


  • Don't quote me on this, but I believe a tug lesion is similar to a little bone spur but it is at the point where a muscle or ligament attaches to a bone. I think they sometimes form in athletes who perform the same motion over and over again...like a baseball pitcher. At the point of attachment the soft tissue is under stress and it is pulled quite a bit from the repetitive activity and the bone develops a bump...almost like a callous.

    I may not be explaining it quite right but I don't think it is anything to worry about. It sounds like the hip itself is fine, no arthritis or other bony changes that might require surgery down the road.

    How long ago was your surgery? It is fairly common to have "issues" with some of the soft tissue that runs from the sacrum over to the hip area --there is a large attachment point that is located just to the outside of the hip socket and when there is pain there it often feels like hip pain. There are a number of large muscles that run through that area, like the piriformis. The sciatic nerve runs right beneath the piriformis. When there is any inflammation in the muscle, it can rub against the sciatic nerve and it feels just like any "radicular" or "sciatic" type pain.

    I have pain in this area and have been working for months with a massage therapist, a guy who is an acupuncturist and also has a degree in Chinese medicine, my PM guy, and lastly, my surgeon. You will find that the surgeons know the least about soft tissue/muscle issues and don't seem particularly interested either. If it isn't something they can fix surgically, they aren't all that interested. I shouldn't say they don't know...of course they know...but it seems to me they are reluctant to admit that something like muscles, tendons and ligaments could be causing pain...or don't want to get involved -- like it is beneath their expertise.

    Anyway, depending on how long ago was your fusion, and depending on what your surgeon tells you, you may have better luck dealing with an ortho. PT, or a medical massage therapist -- someone who knows a lot about how the body moves, how the soft tissue works, etc.

    Sorry this is long -- I hope something I've said helps a little.

    xx Gwennie

    You might want to get a hold of an atlas of the body and look at the drawings of the musculature, tendons and ligaments around the pelvis, sacrum and hip area. It is an amazingly complex area of the body...with the nerves weaving in and out.
  • I hear what your saying, i'm 4 weeks post surgery, the pain i'm getting is new, intense and i'm using a walking stick because of it. I was hoping I would be able to look after my kids by now, to ease the strain for DH, but no luck.

    I've been searching and it looks to me that a tug is more like a fracture or an avulsion, I could be wrong though, there's not much on that particualr terminology.

    My NS doesn't want me to have any kind of therapy until 6 weeks, so I have another couple of weeks to hang in there.
  • Well, you'll find out when you see your doctor....but I wouldn't worry. I think you'll find it is something you've probably had for a long time.

    Four weeks is very early in your recovery. It is not unusual to have a variety of pains at this point, some old and some you've never had before. Just follow your surgeon's recommendations, avoid doing too much...and walk and rest, walk and rest.

    I didn't start PT until 16 weeks. Every surgeon has a different opinion on that!!
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