[30F] With pelvic instability, groin pain, and systemic symptoms

What might be happening

Based on the information you’ve provided, your symptoms likely involve multiple underlying issues. Here’s a summary of the most likely causes:

1. Chronic Lumbar Radiculopathy

Your EMG findings suggest chronic irritation or compression of the L4 and possibly L5 nerve roots in your lumbar spine. This can explain:

• Groin pain: Nerve root compression can cause radiating pain to the groin, outer hip, and knee.
• Pelvic tilting and instability: Weakness in muscles like the gluteus medius and rectus femoris can lead to abnormal pelvic alignment.
• Knee weakness and unsteadiness: Early neuropathic changes in the tibialis anterior muscles may contribute to difficulty walking.

2. Pelvic Floor Dysfunction

The pulling sensation in your pubic area, tightness during intimacy, and changes in pelvic alignment may be related to pelvic floor muscle dysfunction. This could stem from:

• Muscle imbalances caused by nerve irritation (radiculopathy).
• Chronic tension or weakness in the pelvic floor muscles.
• Possible structural changes in the pelvis.

3. Autoimmune or Connective Tissue Disorder

Your history of sun sensitivity, rashes, purple knees, and systemic symptoms (e.g., weight loss, fatigue, enlarged lymph nodes) raises concern for conditions like lupus or dermatomyositis. These could explain:

• Scapular winging: Muscle inflammation or weakness.
• Systemic symptoms: Fatigue, fevers, and weight loss.
• Lymph node enlargement: Cortical thickening on ultrasound may indicate inflammation or immune system activation.

4. Neuromuscular Disorder

While less likely, your symptoms (e.g., difficulty swallowing, muscle weakness, and pelvic instability) could suggest a neuromuscular condition like myasthenia gravis or ALS. However, your EMG findings do not strongly support these diagnoses.

What you can do

1. Address Groin Pain and Pelvic Instability

• Seek imaging: A lumbar MRI is essential to confirm nerve root compression and identify structural issues like disc herniation or spinal stenosis.
• Consider physical therapy: Work with a pelvic floor specialist or physical therapist to improve muscle balance and pelvic stability.
• At-home care:
  • Avoid activities that worsen pain, like prolonged walking or standing.
  • Use supportive seating to relieve pressure on your pelvis.
  • Gentle stretches for the hip and lower back may help reduce tension.

2. Evaluate Systemic Symptoms

• Consult a rheumatologist: Blood tests for autoimmune markers (e.g., ANA, anti-dsDNA) can help rule out lupus or other connective tissue disorders.
• Monitor lymph nodes: If they remain enlarged or worsen, further imaging or biopsy may be needed.
• At-home care:
  • Protect your skin from sun exposure with sunscreen and clothing.
  • Track systemic symptoms like fevers, fatigue, and weight loss using MDandMe to share with your doctor.

3. Manage Muscle Weakness

• Neurology consult: A neurologist can assess for neuromuscular conditions and correlate EMG findings with your symptoms.
• Physical therapy: Exercises targeting scapular winging, neck strength, and lower extremity stability can help restore function.
• At-home care:
  • Avoid heavy lifting or activities that strain weak muscles.
  • Use heat or ice packs for pain relief in affected areas.

4. Address Intimacy Concerns

• Pelvic floor evaluation: A specialist can assess tightness or dysfunction in the vaginal and pelvic muscles.
• At-home care:
  • Practice relaxation techniques to reduce pelvic muscle tension.
  • Consider using a vaginal dilator or lubricant if intimacy becomes painful.

What you should look out for

Seek urgent medical attention if you experience:

• Worsening groin pain or inability to walk.
• Severe pelvic instability or inability to sit upright.
• New or worsening systemic symptoms, such as high fevers, night sweats, or rapid weight loss.
• Signs of nerve damage, such as numbness, tingling, or loss of bladder/bowel control.

Your symptoms are complex and require attention from multiple specialists, including a neurologist, rheumatologist, and pelvic floor therapist. Using MDandMe to journal your symptoms and track progress can help provide valuable insights for your providers. Let me know if you need further clarification or support!