Psoas Mass

30 year old female. Consistent R sided low back and right anterior and lateral hip pain when back gets really bad.  Currently an achy dull 2/10 but gets up to a sharp stabbing 9/10.  Provocative is lumbar extension, also abdominal training, and sitting for 3+ hours hip flexion after leg day is also painful.  Palliative is laying on her stomach and child’s pose.

Patient has had this pain for 9 years.

All level one tests are 100% with the exception of QLF which is 60% 11112.  SLPF also brings on tension in the right side of the low back and right posterior thigh, patient can touch the floor.

Patient came to me with an MRI and a neurosurgical referral.  

MRI findings:

At L2-3 there is a large right sided cystic mass within the right psoas muscle measuring 5×4.5x3cm and protrudes into the right L2 neural foramen. Radiologist believes this is a psoas abscess, and states that a cystic neural tumor would be extremely rare.

Patient went for neuro consult today and neurosurgeon ordered an MRI with contrast to better visualize the mass he believes it is a cystic schwannoma.  She follows up with him next week after the imaging and he has put the option of surgery clearly on the table.

The MRI also shows an L4-5 annular bulge.

Diagnosis at this point:

1-Right psoas mass causing L2 foramen crowding

2-Adhesion in bilateral multifidus, Longissimus muscles

3-L4-5 annular bulge

My question is, “Is now the right time for my treatment?” 

Using reverse compatibility some data points go toward disc and some go toward this mass.  So I feel treatment is warranted at this time even though it likely wont effect the priority problem.