As some of you know, I can be quite obsessive compulsive when it comes to test results. Mri #4 being no different! I was told that it would take 2 business days for the report to be done and delivered to Dr. K. My MRI was Fri at 7am. I called Tuesday, no report. I called again on Tues, no report. I called Wed, no report. So I called the radiology department directly (did I mention I have a touch of OCD), they confirmed that the report was indeed done, and had been sent to my doctor. Hmmmm, sigh! So I called his office yet again (they must love me) and informed them that the report was ready. I was told that they would send someone to go pick it up. I left my fax number and everything. No report. Today I was running out of patience, so I called his office again, no report. I told them it was done, and asked why they didn't have it, they told me that if they didn't have it by mon or tues (today is thurs) that they would send someone to go get it. I got off the phone feeling annoyed and exacerbated, called radiology again and explained my dilema. They offered to fax it to him (they can't fax it to me directly) on the spot, given my annoyance! 30 minutes later I called his office and they had it in the fax machine, now I hold a copy in my hot little hands!!!
Right Hip MRI #4 (edited)
There is mild trochnateric bursal thickening bilaterally. The anterior labrum is somewhat small probably related to debridement. the anterosuperior labrum is deficient, similar to the prior study, with the posterior labrum being intact. There is defect in the anterior capsule superiorly in the region of the surgery extending 2.5cm in transverse dimension.
Cartilage over the femoral head is thinned anterosuperiorly. Focally, there is no full thickness loss. the superior cartilage is high signal. The acetabular cartilage has thinning anterolaterally, slightly more prominent on the prior study as well as anterosuperiorly where there is a focal area of near full thickness loss which has increased from the prior study over 4mm. there is no prominent effusion. No reactive signal in the underlying bone is evident.
The patient has undergone anterior bumpectomy with remodeling of the anterior femoral neck. focal adjacent scar is evident.
There is iliopsoas tendon thickening and high signal representing tendinosis bilaterally.
Prior abdominal surgery has been performed
There is a transitional lumbosacral junction. Disc signal is mildly lost at what appears to be L4-5 where there is a small to moderate central disc protrusion. The sacroiliac joints show mild high signal and osteophytes. Minimal free fluid is the cul de sac. Hamstring origins are intact.
The muscles appear fairly symmetric.
The previously demonstrated left sided edema, presumably from arthroscopy of the left hip has dissipated.
There are 14 degrees of femoral anteversion.
Impression:
Interval bumpectomy since the prior study with postoperative scar and anterosuperior capsular defect.
There is persistently deficient anterosuperior labrum. Since the prior study, there has been a slight increase in the focal acetabular cartilage anterosuperiorly, without advanced arthrosis.
5 comments:
ummmm....so as impatient as you were for the results, i was too. ok, so i also have ocd. :) but i don't understand the report. is anything wrong?
soccermom
see next post!
Susie, must you rush into anything? I know you are in pain. This seems all so confusing as to the next course of action. Even being an nurse and having this surgery myself, not sure of the long term significance-but of course you are sick and tired of pain and even having to think about your hips after all this. Wonder was other docs would say-good luck.
Susie,
3 things struck me most reading your report.
1) The thickening of the psoas, tendinosis bilaterally;
2) Transitional lumbar/sacral area;
3) SI joint osteophytes
Of course there are the other listed issues, as related to your previous surgeries, but these "additional" issues struck me enough to question whether or not the effects of the transitional spinal area could be contributing to your hip pain/issues (and development of the other issues as well)?
I had read some information stating that lumbosacral transitional vertebra may be associated with hip issues, due to the associated changes in pelvic tilt...potentially predisposing one to joint laxity, subluxation, etc.
Of course, this was read about in dogs and not in humans, as all of this hip stuff is rather novel in humans anyway. But, it makes one think...
So I would wonder if this could contribute to those issues you are experiencing. It would seem feasible (to a lay person)that the pelvic tilt being off leading to those secondary issues could then possible contribute to tertiary issues such as labral tears, cartilage degeneration, and early onset osteoarthritis in the hip joint.
Anyway...food for thought?
BTW, have you considered a potential botox injection into your psoas at all, if DR. K thinks your psoas is contributing?
So he thinks the psoas is responsible, but we have had the same discussion in the past, excpet this time I have major (painless) snapping in the front. He does want me to have it injected with cortisone, to see if it calms everything down. But, as you can probably attest to, when you have a certain pain over and over, you know exactly where it is coming from, regardless of what a scan will show. My pain feels distinctively "jointy". Yes, the psoas runs through the joint as well, but my guess is that there is some acute inflammation in there.
The back stuff is pretty insignificant. I can't tell you how many people walk into my office with a diagnosis of a herniated disc. There was a study done where 50% of the participants, who had no back pain or symptoms, had a herniated disc in the lumbar spine. Given my age, number of pregnancies and type of work, it does not surprise me. The SI joint issues also don't surprise me given the amount of times I have had SI dysfunctions.
My pain is centralized in the groin only, as it was before all 3 surgeries.
Going back to the psoas thickening, I would guess that each time it snaps over the iliopectineal eminence, there is minor trauma to it.
I think injecting the joint is a good starting point as it will take care of alot of the structures, it won't be as accurate diagnostically, but since I am not looking into having surgery, I don't care all that much as long as it will alleviate my pain.
As far as a second opinion, again, since I am not contemplating surgery, I don't feel the need. Also, I feel like I already see one of the best scope surgeons in the country, who I am very happy with, so where do I go from there?
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