Shoulder Update

I was able to get an appointment today for my shoulder, luckily, as I don't think I could have gone on for one more day with that pain. My shoulder OS was not happy to re-inject me at all :-( He was worried about fat atrophy and warned me that if ti happened I would not be happy. I explained that I am having hip surgery on 12/1 and cannot address shoulder until after that. I also added that it is hard for me to work and function at the moment given the pain. He thinks I need to get it taken care of, possibly before hip. Given my current mental and emotional state regarding my hip, that is not even up for discussion. He asked me how often I use my hip to manipulate a patient!!! Good point, but I'm still not even considering that. I think I am probably going to schedule it about 5 weeks after hip surgery, I know it is crazy but I need to get everything taken care of once and for all.

I spoke to my PT since I was at the hospital and we discussed my upcoming hip surgery and I wanted his take on the shoulder. He agrees that it needs to be taken care of and thinks 5 weeks after is not at all unreasonable.

So...hip then shoulder.......HEELLLPPP!

Why Why Why

Aside from my ridiculous, drawn out hip issues, I think I have mentioned that I also have a shoulder issue. I have had 2 cortisone injections, the each last about 6 months. I am at that 6 month mark right now and in excruciating pain. the last time I saw my shoulder doc he warned me that he won't keep injecting me forever, eventually I will have to "address" the issue. "Addressing" the issue obviously means surgery, which at this point is just plain funny to me, I mean, how many surgeries can one person have in such a short amount of time?

At the same time though, how much pain can I deal with in such a short amount of time? People have suggested that I have my shoulder and hip done at the same time which must be just about the dumbest thing anyone could say. But, I am seriously considering doing it 4 or 5 weeks later...the pain is that bad. I have an appointment with my shoulder doc in about a month but there is no way I can wait that long. I am going to call today and beg and plead for an appointment tomorrow, I need an injection just to work, sleep, take care of my kids etc. And I will be open to discussing (not scheduling) surgery...I can't keep living like this.

On a brighter note, I have had to pop Advil like candy just to function with this shoulder pain and my hip is reaping the benefits!!!

The Pre-op Appointment

I field a lot of questions from fellow hip pain sufferers, whether it be about surgeons, surgeries, insurance questions etc. I am more than happy to help since I know first hand what it is like to be alone and afraid and not have the answers. The only question that often times annoys me is "what should I ask my surgeon"? I really can't answer that, you need to ask him the questions that YOU have about your hip. What may be important to me may not be important to you and vice versa. With that being said, I went to my appointment with a LONG list of questions for my OS.

I needed this to help calm me down and get all of my questions answered. I also needed this to make it more "real" for me! It went really well and he answered a lot of my questions before I even asked them! Its good that we can still joke around about things bc it makes difficult decisions a lot easier! When I told him that I need the post-op/ rehab to be perfect bc this is the 5th time we are having this conversation, he jokingly said "No, its the 4th time, don't exaggerate!!"

So below are the questions I had written down to ask him followed by his answer. I also scheduled another appt a few weeks before the surgery bc I'm sure I will have more questions. If u think I left something out plz let me know and I will bring it up next time.




1)What r we calling the procedure?
Labral reconstruction
2)How long will the procedure take?
Forgot to ask!
3)Will I be able to go home that day?
Yes
4)What will u be using for the allograft for the labrum and the capsule?
Labrum- sometimes uses a rectus femoris autograft but will use semitendinosus allograft
Capsule- achilles allograft with synthetic scaffold
5)How do u secure the allograft?
The same way as a labral repair- with anchors and sutures + scraping bone to make it bleed a little
6)What exactly is the scaffold that u want to use for the capsule?
He used a name but I forgot! It has been used for rotator cuffs for abt 10 years
7)I really think its impt for the capsule to scar down- brace? For how long?
Not the philippon brace bc its not too effective, not hip dislocation brace bc I will be miserable- he found a different brace at bauerfiend, looks like philippon brace but "better", also 1 boot @ night to prevent rotation
8)What will my WB status be and for how long? Do we need to protect the graft?
Same as labral repair, labrum is not load bearing and only stressed in extreme ROM, so 2 weeks of 20lbs wb and mostly to my comfort
9)How long until I can drive?
When I am off narcotics
10)My hamstring tendon has a chronic tear, r u going to address it?
Prob not, it tends to tear with hip pain bc you post tilt your pelvis and it becomes shortened and can tear and in severe cases rupture. He may put in PRP
11)Sub spine impingement- do I have it?
Prob don't have it but will double check- doesn't really matter bc the part he will be scraping down to attach the allograft is where he would shave down
12)What do I do abt PT? I only want P...does he only see professional athletes these days :-)
Yes- professional athletes and me!!! Absolutely, he wouldn't have me go to anyone but P
13)Shoulder- when to get cortisone injection? I already had 2, shoulder OS said only one more- so do I get it now? Or will my shoulder be worse on crutches, should I save it for then? Or can I convince shoulder OS to inject 4x?
It will prob hurt on crutches but don't worry, I can inject it for u a 4th time but don't tell him :-)
14)Pre-op Class, do I have to go?
Yeah, if u want to teach it!!
15)Pre-op online questionnaire do I fill it out?

Yes, its like a report card on me! Hopefully one day ur score can be high!!
16)Post op appts- I want to see my OS at suture removal- receptionist said I can only see nurse- I was pissed!
I can see OS

I Scheduled It...AAAHHHHHH

I was at work today, minding my own business, and my cell phone rang. It was my OS' surgical scheduler. And in a peppy voice, she said "Hi, I'm calling to schedule your surgery", as nonchalantly as someone would call and ask what I would like to order for lunch. I was a little caught off guard, but managed to hold it together long enough to get this done!

So, surgery #5 is scheduled for....drum roll please....December 1, 2011

Let the countdown begin! (anyone have a Xanax)

More Problems With UHC

I know a lot of you are drawn to my blog because of the battles I had with United Healthcare at the time of my last surgery. I hope my blog has been helpful to you. Now I am back in the trenches with them and extremely mad. This time, it is not about my hip, but it is about reimbursement. If anyone can share some advice on this, I would be grateful.
About a month ago, I had a bad infection on my hand that required me to go see a hand surgeon. I needed to be seen right away and ended up going to someone out of network who saw me that day. I paid upfront, she did a procedure in the office, and my hand got better. United Healthcare is allowing a fraction of the amount I paid the surgeon and reimbursing me very very little. Has anyone ever dealt with this before? I have to appeal this now, but don't have as much time as I did with the last appeal since I am currently working, and not home recovering from surgery.
Please comment here for others to see as well, or email me suzq613@aol.com

The Plan...Finally

So after 6 months of pain, x-rays, MRIs, injections, talk of alternative therapies and talk of crazy surgeries, I think I have found my happy medium. I spoke with my OS and this is what we decided.

First of all, he is not upset at all that I went to see OS2, he said he prob should have sent me himself.
The only reason he has suggested open surgery for me is bc he feels that after 3 failed scopes, we prob should try something different. But at the same time, the scopes were all done for different reasons. Other than having to send a young patient for a hip replacement, one of the things he really hates is unnecessary open surgery. He told me there is nothing he cannot do arthroscopically that can be done with an open surgery. I think this was one of my happier moments of the past 6 months!
He said usually, in a scope, he will use an autograft from the capsule and rectus femoris to augment the labrum. Since my capsule is already compromised he will do it with an allograft. Since my capsule has already been repaired once and failed again, he will use allograft tissue there as well, he will also use a scaffold to strengthen it (this is apparently done often in shoulder surgery).

We discussed the ligamentum teres and my wishes for a new one! He said that u don't need it unless ur capsule is compromised. My thought is if ur already scoping me, just do it. He said it is EXTREMELY experimental surgery, they still don't know a lot about the biomechanics of it, and he wouldn't know how tight to make it, and he thinks I will hate it. He said right now I am having trouble bc the ligamentum teres is torn and getting caught. Once he debrides it and fixes the capsule, I will be happy again.

I am concerned about the post-op period, since I tend to be lax with the brace and weight bearing. I asked him to put me into a very restrictive brace post-op. He said absolutely, he will have me fitted for a hip dislocation brace and have it set to slight IR, and not allow more than 30' ER for the first 6 weeks. He warned me that I will hate it!! I'd rather be miserable for 6 weeks than be back to where I am right now in another 2 years.

I asked if he's ever scoped someone's hip 4 times, he said never his own patients, other ppls screw ups yes, but never his!

So I have to let him know when I want to do this, so he can plan accordingly, get his allografts and scaffolds together!
Even though it will be my 5th surgery, I am so happy that we have found a way to do it that doesn't make me want to throw up every time I think about it!

The Second Opinion

Surprisingly, I got a call back from the second opinion doctor's office on Monday, and they were able to see me on Wednesday due to a cancellation. I was so happy but a little nervous because I was not really prepared yet. To simplify things, he will be referred to as OS2. OS2 took about 30 minutes to go over my films, re-checked all of my angles on my x-rays, and read my latest MRI. He was wonderful, I explained my long history to him. He did a clinical exam. He found that I had almost no IR and about 90' of hip flexion (I was having a really bad day yesterday). The test he did for instability was positive, but not as positive as he would like it to be. He would have liked me to have jumped off the table with that. I dont know what to think, I don't think I have "instability", I think it is "micro-instability", so I am not sure what that test should show. OS2 then suggested that it would probably be a good idea to call my OS...uh oh!!!! This was a 'top secret' appointment. I explained to him that my OS hadn't sent me, and didn't know I was here. He assured me that he wouldn't be upset, that he would actually be relieved to have help with this complicated case. I told him that what I wanted to do was hear what he thought and what he proposed, and then decide if he should call my OS. He agreed to that!

He thinks I have a loose body in the joint. He does not think that my labrum is too small at this point and he is recommending a scope to look around and try to fix things. He thinks an open dislocation is a huge deal and thinks that by trying a scope I am not burning any bridges, and if there is a possibility that I can be helped with a much smaller surgery, then he sees no reason to try it.

I decided to let him call my OS and discuss. And he did, while I waited!! They spoke for a while, and I patiently waited. When they finally got off the phone, OS2 called me into the room that he was in to discuss.

He said my OS agreed to do a scope, he wasn't too keen on the idea since it failed so many times, but OS2 pointed out that my left hip is awesome! So I should have scope potential! OS2 said that he still doesn't think my labrum is too small or should be causing me issues, but my OS fought him on that and said he has been in my hip 3 times and knows what it looks like and it is definitely too small. So he will put in an allograft to create a new labrum, re-repair the capsule, and...here is the kicker....they will do it together!!! OMG...I was laughing so hard, but I was so happy. I've never been happier being told I need surgery, but a scope vs open.....I am thrilled!!!

What A Long Journey This Has Been

I definitely owe everyone a quick summary of what has been going on lately with my hip, but today is my 10th wedding anniversary, and all I can think of is that I have been dealing with my hip for half of my married life. It is making me very depressed.

To quickly summarize what has been going on, my OS really would like to avoid operating on me, for the 5th time. I can't blame him! So he is proposing we try something called ARP wave therapy. No one really can tell me what it is, other than a certain type of electrical stimulation. No one really knows if it will work but it can't hurt, so why not. I will hopefully know more about it in the next week.

In the meantime, I have decided to get a second opinion from another surgeon, an unbiased, no baggage, black and white, second opinion. I think that my OS and I have too much history for either of us to make the right decision at this point. If in the end I do need surgery, I will probably go with my OS, but I would like someone else to look at my films and tell me what they think. Someone who doesn't know me, and frankly, doesn't care if I have more surgery or not. The appointment is not set up yet, I left a message for his office staff.

In the meantime, I go through good days and bad days, and of course, this makes the process so much more difficult. If I always had good days, well, you wouldn't be reading about this. If I only had bad days, I wouldn't question anything. Its the good and bad that make me doubt everything, make me question everything, and quite frankly, are driving me crazy. There is no rhyme or reason at times either as to why I feel the way I do. I wore heels for a few hours yesterday without a bit of pain. I can actually usually wear heels and my hip doesn't hurt. It does feel awful in the sense that I don't walk well with them, I feel unstable, and my feet hurt!! I actually often have a sense of instability in my right hip, I try to avoid extending it fully when I walk by doing a strange rotation thing with my pelvis. Very strange!!

So the waiting game continues. I am waiting to hear more about the ARP wave, waiting to see if it works, waiting to get an appointment from my second opinion, and waiting to see if this will all go away, just as quickly as it came on!!!

Thinking and Worrying

Since I had spoken to my OS on a Friday evening, I had to wait until Monday to really explore my options. The first thing I did was call the chiro to see if he was a good fit for me, and to see what his fees are since they do not take insurance. To make it short, sweet and simple, I hated him! He was arrogant, condescending and an all around asshole. There is no way I can work with someone like that.
I also have gone over the MRI report and gone over it again and again. I have discussed things with my husband to no end. He thinks I am being silly and stubborn and need to bite the bullet and agree to an open surgery. I think I am starting to agree, but the thought of it scares the crap out of me. TO scare myself even more, I watched a video of the procedure today....probably a very bad idea.
I emailed my OS because I have a ton of questions and think we need to address a lot of issues, mainly that I am freaking out!!!! Of course he has to be on vacation at the exact time that I am having an emotional breakdown, but I guess it doesn't really qualify as an emergency!
So I will "patiently" wait to hear from him, and go from there!!

MRI # 7 Report

On the current examination, there is no occult fracture or osteonecrosis. No bulky synovitis is seen. There is however, marked attenuation of the iliofemoral ligament with some progressive hyperintensity in the interval since the prior study in 3/10 but overall residual discontinuity and poor tissue remodeling. There is considerable scarring of the synovium adjacent to the ligamnetum teres and this is progressive in the interval since the prior study. Effects of neck debridement are noted. There is high grade cartilage loss over the posteromedial parafoveal aspect of the femoral head extending focally down to the subchondral bone. Marked hyperintensity and high grade partial loss is seen anteriorly over the dome with progressive hyperintensity and partial wear since the prior study. No defined bone on bone contact is seen. There is intrasubstance degeneration of the superior labrum as well as degeneration of the anterior labral remnant but no defined split.

The hip abductors and short external rotators are notable for mild insertional gluteus minimus tendinosis. Insertional iliopsoas tendinosis is seen with a remodeled insertional partial tear. There is no atrophy of the iliacus muscle in the pelvis. There is no trochanteric or iliopsoas bursitis. No ischial bursitis is seen. Bilteral hamstring tendinosis is seen with a nonacute low grade partial tear affecting the semimembranosous origin on the right.

Subsequent quantitative MR imaging demonstrates prolongation of relaxation times, most strikingly affecting the parafoveal posteromedial aspect of the femoral head, some prolongation anterior medial dome with relative preservation over the superolateral dome.

Impression:
MRI of the right hip demonstrates features of instability with poor remodeling of the iliofemoral ligament and progressive scarring of the synovium, adjacent to the ligament teres in the interval since prior study 03/10. There is also progressive wear of cartilage with corresponding prolongation of relaxation times, as outlined above. Degeneration of the anterior labral remnant is noted without acute split.

Psoas Release...something to consider

A few years ago, prior to my first revision surgery, I had an argument with my OS about whether my psoas tendon should be released or not. I, under no circumstance, wanted it released. He insisted that I should let him release it. I ended up not allowing him to, and 4 years later, we have this study. I do not have increased femoral anteversion, but I am having other types of instability and cannot imagine where I would be now if we had to add a lengthened psoas to the mix of issues.


Study Identifies Patients Who Should Not Undergo Surgery for a Snapping Hip Tendon New York—July 10, 2011

Researchers at Hospital for Special Surgery have identified a group of patients who may have increased difficulty for surgical treatment of a snapping psoas, a condition that usually develops because a teenager or young adult has a pelvis that grows faster than their psoas tendon. The study will be presented at the annual meeting of the American Orthopaedic Society for Sports Medicine (AOSSM), held July 7-11 in San Diego.

“The conclusion from this study is that you should be cautious about releasing the psoas tendon, particularly in cases where there is some structural instability in the hip, specifically increased femoral anteversion, because although the tendon may be causing pain, it is also providing some dynamic support to the hip so it can cause problems if it is released,” said Bryan T. Kelly, M.D., who led the study and is co-director of the Center for Hip Pain and Preservation (www.hss.edu/hippain) at Hospital for Special Surgery (HSS) in New York.

The study received the 2011 Herodicus Award given annually by the Herodicus Society at the AOSSM meeting for the best paper submitted by an orthopedic resident or sports medicine fellow.

The hip is a ball-and-socket joint where the head of the femur (thigh bone) rotates within the cup-shaped socket of the pelvis. The head of the femur is supported by an angled neck which joins to the long thigh bone. At the base of the femoral neck is a boney protrusion. The psoas tendon is one of two hip flexor tendons that attaches to this protrusion. When the pelvis grows faster than the psoas tendon, this tendon becomes tight and snaps over the pelvis during walking or other activity. This condition, which can be painful, is known as a snapping psoas tendon.

“The reason that it snaps usually has to do with the anatomy of the pelvis. We usually see it in adolescent hips where the pelvis is growing at a faster rate than the tendon can accommodate for the growth,” said Dr. Kelly. “Structurally the tendon is not long enough to accommodate the bony anatomy.”

Doctors usually treat a snapping psoas tendon with physical therapy that involves stretching and strengthening, anti-inflammatories and corticosteroids, but if this doesn’t work, doctors resort to surgically lengthening the tendon. Because the tendon does not have the ability to stretch, surgeons cut slits in the tendon in what is called a partial release of the tendon or a fractional lengthening. “You cut it in a way that allows the muscle to elongate,” Dr. Kelly said.

Studies have shown that arthroscopic and open surgery can achieve similar outcomes for this condition. Few studies, however, have studied whether abnormalities in hip structure, specifically femoral anteversion, can impact outcomes. In most people, the center of the femoral neck points toward the center of the hip socket. Femoral anteversion is a condition in which the center of the femoral neck leans toward the front of the socket. This causes the knee and foot on the affected side to rotate internally or twist toward the midline of the body.

In December 2006, HSS researchers started a prospective registry of all hip arthroscopy procedures performed during a three-year period, 2006 to 2009, by a single, high-volume arthroscopic hip surgeon, Dr. Kelly. The study presented at AOSSM included all patients who underwent a psoas tendon lengthening at the time of surgery, a minimum of six months follow-up, and a preoperative high-resolution computed tomography (CT) scan to detect femoral anteversion. Patients were not included in the study if they had previous tendon hip surgery or hip trauma.

Sixty-seven patients underwent arthroscopic lengthening of a symptomatic psoas tendon, either in isolation or in conjunction with treatment for hip impingement. CT scans showed that 19 of 67 patients had high anteversion. The researchers assessed clinical outcomes both before and after surgery with modified Harris Hip Score (MHHS) and Hip Outcome Score (HOS) questionnaires. These are commonly used to evaluate a patient’s ability to carry out specific activities that involve the hip: activities of daily living, such as climbing stairs, and athletic activities, such as running and jumping.

Prior to surgery, patients who had high anteversion scored significantly worse in terms of athletic activities on the HOS, but there was no difference in either questionnaire scores in terms of daily living activities. After surgery, patients who had high anteversion scored significantly worse on the MHHS questionnaire with regard to athletic and daily living activities, but the HOS scores were similar between the two groups. Twice as many patients who had high anteversion had to undergo revision surgery.

The researchers say the psoas tendon may be an important stabilizer in the hips of patients with high anteversion, and the tendon’s release in these patients may result in a delayed return to activities after surgery and inferior outcomes.

“The results of this study indicate that there are certain groups of patients that respond very favorably to surgical treatment of the psoas tendon, but there are other groups of patients that due to mechanical reasons, surgeons should exercise extreme caution in proceeding with any tendon release around the hip,” Dr. Kelly said. He said these patients should be considered for alternative treatment strategies.

Other authors of the study are lead author and orthopedic surgery resident Peter D. Fabricant, M.D., and Katrina Dela Torre, R.N., M.Sc., at HSS, and Asheesh Bedi, M.D., former HSS fellow now at the University of Michigan.

MRI Verdict

I spoke with my OS abt the latest MRI. We did a T2 mapping study to visualize the cartilage and get a better picture of the hip. He reviewed my MRI w the radiologist and says that there is no question that I have micro instability bc: 1) the ligamentum teres is torn (not sure if more torn since last surgery bc its the most difficult structure to image) 2) labrum is very small and can no longer provide suction to the joint 3) the anterior capsule is thinned out near the iliofemoral ligament, this is an area that was previously thickened (after the last surgery).
All of this is causing small, excessive motion in the joint. He is not 100% sure what is causing the posterior pain but says it is most likely the ligamentum teres. The cartilage in the back of the joint is a little thinned as well.
He wants me to continue to strengthen the muscles around the hip in order to provide stability to it. The only surgical option is an open surgery- which I told him makes me want to throw up! He knows I feel very very strongly abt not wanting more surgery. We did not get into details abt what he would actually do in said surgery, other than the fact that its a big deal and he has only done 5 of them before.
He is recommending I see a chiro who deals with musculoskeletal issues and treats professional athletes (not sure how he will feel about treating an everyday housewife :-) and does "different" types of therapies. I obviously don't need ART or any release work since I already have instability, and I looked up the chiro and all his techniques are release techniques...but I guess we need to try everything, and I know enough (and have a big enough mouth) to not let him do anything I think will make me worse.
So it's off to the chiro I go!!!!!

Micro Instability???

I'm sorry that I haven't been updating my blog too frequently, it has been tough lately since a) I'm not really sure what is happening in my hip and b)I have very little free time.
I have been in PT for 2 months now and overall have not seen a change in pain level or symptoms. I'm pretty frustrated bc I was really hoping that this would be the solution for me. I saw my OS yesterday to review things again and decide what to do.
PT has been addressing the muscles, and trying to correct a muscle imbalance, I have not made progress :-(
My biggest issue is that I am having all this pain, off and on, yet my MRI shows nothing. To me, this is worse than if it showed a lot of issues, I feel like I am crazy!! My OS assured me that I am not crazy :-) and agrees that we need a better way to image this hip. He is recommending a new MRI with a stronger magnet that can map out the cartilage in the hip. He thinks that I probably have some micro instability due to issues in the capsule and ligamentum teres, and hopes that this new MRI will show something. He also thinks that my labrum is very small, so it is possible that it is no longer providing the suction in the joint that it is supposed to provide.

He explained that he looks at hips in 4 layers- 1) the muscles 2) the 'inert' labrum, ligaments, capsule 3) bony structures 4) nerves. He suspects my problem is with level 2
If you have read previous posts, you will know that me and MRIs do not get along. So I was not thrilled to hear that my first MRI was not of the greatest quality and that I would need another one....So to 'cheer me up' he gave me a rx for Valium for it!
He thinks that if the ligamentum teres is the problem, it will show some changes to the cartilage around the ligament.
If this is the case, then he thinks it would require surgical intervention...then he started talking about the possibility of an open surgery....at that point I freaked out....really really freaked out!!! I told him that I just couldn't discuss it right now, and that I thought the best thing would be to get the MRI first, then discuss it, if needed. He agreed and is happy that we are both on the same page, meaning wanting to avoid surgery at all costs.

Or Is It?????

I am starting to have my doubts again....Over the last week or two, I have been having a gradual increase in pain. Is it because the honeymoon from my vacation is wearing off, or did my cortisone injection actually help more than I thought it did, or am I just plain screwed at this point?????

My new PT continues to address issues in my thoracic spine, ribs, abdominals, which are extremely messed up. I saw her last week, she barely touched my hip and worked a lot on my ribs, which are incredibly messed up, 2 are practically stuck together. She also worked on my thoracic spine and teaching me how to breathe. When I left, my hip was killing me. I thought it was so interesting since she barely worked on it.
What I am experiencing now is an irritation inside the joint when I try to work on hip flexion. I do it in quadruped with gentle rocking, and in standing, by hip hinging. When I try these, I end up with an extremely sore and angry joint.
I am also experimenting and seeing what happens if I only work on the hip or if I only work on the back...what will the hip do. So far both irritate the hip...so I am at a complete loss.

I saw my OS last week, and he agrees with me that I should continue to work with my new PT. He told me that he is finding a different type of problem in women. He called it acetabular-femoral impingement. When someone has regular FAI, in some people, the pelvis will tilt posterior to ease the pain of the impingement, and they end up with issues in the back, like on the hamstring etc. My conclusion is that I have the opposite, I have some sort of problem in the posterior side of the joint so my pelvis is tilting anterior, in turn, all of my anterior hip muscles are "freaking out". One thing my PT is very frustrated at times with is that my pelvis remains more anterior on that side, despite trying to hard to correct it. I am wondering if this is what I am experiencing. Definitely something to discuss this week.
My OS still cannot find anything really wrong with my MRI, which is good and bad! He wants me to come back in 6 weeks, but if things are not better in 3-4 weeks, he wants me to call him. I decided to ask a stupid question, what if PT doesn't help me...then what. He said he would want to scope it, to see what is happening......NO WAY. He promised me that he feels just as strongly as I do about NOT wanting to scope this hip...but it may be the only thing left to do. So....PT needs to start working really well ASAP!

Wow, PT is working!

I have been to my new PT twice so far, but I am definitely more compliant with my exercises than I have ever been in my life. We (she) have discovered that my glutes have completely stopped working, my hip slides anteriorly, my ribs/ thoracic spine are really tight, all of my "large" hip muscles are working overtime and my smaller, stabilizing hip muscles are not working at all. Even if my ligamentum teres is torn, she thinks that by strengthening the proper muscles and getting the "wron" ones to shut off, I will regain my ROM and restore my pain free status.
One of he things I have been doing alot of is rolling on a tennis ball to release trigger points in my muscles. I am amazed at how tight and painful my quad is. It is by far the most painful muscle to roll out.
I still have pain with sitting but it is nowhere as bad as it used to be. I am definitely seeing a light at the end of the tunnel and am keeping my fingers crossed that this is what I have needed the whole time!

Taking a Different Approach

Sorry if I left you hanging! I was on vacation for 10 days and as usual, incredibly busy with life at home. The good news is that while I was on vacation, I felt great, after a few days in sunny Florida where I did absolutely nothing, my pain started to disappear. Once I got home, it slowly started to come back, which leads me to the conclusion that I should retire now!
It is not as bad as it was before I left and I can tolerate sitting which is a huge plus. But I have decided that I need to do something, and everything that I have been doing is not working, and no one that I have worked with knows how to help me, and my brain has shut off regarding this. So I found myself a new PT. I definitely feel that I am cheating on my old PT, but since I wasn't getting better, I needed to move on.
I saw my new PT yesterday. It is a totally different experience than my old PT, who ran his office similarly to the way my office runs. Chaos, patients everywhere, running around from one patient to another. My new PT only sees one patient at a time, the office reminds me of a spa, I walked in to absolute silence. A completely different experience than I have ever seen at a PT clinic. I gave her my ridiculously long hip history, which took up most of the session!!! She found a lot of dysfunction in my back, it is stiff and I don't move well. Also instability and weakness in my hips. Surprising to me, she found a lot of tightens in my upper back and she thinks that those restrictions are what is causing my hip and SHOULDER problem. I am definitely getting a bang for my buck!!! As she started releasing restrictions in my upper back, I don't think I have ever experienced such pain before. But then she re-checked my hip flexion and I had gained ROM. She then checked my abdominals and found a lot of restriction in my external obliques. She also said my rib cage was tight. So she worked on releasing restrictions there, ouch. Ounce again, my hip flexion ROM increased. It was pretty incredible, something I had never thought of.
I am going to try to see her 1x/week, I have appointments set up for the next 6 weeks. It is pretty far away and she doesn't take insurance, but I think that if she can help me, it will be priceless.
My homework is the continue to work on releasing restrictions in my abdominals, and try to expand my ribcage. Also quadruped rocking to maintain my hip flexion, and learning to breathe properly with diaphragmatic breathing.
Keep your fingers crossed that this is the solution!!!

Video Presentation on the Ligamentum Teres

During my "research" today, I came across this: More than 120 physicians from around the world gathered in Vail, Colorado on March 17–19 for Smith & Nephew’s 5th annual Vail Hip Arthroscopy Symposium. The three-day educational event was led by Marc J. Philippon, MD, managing partner of the Steadman Philippon Research Institute. Link to Symposium info The focus of the symposium shifted to “New Procedure and Unique Cases” on Day Two. Richard Villar, FRCS, Spire Cambridge Lea Hospital, UK, opened the session with a presentation called “Ligamentum Teres: The Forgotten Ligament.” Mr. Villar described the three classifications of ligamentum teres injuries; Type 1 (complete tear), Type II (partial tear) and Degenerative (not torn but not functioning). Treatment options include removal (with RF or shaver) or reconstruction. Mr. Villar reached the following conclusions:  The ligamentum teres is likely to have a function; do not ignore it  Arthroscopic surgery (of whichever sort) appears to work  The ligamentum teres may have healing potential Video

PT...Again

I had my latest PT appointment on Thursday, it was incredibly disappointing. I guess I am looking for a miracle and there really isn't a miracle out there at the moment. I said to my PT "so, he didn't know what to do with me so he dumped me on you", he agreed!!! He is at a loss, pretty much, and with his expertise, if he is at a loss, I am screwed!! He said he wants to treat it like an ACL/PCL injury in the knee, where all the stabilizing structures are gone. So we started with some gentle isometrics and proprioception exercises. I am going on vacation tomorrow so will continue to do them while I am away and see him when I get back. In the meantime, I deiced to explore some other options and contacted another PT who may have a different kind of approach. I am going to see her at some point as well when I get back from vacation. I hope she is more optimistic and can help me, bc I don't know how much more pain I can take at this point.

The Latest Appointment, Still No Answers

I saw my OS yesterday...he still doesn't really know what's going on. His best guess is that ligamentum teres is torn, which is why I am having so much posterior pain and so much trouble sitting, and that the capsule got stretched out, which is why I am having muscle spasms, to try to stabilize the hip. I have a lot of clicking going on, he initially said its prob psoas but then he actually heard it and said it is not psoas, sounds like intra articular clicking, maybe ligamentum teres...bottom line is he said avoid doing it! He also said that he was actually really upset that I had relief from the cortisone injection since it does mean that the problem is coming from the joint, he was hoping that it wouldn't help at all and we could address things outside of the joint. We discussed the drugs I have tried so far, Celebrex made my Crohn's disease flare up, and Ultram made me dizzy and crazy. "Lucky" for me, I brought J along with me for "support", my OS wanted to know how Ultram made me crazy, "basically, it turned me into a psychobitch", to which J added "well, it was hard to tell the difference from how she normally is". Thanks J, really appreciate the support :-) I made him compare my 2 MRIs side by side, to actually see if there was a change in the capsule, they both looked pretty good (one from this month and one from last year), so he doesn't think the capsule is actually torn. He wants me to go back to PT, gave me Baclofen for the muscle spasms, and see what's happening in a few weeks. He also wanted to give me a medrol dose pack for the pain but we ended up agreeing that it wasn't what I wanted bc of the very remote possibility that it can cause AVN. He wants me to be patient and try to work through it w PT and see what happens! When I came out of the room his PA was there, so I said to him "he basically has no idea what is going on", and he told me that my OS studied my mri so hard, trying to see a problem. "I guess I have really photogenic hips" I said So that's the story!

Turning Point

Last Friday was definitely "rock bottom" for my latest hip saga. Things began turning around this past week, I think I was wrong about the cortisone and it is finally kicking in, it took its sweet time but yes, I began feeling its effects mid week. Most importantly, sitting is not excruciating anymore. The best days were Wed and Thurs I think, I had absolutely no posterior hip pain at all, I had some groin pain those days, but I did well physically and emotionally. Friday was not as good as Thursday and Saturday was not as good as Friday, but I hope to continue to get some help from this latest injection. Yesterday I had an event to go to and I had to wear heels. I had no pain while wearing them, but I just did not feel good about it. My hip could not handle the heels and the joint just felt "slidey", like it could not control my leg in the shoes. Ironically,I came home and put on sneakers and had a ton of pain, go figure!!! As I sit here writing this, It is getting a little difficult to sit. My husband keeps telling me to "stop thinking about it", but how can I not, I am still nervous, and I am still in pain. I see my OS on Tuesday, stay tuned for an update Tuesday night!!!

And The Saga Continues

Monday was my cortisone injection, Tues-Thurs were a little bit better. I went for a session of reflexology on Thursday afternoon, since it usually helps relax me, and my nerves have been shot lately, Ive never had so much anxiety in my life. I was speaking to the massage therapist about my "issues", and he thought I should get a massage. My muscles are in horrible spasm, I kind of wanted a massage but was scared of getting one because in my mind, the muscles are in spasm for a reason. I texted my PT, he said to ice and tape my hip. I really cant tape it on my own, and I cant stay in bed all day with ice. I texted him again on Friday morning and asked if I should just get a massage to ease up the spasm. He called me back and said that a deep tissue massage would be a bad idea, but a lighter massage may help. I told him that if one more person at work asked me if I was ok, if I should be working, if I should be doing this, I was going to scream. He gave me permission to punch the next person in the face :-) He also, again, said I need pain meds! So he called my OS office and I got Ultram. I took one Ultram late Friday afternoon, it helped with the pain but not fully. so I decided to take another. Bad idea. I could barely get off the couch, I was so dizzy and lightheaded for the rest of the night, and I didn't sleep well. Saturday I took 1/2 of a pill and was less dizzy, but dizzy nonetheless. The good thing is that for me, a little goes a long way and it has really helped my pain. I don't want to take one today because it is L's b-day party in the afternoon and we have a lot to do, and I don't want to feel like crap. Icing also goes a long way for me, unfortunately its hard for me to find time to do it. The second I lie down with ice my kids either need my ice, need me to get up and do something, or decide to jump on my leg.

Hip Injection #8...done

I was able to get in for an injection yesterday afternoon purely by the grace of G-d...and maybe a little begging on my part to "please take me out of my misery"!! Driving down I could barely sit, the posterior joint pain and lateral posterior pain (what I believe to be ischiofemoral impingement (IF) was really awful. Before I had left my house, I tried some pain provocation tests so that I could have a baseline and a before and after. I did a lunge with the left leg in front and on a stool, some impingement tests and some other movements of the leg. The injection was more painful than I remember it ever being, probably because I have scar tissue built up in there. Before the injection the radiologist tried to provoke pain, he did some FAI tests and they hurt in the groin, he could not reproduce the posterior pain but I explained that I had been able to earlier. He told me to check those maneuvers out again later. I said if I could drive home without pain I would be thrilled!! After the injection most of the tests he did provoked no pain anymore. I limped back to my car, sat down and panicked...the back of my hip still hurt. After a minute, I guess the drugs made their way back there and posterior pain was GONE! I drove home comfortably and happy. The IF pain was still there but without the posterior joint pain it seemed a lot more manageable. After 3 hours my "honeymoon" was over and the pain hit hard. When the kids were finally in bed I was able to ice for about an hour. I then decided to go to sleep but the pain was there so I went back for the ice and ended up falling asleep with it on until I woke up 3 hours later! This morning I think the posterior pain is better, the true test will be when I get into the car in an hour! Keeping my fingers crossed

Why Why Why

Thurs morning after PT I was in the car and using the "water bottle trick", after about 2 minutes I began having anterior hip pain. When I got out of the car my psoas/ iliacus were in spasm. That's when I began to freak ot. I texted my PT with a desperate message. He called me back, said to stop doing that bc it was causing my femur to be pushed anteriorly and making the psoas try to stabilize it. He also said I needed to get my pain under control ASAP, I coldn't sit down. So I tried to get in touch with the OS office.....
Yesterday I iced, took Vicodin, Motrin....Was in a lot of pain. I was up in the middle of the night icing and medicating...its been rough.
I finally spoke to the PA today, he called in Celebrex for me and I am going to try to get a cortisone injection next week into the joint to calm things down. He said the psoas is going into spasm to stabilize. I don't like this one bit.

Still No Answers

I got home from PT last night with more questions than answers. My PT thinks the hip is loose and and lax,this is about all I got. I am also really weak in the glutes, he is not sure if it is a straight out weakness or if they re inhibited by pain. The rest kind of went in one ear and out the other. I am so overwhelmed with all of this that I cant even process anymore. He thinks there may be a coverage issue somewhere (don't ask me where) but I could be getting pinching from some sort of impingement posteriorly. Honestly, this is all too much for me to handle. I was doing a lunge yesterday (just to demonstrate for a patient) with the good leg, the bad leg was behind me, in extension. This set off so much pain I think I saw stars and almost passed out in the middle of my office. My PT wanted me to try that with a posterior pelvic tilt and an anterior pelvic tilt to see if one was better, I was too scared to reproduce that pain again that I couldn't do it. He thinks I may need a stress test to check for laxity in the hip, I'm not sure what this would accomplish, or what it entails, I was too scared to ask.
In the meantime he gave me one exercise to do at home, a standing hip abduction with my hip in IR. He also told me to put a small water bottle under my thigh near my butt when sitting to make sitting less painful, it takes the pressure off of the ischial tuberosity.
And so the roller coaster ride begins, and the psychosis, paranoia etc. Because there will be days when I have no pain at all, and days that are excruciating, and it will drive me up a wall!!

It's Official, My Shoulder Officially Sucks

Tomorrow will be 2 weeks since I had my AC joint injected and my pain is back full force. I guess I was dreaming when I had hoped to get 6 months out of this latest injection. I don't know what to do now, But working is killing me. I had someone in my office work on it today, I got a whole 90 seconds of relief...so not worth it!!!

Hip MRI #6...done

Yes, I had yet another MRI on my hip. Last week my x-ray was fine, over the weekend I was able to ice and rest and was feeling better. Monday the pain was back with a vengeance. I freaked out and emailed the PA from my OS office. He said to have an MRI and come in today.
Since this latest "episode" of hip pain started, I have been having a ton of anxiety and been having trouble eating bc I am so scared. I took (my first ever) Xanax on Monday night. this morning I woke up at 3:30 with my heart racing and my stomach in knots. By 5:30 I decided to eat something since my stomach probably hurt from lack of eating. By 6:30 my heart was still racing and I felt like I was going to throw up. Xanax #2 was a god send. It totally calmed me down and took the edge off. The MRI was almost relaxing!! It was the first time I was able to rest with no kids calling me, no blackberry, no work!!

Right after the MRI I went to see my OS. I explained what happened, and that I was having posterior joint pain. He looked at the MRI, the labrum and capsule were fine, thank goodness. There seems to be a little abnormality at the ligamentum teres, which could cause posterior joint pain. there is also irregularity at the quadratus femoris, which is what can get impinged with ischiofemoral impingement. I have not done all that much research on ischiofemoral impingement but I guess that will be on my to do list. It is an extra-articular impingement, he thinks its possible that bc I have some more motion now that that is getting pinched. But, I have pain in the joint with internal and external rotation, which leads him to believe it is being caused by the ligamentum teres.

The plan is to keep trying to ice and rest, go back to PT, in 2 weeks if its not better then we can discuss an injection. Where? I'm not really sure, but I'm hoping that PT can help decipher where the pain is coming from, and better yet, eliminate it to avoid an injection.
When I left his office, I was feeling better, less anxiety, but later in the day the pain got bad again and all of my anxiety came back....I don't know where I am going to find the strength to deal with this...again

##$%#&* Right Hip

Ok, so if you read the yahoo group postings yes, I am having hip issues again. At first I was having throbbing in my hip at night mostly. The pain started getting worse, it was radiating to the side of my hip, the back of my hip and down my thigh. It was for the most part groin pain though. I was trying to stretch it and stretch it since it is tight in the front still, and at times it bothers me that it is so tight. Yesterday, i was stretching it and got a good pop, which is not abnormal for me, when I had it in external rotation. Since then, I have a lot more range into ER, but when it gets to endrange, I have pinching in the back of the joint and behind the greater trochanter. I also have a ton of posterior hip pain, all the time, it hurts to sit down which is really hard for me.
I had an xray today, and of course I had no idea what happened to me (it wasn't until later that I was able to clear my mind and and remember these events, and even now, I'm not 100% sure if this is the issue). Thank goodness the xray was fine, no fracture or infection, which was a big concern of mine. As of now, my butt really really hurts, and ER, which used to be my position of comfort, is not uncomfortable. I am limping at times....this stinks.

Hopefully hopefully hopefully, it was popping of scar tissue, and now there is localized inflammation and it will pass in a few days. I will keep you posted!!!

The Good and Bad News

I had been putting off going back to my shoulder doctor for fear that he would want to order an MRI. The good news is that things looked bad enough on x-ray so an MRI is not needed. The bad news is that I am practically bone on bone in my AC joint and he is recommending a distal clavicle resection. It does not need to be done now, he did give me another cortisone injection, but warned me that I cannot keep having them, and I will have to have it 'fixed' sooner rather than later. I am hopefully going to get a long stretch of relief from this injection and not have to think about this for a while.

Popping In To Say Hi

I haven't bothered anyone with my woes lately, life has been busy, the kids are 6,5 and 2, and getting big! My left hip as always, is perfect. My right has been once again giving me some trouble, I'm not sure exactly what is going on, I see my OS next month, so we will find out then. My shoulder is a mess, I see the shoulder OS on Tuesday, hopefully for another lovely dose of cortisone!!! I just wanted to add a few cute pics of the kiddies and day hello!

New 2011 CPT Codes for Hip Arthroscopy

◦29914 – Arthroscopy, hip, surgical; with femoroplasty (ie, treatment of cam lesion)
◦29915 – Arthroscopy, hip, surgical; with acetabuloplasty (ie, treatment of pincer lesion)
◦29916 – Arthroscopy, hip, surgical; with labral repair

Aetna and FAI 2

A few months ago a fellow hipster sent me a post and asked me to publish it on my blog. It was about Aetna and their refusal to cover FAI surgery. That post generated many replies, including the one below.
This is a response from Aetna:

The date on our website is not the date that the update will be published, but the date that it will be discussed by our Clinical Policy Council. All updates have to go through a subsequent review, approval and implementation process. We expect the update to be published by the end of the year.



Should you have any questions or concerns, regarding these policies contact provider of services dedicated lines; Indemnity and PPO- based benefits plans 1-888-MD Aetna (632-3862) for HMO benefits plans – 1800-624-0756. Our Provider Service Representatives are trained to specifically handle any concerns you may have.



Also, for your convenience any future concerns or questions regarding our policies can also be faxed to us at 859-425-3379.

November 18, 2010 11:56 PM

Below is the original post:
Sent to me by a fellow hip friend:

Aetna’s assessment of FAI is archaic and asinine!

As you all are aware, our cause for UHC’s coverage of FAI was very successful including a NY Times article and many reversed appeals in favor of the patient. UHC along with other major insurers (BCBS, Cigna, Kaiser) now covers the arthroscopic treatment of Femoroacetabular Impingement.


Unfortunately, Aetna still has not caught up with the times. Many of our fellow patients have been successfully treated with hip arthroscopy and have been able to move on to enjoy active lives. People that are insured with Aetna are being discriminated against IF they also have a diagnosis of FAI. Aetna has taken the position that the use of the hip scope is unproven and/or experimental. This is absolutely ridiculous. It is very obvious that the bottom line is that it IS a covered procedure by the other insurers so how is Aetna’s non-coverage of this procedure accurate?



Aetna would rather have a young active patient become so disabled that their medical situation deteriorates to the point of needing a total hip replacement with all the associated medical risks and financial costs. Take the example of your typical patient. Young, active 30 year old Aetna consumer who is denied access to treatment for FAI. Based on Aetna’s opinion, the patient will go untreated for years UNTIL the patient requires a total hip replacement. Of course, doctors won’t typically do a THR on someone under 60 so this patient has to wait 30 years for treatment because of Aetna’s inaccurate and woefully pathetic position on FAI treatment.



Mr. Ron Williams (CEO of Aetna) when is Aetna going to catch up with the peer reviewed literature and your peers? When is Aetna going to reverse the policy so that your clients that need this surgery will have the same rights as patients that have UHC, Cigna, BCBS and Kaiser? When will Aetna decide that they would like the “A” in Aetna to equate to “Amazing” instead of “Awful’?posted by Susie at 7:47 PM on Sep 28, 2010

Double Update

Hip: I had an appt with my hip OS a few weeks ago but haven't had a chance to post yet. I am almost 1 year out from my last (4th) hip scope and very pleased with the results. I have no pain at all in my hip. the only residual effect from that surgery is that my hip is really tight and still catches and pops quite often. I don't care though, I will take that over groin pain any day. My OS explained that during the capsule tightening procedures, sometimes they make it a little too tight, he recommended more PT to keep it loose, since that is what I do when it gets bad, but he would like me to take a more preventative approach with PT and go before it gets bad. In theory, that is a wonderful idea, in reality, who has time for more PT!!! He also offered me a cortisone injection into the capsule, which I politely declined as well...no more hip injections for me! I will deal with this!

Shoulder: It has been 2 weeks since I had the AC joint injected and I am thrilled with the results. The joint does not hurt at all anymore. Although I still get some pain around the area sometimes, It is tolerable. In a very "susie-like" fashion, I requested the OS office note and the radiology report on my x-ray...OS suspects AC joint arthritis, if the injection doesn't help he will order an MRI to rule out osteolysis, which is not a common problem in 30 year old housewives!!!! (ok, I work too, but still...), it is more of a weight lifter issue, and the only weights I lift are 40 lbs toddlers and pots and pans!!!!

Cost of Hip Arthroscopy has been updated

http://susie711.blogspot.com/2008/01/cost-of-hip-arthroscopy-and-its.html


Surgery # 4 numbers have been added...1 year later!! Life has been pretty busy!

Cortisone Injection # ?????

As I had hoped, my "new" OS gave me a cortisone injection. He agreed that whatever my issue is, it is coming from my AC joint. He is not sure what or how I injured it since there was no trauma, but he thinks that given my line of work, it is not too shocking. My x-rays were good, no arthritis or separation, he thinks that it is just a local inflammation and hopefully the cortisone will knock it out.
Most of his pain provoking tests referred pain to the front of my shoulder, at the AC joint, and there is tightness with horizontal adduction. I am pretty sure the cortisone in working, I felt no pain right after which is good since he used some local anesthetic with the steroid when he injected.
I hope to continue to report improvement with the shoulder!

Shoulder...

As my shoulder issue continues to be an issue, I am happy to report that I finally took the time to listen to what my body was telling me and self diagnose!!! I do not have a labral injury or a rotator cuff injury, rather, an acromioclavicular (AC) injury, or, a separated shoulder. Whats funny is that this is usually caused by trauma or a direct fall onto the shoulder....but not me, I just 'develop' these issues! Since it does not seem to be getting better, and I am having trouble sleeping at night and difficulty working, I made an appointment with a shoulder specialist. What a breath of fresh it air to deal with his office...I called Thursday and was given an appointment for Tues...5 days later....I think I waited for my first hip appointment 4 weeks and currently people are waiting 6 weeks or longer to see my OS. So I will hopefully see him tomorrow, hopefully he will give me a cortisone injection and I will be on my way!!!

Massage...Ahhh!!

I went for a 1 hour massage on Tuesday in hopes of leaving a little more relaxed and in less pain. The massage therapist asked if I had any "problem areas", so I told her my right shoulder had been bothering me. She said she would focus a little more on it while she worked.

So the massage began and she began working on my scapula and upper trap, "wow", she said, " this is really bad". She continued for another few minutes, and then said "I think I can spend the entire hour on this shoulder, if you want, or I can leave it if this is too painful for you and do the rest of your body". I told her to just do the shoulder. It was excruciating, every spot on the entire upper right quarter of my body was so painful. There were knots everywhere, she used her elbow, she was dripping sweat halfway into the massage. After the hour was up, she said that it looked better, definitely lower and softer, but she could spend another 2 hours on it if she had the time.

The rest of the day and into the next day were really painful. It hurt to touch the area. By Thursday night it was beginning to feel better. I have had a lot less pain in it and am able to use it more than I was. I am hoping that it was a big muscular issue and I won't be dealing with it anymore. I will keep you updated since I still continue to have pain at night and some of the surrounding muscles still hurt.

Running...Again

I decided to give running one more chance, how bad can it be, I already had 4 hip surgeries, hurt my ankle, peed all over myself and hurt my shoulder...does lightning really strike twice????

So....most importantly, the pelvic floor exercises really worked, no more incontinence on the treadmill!!! This was the main reason I hadn't gone back to running. It was a huge concern of mine and luckily I was able to take care of it. The hips and ankles did great as well. Unfortunately, running bothered my shoulder.....strange as it sounds. At about 22 minutes I gave up completely on running and stuck to walking, I guess the pounding and vibrations seem to upset it too much.

Shoulder Update

For those of you with shoulder issues, please chime in and tell me if any of
this is familiar. I have pain on and off, sometimes I am 100% pain free, other
times I am in agony. I can do anything with it, but will immediately know if I
shouldn't have bc it will hurt. Nights are the worst, sometimes I can't sleep it
is so bad. The pain is usually right at the top/front of the shoulder but will
radiate to the back of my scapula, down my biceps or triceps and into my upper
trap. I guess it depends what I do and how I compensate. I ice, I heat, I
Flector, they help but the pain come back. I am trying to strengthen my rotator
cuff but it is painful and I usually have more pain later in the day when I do.
My ROM is starting to feel limited at endrange, so I am stretching it daily.

So...those are my symptoms. I have also done acupuncture and moxa, acupuncture
didn't help, moxa may have, I just did it last night so the jury is still out. I
just want a quick fix and for the pain to go away!

Shoulder Now.....Please Make It Stop

Very interestingly, a few weeks ago, it was brought up on the FAI yahoo group that many people on the list who have had an acetabular labral injury have also had a glenoid (shoulder) labral injury. While the anatomy of the 2 is very different, the hip is an inherently stable joint and the shoulder is an inherently unstable joint, I found it odd that so many people had both issues. I don't think there is a relationship and I doubt that so many people have any underlying soft tissue pathology, but who knows. Honestly, I think that it has to do with the fact that these types of injuries occur in young and active populations. I didn't think much of it until about 3 weeks ago when my shoulder began hurting...alot.

For the past several months, I have had pain at the top of my shoulder and my upper trap, I attributed it to stress and promised myself that I would schedule a massage. Of course I never found time for a massage so continued to suffer. It was especially bad at night, so I attributed it to my pillow and switched to another one. That didn't help. The pain then travelled into my shoulder joint, into my biceps and posterior scapular muscles. It hurt at rest, more at night, felt weak, at times it is difficult to hold a glass of water or coffee cup. I can do everything with it, and it usually doesn't hurt while I am doing it, but will hurt right after. It feels weak but I cannot pinpoint one spot where the pain is, it is an entire area. The last 2 nights I have slept with a Flector patch on it and it seems to be helping.

Just as the hip issues were beginning to clear up, this happens. I am at a loss with this and don't know what to do.....

Aetna and FAI

Sent to me by a fellow hip friend:

Aetna’s assessment of FAI is archaic and asinine!

As you all are aware, our cause for UHC’s coverage of FAI was very successful including a NY Times article and many reversed appeals in favor of the patient. UHC along with other major insurers (BCBS, Cigna, Kaiser) now covers the arthroscopic treatment of Femoroacetabular Impingement.


Unfortunately, Aetna still has not caught up with the times. Many of our fellow patients have been successfully treated with hip arthroscopy and have been able to move on to enjoy active lives. People that are insured with Aetna are being discriminated against IF they also have a diagnosis of FAI. Aetna has taken the position that the use of the hip scope is unproven and/or experimental. This is absolutely ridiculous. It is very obvious that the bottom line is that it IS a covered procedure by the other insurers so how is Aetna’s non-coverage of this procedure accurate?



Aetna would rather have a young active patient become so disabled that their medical situation deteriorates to the point of needing a total hip replacement with all the associated medical risks and financial costs. Take the example of your typical patient. Young, active 30 year old Aetna consumer who is denied access to treatment for FAI. Based on Aetna’s opinion, the patient will go untreated for years UNTIL the patient requires a total hip replacement. Of course, doctors won’t typically do a THR on someone under 60 so this patient has to wait 30 years for treatment because of Aetna’s inaccurate and woefully pathetic position on FAI treatment.



Mr. Ron Williams (CEO of Aetna) when is Aetna going to catch up with the peer reviewed literature and your peers? When is Aetna going to reverse the policy so that your clients that need this surgery will have the same rights as patients that have UHC, Cigna, BCBS and Kaiser? When will Aetna decide that they would like the “A” in Aetna to equate to “Amazing” instead of “Awful’?

Hip Issues and Incontinence

If you are thinking this is TMI, then I suggest you stop reading. As usual, I have no problem discussing the things that no one else wants to.
When I initially had hip pain, over 3 years ago, one thing In noticed was that I had to do a pelvic floor muscle (PFM) contraction, or kegel, when I would cough or sneeze. I never actually leaked urine but felt that I was going to. With regular PT, this got better and I forgot about it. Last week I was doing jumping jacks with L when I suddenly leaked so much urine that it was running down my legs. I was shocked. I not only had never actually leaked urine, but this was a huge amount, and completely out of the blue. I have been having a lot of tightness in my hip, and even had to go back to PT yesterday for a "tune up", but I see no other reason for this.

At PT, my PT loosened up the anterior capsule for me and sent me on my way, encouraging me to go back to running to keep the hip stretched. I did, last night I got right back on the treadmill and began running. I started feeling leakage again and couldn't believe it, I was leaking urine again. Now, jumping jacks I don't do on a regular basis, but running...I never ever had a problem with running. I am totally freaked out by this. My only saving grace is that I was home both times. Yes, I ahve had 3 babies, 4 hip surgeries, but urinary incontinence is NEVER normal.

So, what am I doing about it? PFM exercises, and more PFM exercises. Kegels when I remember, plus hip adduction (squeezing a ball in between my knees) and hip ER/abd with a theraband around my knees. I am going to do them aggressively, I won't be running for a while because I will be travelling a lot in the next week and a half, but hopefully when I get back things will be strong again and I wont have this problem anymore.

Checking In

Wow, what a slacker I have been! The truth is that I turn to my blog when things are not going well, and well, for the most part they have! I am not running at the moment bc it was bothering my hip, but between you and me, running is probably stupid and I shouldn't be doing it. I also just left my job of 5 years, but decided I wanted to try my new job before quitting, so for a period of time I was at 2 jobs. I am now back down to one job and feeling a lot more calm. As far as my hip goes, it has been tightening up, and the capsule gets caught on something and I experience a lot of clicking. It also gets stuck sometimes and will pop loudly when it finally gets unstuck. I should go back to PT for a "tune up" but haven't had time! I will see how things go, and now that I have more time I will go back to running again, and see how I feel!