Hip Labral Tear and FAI Articles

Acetabular Labral Tears
by Cara L Lewis and Shirley A Sahrmann
PHYS THERVol. 86, No. 1, January 2006, pp. 110-121
Anterior hip or groin pain is a common complaint for which people are referred for physical therapy, with the hip region being involved in approximately 5% to 9% of injuries in high school athletes.1 Although anterior hip pain is known to result from a number of musculoskeletal and systemic pathologies, a tear of the acetabular labrum is a recent addition to the list that is of particular interest to physical therapists. This mechanically induced pathology is thought to result from excessive forces at the hip joint2,3 and has been proposed as part of a continuum of hip joint disease that may result in articular cartilage degeneration.2 Although the number of recent articles in the orthopedic literature identifying acetabular labral tears as a source of hip pain is increasing, labral tears often evade detection, resulting in a long duration of symptoms, greater than 2 years on average, before diagnosis.4–8 Studies have shown that 22% of athletes with groin pain9 and 55% of patients with mechanical hip pain of unknown etiology2 were found to have a labral tear upon further evaluation. In order to provide the most appropriate intervention for patients with anterior hip or groin pain, physical therapists should be knowledgeable about all of the possible sources and causes of this pain, including a tear of the acetabular labrum and the possible factors contributing to these tears. Therefore, the purpose of this article is to review the anatomy and function of the acetabular labrum and present current concepts on the etiology, clinical characteristics, diagnosis, and treatment of labral tears.


Acetabular Labral Tears of the Hip: Examination and Diagnostic Challenges
RobRoy L. Martin, Keelan R. Enseki, Peter Draovitch, Talia Trapuzzano, Marc J. Philippon
J Orthop Sports Phys Ther. 2006:36(7):503-515. doi:10.2519/jospt.2006.2135

The purpose of this clinical commentary is to provide an evidence-based review of the examination process and diagnostic challenges associated with acetabular labral tears of the hip. Once considered an uncommon entity, labral tears have recently received wider recognition as a source of symptoms and functional limitation. Information regarding acetabular labral tears and their association to capsular laxity, femoral acetabular impingement (FAI), dysplasia of the acetabulum, and chondral lesions is emerging.
Physical therapists should understand the anatomical structures of the hip and recognize how the clinical presentation of labral tears is difficult to view isolated from other hip articular pathologies. Clinical examination should consider lumbopelvic and extra-articular pathologies in addition to intra-articular pathologies when assessing for the source of symptoms and functional limitation. If a labral tear is suspected, further diagnostic testing may be indicated. Although up-and-coming evidence suggests that information obtained from patient history and clinical examination can be useful, continued research is warranted to determine the diagnostic accuracy of our examination techniques.
Video of Hip Exam from this Article


The Hip Joint: Arthroscopic Procedures and Postoperative Rehabilitation
Keelan R. Enseki, Peter Draovitch, Bryan T. Kelly, RobRoy L. Martin, Marc J. Philippon, Mara L. Schenker
J Orthop Sports Phys Ther. 2006;36(7):516-525. doi:10.2519/jospt.2006.2138

Recent technological improvements have resulted in a greater number of surgical options available for individuals with hip joint pathology. These options are particularly pertinent to the relatively younger and more active population.
The diagnosis and treatment of acetabular labral tears have become topics of particular interest. Improvements in diagnostic capability and surgical technology have resulted in an increased number of arthroscopic procedures being performed to address acetabular labral tears and associated pathology. Associated conditions include capsular laxity, femoral-acetabular impingement, and chondral lesions. Arthroscopic techniques include labral tear resection, labral repair, capsular modification, osteoplasty, and microfracture procedures.
Postoperative rehabilitation following arthroscopic procedures of the hip joint carries particular concerns regarding range of motion, weight-bearing precautions, and initiation of strength activities. Postoperative rehabilitation protocols that have been typically used for surgeries such as total hip arthroplasty are often not sufficient for the population of patients undergoing arthroscopic procedures of the hip joint. Postoperative rehabilitation should be based upon the principles of tissue healing as well as individual patient characteristics. As arthroscopic procedures to address acetabular labral tears and associated pathology evolve, physical therapists have the opportunity to play a significant role through the development of corresponding rehabilitation protocols.

Video of Hip Arthorscopy from this article


Acetabular Labral Tears

J Bone Joint Surg Am. 2009;91:701-710. doi:10.2106/JBJS.H.00802
Paul E. Beaulé, Michelle O'Neill and Kawan Rakhra
Acetabular labral tears rarely occur in the absence of a structural osseous abnormality.
Labral tears are frequently associated with lesions of acetabular cartilage such as delamination.
Hip arthroscopy is the preferred operative approach in the treatment of labral injuries in the absence of substantial structural osseous abnormalities.

see a later posting for more on this article

What My Readers Symptoms of FAI or Labral Tear Were

Ok, so this is not a scholarly peer reviwed journal or anything, but I have found it helpful to know what other people have experienced, and I assume you do too, or you wouldn't be reading this. In the past, I have polled my readers to find out what their symptoms of FAI and or labral tear were, here is what they have shared. Feel free to add your own in the comments section, or email them to me and I can edit this post.
Here were my pre-op symptoms: Groin pain, deep deep groin pain, not always excruciating, but so annoying I felt like cutting off my leg, tight hip flexors, pain with sitting, pain with walking uphill, pain with pushing my stroller. I did not have radiating pain down my legs, all the hip pain was anterior medial.
This is what my readers had to say:
-At original onset of pain, I had acute, sharp pain along with a deeper pain in the anterior (non-PT term - front) hip. Once the acute pain subsided, I was left with a persistent but not 100% constant deep ache (only way I can describe it is comprable to early labor pains, or really bad menstrual cramps, or, in other words, not bad enough to put me in bed, but bad enough to ruin my day - but deep in my hip joint) along with the occasional "catching" of my hip. I would be walking and suddenly it would pinch and hurt too much to walk normally. I would usually stretch or range my hip and that would sometimes work. Otherwise I'd just have to wait it out, and later that day, the ache would be particularly bad. Now (3 + years post op) I'm at the achy stage, with occasional catching and occasional pain that is bad enough to keep me from sleeping, ie: can't find comfortable position, even with pillow between legs, must get up and take 600-800 mg Advil and wait. Those have been my symptoms to date. Hope this helps. I am eager to read about other people's symptoms - knowledge is power. (This reader had a scope a few years ago for a labral tear, her symptoms came back, she ended up being diagnosed with FAI and had an open surgery to address it)

-Clicking, catching (especially when changing direction when walking or getting in and out of car), deep aching. Now post op (scope with labral debridement of fibrillated labral tear) and still have aching (especially with sitting for long periods), nerve pain in thigh and butt, episodes of the hip giving way (though less frequent now). Pain is better with rest and worse with increased activity. Am now six months post op. Wish I had just broke it lol

-My symptoms started with groin pain, which seemed both deep and also superficial, and sometimes radiated up to my lower right pelvic/abdominal area. After awhile, I developed pain over my greater trochanter and in my piriformis muscle. Before my first scope I had SI joint discomfort as well, and also IT band tightness and soreness down my thigh to my knee. At first my pain was intermittent, but over time it became constant; it would get better or worse, but there was always a baseline amount of pain. Driving was horrible. Groin pain was always the worst symptom. Yuck!

My 1 Year Anniversary

Today marks the 1 year anniversary of when my hip saga began. For anyone just beginning their journey, I can assure you that in the hands of the right surgeon, there is a light at the end of the tunnel. I am going to do a flashback to November 28, 2006.

Shit, my hip hurts. It hurts when I drive, and especially when I push the kids in the double stroller. It is a really annoying pain. It feels like something is in my joint. My friend/ PT is coming into work around 3, I will ask her to work on it and hopefully get some relief. She showed up and I told her I was dying of pain, she did a painful release on my iliacus/psoas, I felt better immediately, but in the car on my way home, things got bad again.

I went into work the next day, again, in agony. First I had one therapist stretch my hip flexors and ITB, thinking this may help. Then I had another one check it out. She said there is definitely some kind of impingement. Then I asked P for help. He was really busy so I waited until he was done seeing patients. What makes the day so memorable is that it was Jk's 1st birthday, and I was having a small dinner party, and lacking a few key ingredients. I used P's full schedule to run to the supermarket near my office but didn't find what I was looking for (which I now don't even remember what it was). P did all kinds of releases, ART, mulligan mobs...It felt good...until I was in my car again. Shit. What is this????

I got home, L had ballet and there was no food for my party! I ended up ordering pizza, Jk didn't know the difference! After we had cleaned up and the kids were in bed, I hit the computer. I had a feeling I had a labral tear, and the word impingement reverberated through my head. I think I first looked for a surgeon, before I did anything else, that is me, always thinking ahead! I was trying to remember when I had seen a hipscope, and who did them, and no one was popping into my head. At the time, there was a hipscope patient in my office and she was a wealth of information, but I wasn't willing to see her surgeon (he was in NJ), I knew it had to be someone at HSS. So I looked and searched, and researched labral tears, FAI.....Not just that night, but every night after that for weeks. After a week or 2, I decided this wasn't getting and made an appointment with Dr.Kelly. I was between him and another surgeon. I had emailed a professor of mine about this and he had recommended against the other surgeon for personal reasons. So Dr.Kelly it was. If things didn't go well, then I would pursue other options, it was just a consult, right. Hopefully he would order an MRI and get to the bottom of this. The rest is history....but in a nutshell...

3/5/07 R hip arthroscopy, Pincer impingement, labral tear debridement, synovectomy
7/2/07 L hip arthroscopy, Cam and Pincer impingement, labral tear debridement, synovectomy
11/12/07 R hip revision arthroscopy, Cam impingement, removal of scar tissue, synovectomy, upon examination, found to have beautiful psoas

11/28/07 Riding high on life (bc everything else makes me sick) and enjoying a painfree lifestyle, looking forward to ditching my single crutch very very soon! :-)

Dr. Jekyll and Mr. Hyde

(yes, I had to google the spelling of that!)
I am back and forth, back and forth, and change my mind every hour, and sometimes minute, even seconds. Yes, I am definitely losing it...again (or still???)
I am not sure where I stand, and as Rachel pointed out, this gray area stinks!
I had a long sit down meeting with my 2 PTs, J and P to discuss this as well as the work issues. We agreed to really work the psoas for now, so P really did, all the way to the insertion, which is on the lumbar spine, and I felt good after.
What I had decided this morning was that for now, I will hold off on injecting anything, of course, I had minimal to no pain at the time! I want to try to really work on the psoas and see if it is really the issue. But now, as my pain level is slowly creeping up, I am yearning for an injection!
The nice thing for me is that the pain is intermittent, on the flip-side, when it doesn't hurt, I wonder if I am imagining the painful times, and I decide that I am crazy/ier!!!

I had P take strength and ROM measurements for me. The left side is doing well, almost all back to pre-op levels. Right side has lost strength and ROM since the last time we measured, around 7 weeks ago. I am going to aggressively strengthen over the next few weeks and see if I can build it up again, and try not to give in to an injection too quickly!

He Called...finally

So after 2 messages an email, and a conversation with his PA (unrelated to this issue) he called me!!
Here's the deal....the MRI report shows a fraying of the labrum, when comparing the MRI images to the scope pics, he says it is normal, and in the area of the debridement. There is no large flap or loose body in the joint. There is no sign of synovitis, but it is usually not reported, and there is some fluid around the psoas. There is also some loss of cartilage in the area of the original tear, which apparently we knew about after the surgery (I don't recall this though).

I can get the psoas injected if I so desire, at the time of our conversation, I was in no pain, now of course I am!! I told him I would prefer to have the joint injected, since I think that is where my pain is, and that I will call him when I go back to work since that is what has been causing me the most pain. I will decide then.
As for now, I am unsure what this all means. Obviously, a frank, obvious retear would be devastating, but I am pretty sure it is not my psoas.
I have PT tomorrow morning, I will have P really check everything out and we can come to a decision (hopefully together!!) about what to do next!

Incompetencies

I am now waiting to get my MRI results. Having experienced many times the way Dr Kelly's office staff works, I anticipate this to be a long and drawn out process. Nothing huge has ever happened with them, but so many little things, it makes you wonder.
-When I called to make my first appointment ever, the receptionist didn't want to give me one as my injury was not 'sports related'...how many of you actually tore your labrum playing sports? Luckily, I insisted on speaking with his PA who said "definitely come in"
-His PA called me with my first MRI results, I really wanted to speak with him, I left 2 messages....heard nothing, until I sent him an email, heard within 45 minutes (it was nice to bypass his office staff)
-When I was being discharged from the hospital after my first surgery, my Gameready was nowhere to be found...someone forgot to order it for me
-I scheduled my post-op appointment at the same time I scheduled my surgery, when I arrived at 12 days post-op, on crutches, brace, and soaked from an icy rain, I was informed that he was in his 'other' office, 2 blocks away. When I arrived there, they could not find my appointment for the day, and were unsure of what to do, as his schedule was booked. I informed the man at the desk that I was not leaving until someone removed my sutures!
-After my second MRI, it took 3 phone calls to get through to him to call me with the results
-I wanted a copy of the MRI report, it took 3 days to have it faxed over, and multiple phone calls
-Luckily, all of my pre-op requests for my second surgery went through, including time of surgery, anesthesia and post-op meds
-I am eligible for temporary disability, but your doctor must fill out some paperwork. His PA did it for me the first time, and there was no issue, this time, I specifically faxed it to her, but it was intercepted by his office manager, who called to ask me, 4 days post-op, when I was going back to work, so she would know how long to write on the form. I explained that I was hoping to be back in 4 weeks, but Arianna had filled it out for 3 months last time, so she should do the same, just in case 4 weeks was not enough. She answered me with a snotty "well, then we can fill out an extension". Why bother with more paperwork, just fill it out for 3 months, and we don't have to worry about it anymore. The story doesn't end here (are you surprised). In my fax, I had included a note that said please fax back to me. A fax never showed up at my office. So I called, sigh, they couldn't find it, so they 'must have' mailed it to me. It never showed up in my mailbox, sigh, so another phone call, I am going to fax it to you, again, please have it ready for me, I will be in the office tomorrow, to which I got a reply of "I will do my best", as opposed to "I am so sorry I never filled your request, it will be ready tomorrow". I arrived at the office, and it was ready, filled out for 4 weeks of disability. I did end up going back to work at 4 weeks, but, sigh, nonetheless!!
-To schedule my 3rd MRI, at first, they tried scheduling it in the wrong facility, then, gave me an appointment almost a week later. I ended up calling the MRI department and rescheduling myself.
-When I arrived for my MRI, they had forgotten to fax over the prescription
-2 weeks to get the message through to call me with my 3rd MRI results
-When I finally decided that I wanted an injection (right side, 6 months out), I left a message and the office manager called me to see "how she could help me", uh, not at all, please have the dr call me
-At the time of this post, almost 24 hours have passed since I called to have the dr office schedule my injection, waiting to hear back from them
-Another injection nightmare, when we decided to inject my psoas, I got a call from the receptionist early the next day, I was impressed, they took initiative. I told her when I wanted it, she said she would call back with a time. 2 days went by, I called her back, she was going to have the other receptionist call me bc she is actually the one who books it with the radiologist, another day, I called back and asked to speak with receptionist #2, she was surprised I was calling bc receptionist #1 told her she had called me and confirmed the appt. Plus it was the wrong date. She corrected the error, and I thought everything was all good. Until the radiologist called and left me a message saying he wanted to make sure I wanted the 'other' appt, bc there had been some reschedulings done, it worked out and I got the day I wanted.
-So...sigh, nothing huge, but a lot of little things which add up to a lot of frustration!

All in a Day's work

I made it. I am exhausted. But I did it!! Yay!!! I feel so accomplished. Did it hurt? Yes, but it was sooooo worth it!! I am back to work! Luckily, I had a light schedule today. There were a few "issues" involving my work performance, that I had not anticipated. First, I was working with a lady who preferred to be on a low table, so in order to stretch her, I was kneeling, sitting back on my heels, I suddenly developed that deep, gnawing groin pain, and had to find another position to work in. The other issue came from left field. I work in an outpatient orthopaedics facility, with mostly surgical and orthopaedic conditions. We also have a pool. I had a new patient, wheelchair bound, who wanted to use the pool, and needed to be transferred from her wheelchair to the table. This almost never happens, my patients are usually higher level functioning. There was no way in hell I could pull this off, probably even on a good day!!! After some discussion and shuffling, I got the situation under control!!!

Besides for that, everything was going pretty well, until my SI joint decided to give me trouble. Yes, again, when it rains it pours. Interestingly, my dysfunction was a posterior inominate on the right, normally, I get an anterior inominate, I assume it is from the hip flexors tightening up and pulling it forwards. Today it was posterior. P hypothesized that maybe it went that way bc the hip flexors are weak? I muscle tested a 4,4+/5 on that side.....so who knows. He corrected it with a MET, he said I was "stuck" on that side. He also released (sigh, again) my iliacus and psoas, which REALLY hurt. I stood up and felt great, walked to my computer, sat down, and had groin pain (sigh). I am beyond frustarted at this point, I don't even know what to think anymore.

The rest of the day was uneventful,, the kiddies slept late, until almost 5:00, so we did not do anything this afternoon, other than a short trip around the block, L on her bike and Jk in the stroller. What a sight it was, since L is not great at riding, me pulling her with one hand and pushing Jk with the other! As I sit here and blog, my hip pain is back with a veangence, and just in time for my Target excursion!!

If you have gotten this far in my post, I want to try something. One of the hardest things I found when my hip journey began was finding a list of symptoms correlated to a labral tear and FAI. If you would like to help, I want to compile a list of people's sympotms in the "comments" of this post, and in a week or so, publish it as a posting, so others have a place to compare notes.

Here were my pre-op symptoms: Groin pain, deep deep groin pain, not always excruciating, but so annoying I felt like cutting off my leg, tight hip flexors, pain with sitting, pain with walking uphill, pain with pushing my stroller. I did not have radiating pain down my legs, all the hip pain was anterior medial.

Operative Report 7/2/07

Second Surgery
*these reports are dictated, therefore, some words are missing and or incorrect

After the patient was correctly identified in the holding area, she was brought to the operating room. Spinal anesthesia with combined epidural was administered. The left hip was prepped and draped in the usual sterile fashion.

The lateral portal was established under fluroscopic guidance and then a distal lateral accessory portal was established.

Arthroscopic examination demonstrated a large anterior superior labral tear with associated___________ lesion also evidence of a Cam delamination effect and associated synovitis.

At this point, a labral tear debridement was performed at the level of the affected tissue. A smooth contour was achieved to the anterior, inferior, and posterior superior labrum.

Then, the acetabular rim lesion was clearly identified and a rim decompression was performed to reestablish the normal contour of the femoral head and neck junction. At the completion of the rim decompression, a wide synovectomy was then performed using the Tac-S radiofrequency probe.

The cartilage on the femoral head and acetabulum within the joint were in good condition. the ligamentum teres was in good condition, as well. At this point, the scope was brought into the peripheral compartment and a Cam bump identified with clear synovial herniation and pitting.

The junction between the normal articular cartilage and the area where the impingement was occurring was clearly demarcated and a Cam decompression was performed using a 5.5 mm high speed bur. Re-contouring of the affected region was established with good reestablishment of the normal articular cartilage. At the completion of the Cam decompression, all bony debris was evacuated from the joint. No further pathology was identified.

The instruments were removed from the hip and the arthroscopy portals were closed with 3-0 nylon sutures. A "morphine" (should say marcaine) cocktail was placed into the joint. The wounds were cleaned and dried. Sterile dressings were applied. The patient was awakened from anesthesia and brought to the PACU having tolerated the procedures well.

Operative Report 3/5/07

First Surgery
*these reports are dictated, therefore, some words are missing and or incorrect

After the patient was correctly identified in the holding area, she was brought to the operating room. Spinal Anesthesia was administered. She was placed in supine position on the traction table and approximately 10mm of traction was achieved across the femeroacetabular joint.

The right hip was then prepped and draped in the standard, sterile fashion. A lateral portal was established under fluroscopic guidance using the Seldinger technique, distal lateral accessory portal was then established.

Arthroscopic examination demonstrated some cartilaginous loose bodies within the joint and demonstrated a large anterior superior labral tear with an acetabular rim lesion and associated synovitis.

The tissue of the labral tear was of nonviable quality. At this point, a labral debridement was performed . Labrum was recontoured to a normal anterior inferior and posterior superior labrum. Acetabular rim lesion was clearly identified and then, using a 5.5mm high speed bur, the acetabular rim lesion was shaved down to remove the rim osteophyte.

At the completion of the acetabuloplasty and labral debridement, a wide synovectomy was performed using the TAC-S radiofrequency probe. All cartilagenous loose bodies were then removed from the joint. Remaining cartilage surfaces on the femoral head and acetabulum were in good condition. the ligamentum teres demonstrated no significant fraying.

At this point, traction was released. Suction was re-established. No further pathology was identified. The arthroscopy portals were closed with 3-0 nylon sutures and the wounds were cleaned, dried.
The bottom of the page says continued, but I do not have more!

16 day post-op appointment

This morning I saw Dr. Kelly for my first post-op appointment. I actually didn't have to wait too long and was out the door in less than hour. The visit was short and to the point. He showed me the scope pics, pretty ugly stuff inside my joint, he showed me where the tear was, again, it was a large tear, then he showed he the acetabulum and where he shaved down, and the femur, all with before and after shots. I look at the pics and wonder how I didn't have more pain than I did, and how I was able to function.
The newly done hip looks great, the ROM is good, pretty pain free, I am walking with one crutch, he would like for me to lose the crutch soon. He is happy with the progress. As far as the other side, I didn't make a big deal about it, no matter what the issue, there is nothing to do for it right now. He did say that it is common for the other side to flare up like this, but would like me to try anti-inflammatories if possible (see previous post from June, When it Rains it Pours).

As he was checking my hip, he said "we did the femoral side on this hip, what did we do on the other side?" "not the femoral side, just acetabular", I think I momentarily saw a look of worry on his face, but time will tell what the real issue is. He didn't say much about the numbness, although his research assistant was concerned about it. She stayed back after he had gone to get more info on it. There is nothing to be done, I know that, and luckily he didn't bring up taking Lyrica as his PA suggested he may want.
I am going to post the findings on my 1st and 2nd operative report in the following post, as well as add a link to them on the side bars.

Timeline

I know that my blog, up until now, has been out of order and maybe confusing at times, so I would like to make a timeline of events to make it clear what led up to 3 surgeries.
November 2005- Jk was born (2nd child, boy) via VBAC, I felt hip pain, but what didn't hurt! Pain went away on its own.
November 2006- Hip pain came back, ignored it for 2 weeks, on Jk's birthday (how ironic) pain was AWFUL, had 3 different PT's work on it, PT only made it worse
Dec 2006- Exercise makes my hip hurt more, manual therapy makes my hip hurt more, time to look into seeing a hip specialist
Dec 2006- Don't get to bed until after midnight, for weeks as I am doing tons of hip research and investigating specialists, come across 2 articles in JOSPT that are encouraging. Found hip labral tear and FAI web forums, learn a ton from other people's experiences
Dec 2006- Choose hip doc, get an appt one month later (see earlier post)
Jan 2007- See hip doc, agrees with self diagnosis, order's MRI (no injection, he believes his MRI machine is good enough to pick up a labral tear without contrast)
Jan 2007- Receive call form hip doc's PA, MRI showed tear and FAI, go get diagnostic injection and make an appt to see hip doc 2 weeks after
Jan 2007- Have injection (see earlier post), injection provides immediate relief
Jan 2007- Go to Disney World!!!!
Feb 2007- See hip doc again, he is pleased that I got relief with injection, lets hold off on surgery, maybe the injection was enough. I don't agree, I want to get this over and done with, as long as he feels comfortable operating. He says "oh, I feel comfortable, I just didn't know if you did!!"
Feb 2007- Schedule first hip scope for March 5
March 2007- First post-op visit, 1 1/2 weeks later, things seem to be going well, I mention that my other hip hurts, he says its compensation, we leave it at that, he wants to see me in 6 weeks
April 2007- 2nd post-op visit, at this point, the other hip is becoming a major issue, I make it very very clear to him, most importantly, it is affecting my rehab on the operated hip, so I want it injected, just for pain relief, he agrees and wants an MRI too
May 2007- 7am MRI followed by 12pm injection, relief with second injection
May 2007- doc calls, MRI positive, looks identical to MRI on other hip. He generally will operate a second time 8-12 weeks out from the first
May 2007- after 3 sleepless nights, I schedule the second surgery, they will be 17 weeks apart
June 28 2007- Twisting motion while applying make-up causes loud, painful pop in right hip
July 2 2007- Left hip arthroscopy, findings: torn labrum, cam and pincer impingement,loose bodies
July 18 2007- 1st post-op appointment, right hip pain is compenastion, left is doing fine
July 26 2007- Right hip is unbearable, call doc, decide to schedule MRI
July 31 2007- Right hip MRI- shows farying of labrum anteriorly and Cam impingement, doc says it is nothing to worry about, do I want injection? I will think about it
August 28 2007- Finally have arthrogram (intra-articualr injection), got 3 painfree hours
August 29 2007- See doc, discuss cam impingement in right hip, he tells me that sometimes he needs to do revision surgeries in cases like this
September 2007- Discuss situation with doc, he believes it may be my psoas as well, schedule CT scan, scan inconclusive
October 2007- Doc strongly suspects psoas involvement, I still disagree, we agree to try a psoas injection, bad reaction, mild pain relief
October 2007- See doc post-psoas injection, beg him to put me out of my misery, we agree to set a tentative date for surgery and wait 1 week to see how I fare with injection
October 2007- Injection did not help, Nov 12 2007 date set for Right hip revision arthroscopy
November 12 2007-Right Revision Hip Arthroscopy, cam impingement, scar tissue, synovectomy
April 2008- Get pregnant with Zk
January 2009- Zk is born, once again via VBAC (drugless too)
June 2009- After sitting in Indian Style for 30 minutes, I procees to stand up and hip is too painful to stand on
June 2009- MRI of R hip shows increased signal in capsule
July 2009- Intra-articular injection of right hip gives approximately 2 days of relief
September 2009- PRP injection of the joint capsule gives no relief
September 2009- BK tells me he thinks I need exploratory surgery (this will be surgery #4)
September 2009- I freak out, BK agrees to try one more injection
October 2009- Synvisc + Cortisone injection scheduled for right hip
November 2009-Schedule Hip Arthroscopy #4 (#3 for right side)
November 2009- Hip Arthroscopy #4 for possible HO, labral tear and capsular shift
February 2010 Hip begins to feel unstable, joint pain becomes awful at times
February 2010 I begin to become concerned that I have a TON of hip ER, despite capsular shift
March 2010 MRI to see what the issue is (this time...sigh)
March 2010 BK thinks it may be my psoas or capsule or scar tissue
March 2010 Discuss possibility of dynamic ultrasound and/or dynamic CT scan

My own Findings

In my last post, I wrote positive, positive, positive!! But what does this mean?
I have now self diagnosed myself as having a labral tear with some sort of femoracetabular impingement. A quick lit review does not turn up too much info, so off to my PT books, little luck there too. As always, my trusty friend google is here to help!
For days, I spent hours on the computer, finding out everything I could, and more importantly, finding someone who could help me. As a PT, I have seen my share of botched surgeries, although no surgeon will admit it was their fault, it is either the PT's fault for being too aggressive, or not aggressive enough, or the patients fault for not being compliant. I have always known that if I ever needed some sort of ortho work done, there was only one hosptial I would go to, so my surgeon had to be there.
Well, lucky for me, the 2 reputable surgeons in the area who perform arthroscopic surgery for hip labral tears are at that hospital. A quick call to a professor from PT school eliminates one of them, as do insurance issues.
My call to make the appointment did not go as smoothly as I had hoped. The receptionist tells me that this doctor only deals with sports injuries of the hip, since my "injury" did not occur during sports, he would not see me. Seriously, but I have what he treats. Well, I guess he'll see you but if he thinks you are not appropriate for his practice he will refer you out.
OK, so I had chosen a surgeon, and had actually made the call to see him, and his receptionist was going to stand in my way of getting an appointment, no way.
OK, so why don't you give me the appointment, and have his PA call me, I will discuss it with her, and if she thinks my case is not worthy of his time, I will cancel the appointment. This seemed like a good compromise to her, so I got an appointment for 4 weeks later.
2 days later, the PA called me, I explained what had happened with the receptionist, and I told her about my positive findings...."of course you should come in" she said!!
So the take home message is to stand up for yourself, and push for what you believe is right and what you need!!! Don't back down without a fight!!!!
I am writing this 5 months after it happened, the surgeon has gotten one surgery from me and has another one coming in 5 weeks...I wonder if he would agree that my case was not appropriate for his practice!!!

Its always because of the kids

Once you have kids, you always have someone to place the blame on, like when I accidentally hit the yellow pole in our garage, my husband asked me how the yellow paint got on our black car....well, the kids were yelling and I was distracted and as I was reaching back to give them crackers, bam, I hit it!!!!So, how did I injure my hip? Unfortunately for me, I don't have an exciting story, I wasn't skydiving, or skiing or even playing sports. The one thing I am sure of is that prior to this episode, I never had hip problems. I am a PT, in PT school, there are no models, anything you learn, you learn on each other, and then practice again and again on each other. So I know in PT school my hips were perfect.
My son was born in Nov 2005, he was a VBAC, immediately following his birth, I remember having hip pain, but lets be honest, after having a baby, everything else hurts too, so some hip pain was not too alarming at the time. And it disappeared, so I forgot about it.
Fast forward exactly one year later, hip pain. Weird, hip pain, in my groin, I cannot touch it, it is deep and achy, it hurts to drive, it hurts to walk, but my muscles and tendons don't hurt...hmmmm, what is going on.
A few days later, it is still there, I tell a colleague, she works on me, it felt great! She released my iliacus muscle (which killed) and did some traction on my leg, I felt great! I practically skipped to my car, I was cured....Until later that night, I felt worse.
What could be happening??? I decided to try some hip tests on myself, which is awkward, but I was not ready to admit to anyone else I was having a problem, and being the control freak that I am, I did not want any surprises and was not going to let someone else diagnose me before I had already decided what was wrong.
Hmmmm...positive, positive, positive. Now what?
The next day I was worse, so I had 2 other collegues work on me, again, I felt better immediately after, but worse later on.
I needed a better game plan, so I decided to try strengthening as well. Bad idea! Exercise was making me worse as well.
Where would I turn now? As a PT, I was not ready to throw in the towel, but there was honestly nothing I could do to help myself, it was time to find a surgeon who could help me.

In the beginning.....

As a service to myself, as well as to fellow hip pain sufferers (OK, mostly to myself, as my husband is absolutely sick of hearing about my hip), I have decided to start this blog about my journey through arthroscopic hip surgery.
My journey began in Nov 2006 and began with hip pain. I will later give details of the first few months and what led up to my first surgery, too bad I hadn't thought about blogging then!!
I have since had a hip scope on March 5 2007 and am scheduled for a second one for the other side July 2 2007.
There is so little info out there on hip scopes and the recovery/ rehab, so I thought I would share my experience for all those interested.
Just a warning....I talk a lot, so be prepared for some long posts. But I hope I can help other's preparing for this, thinking about this, or going through this as well.