I will be in Dr.Kelly's OR this Tuesday for the 4th time.....
but for the first time, I will not be on the table!!
One of my patients is having her hip scoped and I will be there to watch! You can only imagine how excited I am, and how much I will enjoy this! After all I have been through, I am so excited to see what happened after I drifted off into lala land!!
She has a labral tear, FAI and he is (gasp) releasing her psoas, but my mouth is shut. I can only be a pain in the ass when it involves my own hips and I am so grateful to be allowed in the OR!
Thursday, August 28, 2008
Monday, August 25, 2008
Who's 'da Man
After a rough start to my day, I finished the morning with my ego quite inflated. Let me explain.
I am currently treating a 30 year old woman with hip pain. Plain MRI showed no pathology, I do not have the x-ray reports. Her chief complaint initially was clicking in the hip and pain and tenderness. She was diagnosed with hip flexor tendonitis. A load of crap, said I, humbly!
She did have extremely tight and painful hip flexors but she also presented with a positive impingement sign, and her pain is relieved with traction and any type of distraction I do on her hip. Her hip flexors have started to feel better from the extensive amount of manual work I have been doing but she still coplains of joint instability, clicking, and just a "funny feeling". So I have been telling her from the very beginning that I suspect there may be something wrong with the joint, despite what the MRI said. I think she started believing me and decided to go back to the doctor after we spoke on friday morning.
When I arrived in the office this morning, there was a handwritten note in my box that said to call that OS office ASAP. In my office, we NEVER use handwritten notes, every message is sent via intra-office email, and then the recipient knows who it was from in case they have questions. This had no name in it, no signature, nothing. Just to call regrding this patient, and ASAP. I thought "oh shit", I pissed him off with my brazen hip views and opinions. At that point, all I could do was suck it up and call, take him yelling at me, and move on. Ironically, the patient was in the OS office at the time I called. I also was not sure who from the OS office had called, bc the note said that his office had called, not him personally.
So I finally got through (after about 3 or 4 busy signals), and the receptionist had no idea who had called me. I went on to further explain that the patient was currently in their office and the message was regarding her. "Oh", the receptionist said, and the next thing I knew, the OS picked up the phone. "Fuck", I thought I had gotten off easy this time!
He said he had been talking to the patient regarding the clicking, and I was "right on" thinking it may be a labral tear, and he was going to order an MR arthrogram. "I think that is a good idea", I said. But I didn't stop there. I asked "did her x-rays show any sign of impingement or dysplasia?" "No, nothing exciting there" he replied,"but you are on the right track".
Ok, I obvioulsy didn't mention my own personal "battles", and how I probably know a little bit more about hip issues than the average PT, but what started out as a morning of me pracically peeing in my pants (for different reasons this time) ended up with me gloating and high fiving everyone around me!!!
I am currently treating a 30 year old woman with hip pain. Plain MRI showed no pathology, I do not have the x-ray reports. Her chief complaint initially was clicking in the hip and pain and tenderness. She was diagnosed with hip flexor tendonitis. A load of crap, said I, humbly!
She did have extremely tight and painful hip flexors but she also presented with a positive impingement sign, and her pain is relieved with traction and any type of distraction I do on her hip. Her hip flexors have started to feel better from the extensive amount of manual work I have been doing but she still coplains of joint instability, clicking, and just a "funny feeling". So I have been telling her from the very beginning that I suspect there may be something wrong with the joint, despite what the MRI said. I think she started believing me and decided to go back to the doctor after we spoke on friday morning.
When I arrived in the office this morning, there was a handwritten note in my box that said to call that OS office ASAP. In my office, we NEVER use handwritten notes, every message is sent via intra-office email, and then the recipient knows who it was from in case they have questions. This had no name in it, no signature, nothing. Just to call regrding this patient, and ASAP. I thought "oh shit", I pissed him off with my brazen hip views and opinions. At that point, all I could do was suck it up and call, take him yelling at me, and move on. Ironically, the patient was in the OS office at the time I called. I also was not sure who from the OS office had called, bc the note said that his office had called, not him personally.
So I finally got through (after about 3 or 4 busy signals), and the receptionist had no idea who had called me. I went on to further explain that the patient was currently in their office and the message was regarding her. "Oh", the receptionist said, and the next thing I knew, the OS picked up the phone. "Fuck", I thought I had gotten off easy this time!
He said he had been talking to the patient regarding the clicking, and I was "right on" thinking it may be a labral tear, and he was going to order an MR arthrogram. "I think that is a good idea", I said. But I didn't stop there. I asked "did her x-rays show any sign of impingement or dysplasia?" "No, nothing exciting there" he replied,"but you are on the right track".
Ok, I obvioulsy didn't mention my own personal "battles", and how I probably know a little bit more about hip issues than the average PT, but what started out as a morning of me pracically peeing in my pants (for different reasons this time) ended up with me gloating and high fiving everyone around me!!!
Wednesday, August 20, 2008
As the Snapping Continues, I Think Happy (and cute) Thoughts
We had a great time at Victorian Gardens in Central Park with hipster Amy last week!
Monday, August 18, 2008
This is Not What I Signed Up For
Firstly, I would like to address an issue that has been brought to my attention. Mainly, it is that I am generally feeling awesome. I don't know how well it is reflected here since I usually only blog about the bad days, If you would prefer, I could post each day and write something to the likes of "Today I had no hip pain". But that would be kind of lame and boring, but it is the case most of the time. And no matter how much I complain, anything I speak of is nothing compared to pre-op and I have never once had second thoughts about surgery (revision too) and continue to be really happy with the results.
That said, I will begin by saying that what is happening now sucks! I think my pelvis/ SI joint is becoming increasingly unstable from the pregnancy hormones, so, like in the past with unstable joints, the muscles are tightening/ spasming in response. This time, it is not my psoas (yay), but my right IT band (revision side). It is so tight it has begun snapping. I never really understood the full implications of a snapping IT band...until now. It is a painless snapping that began a few days ago. My greater trochanter on that side is also tender to the touch. I don't know if maybe this is partly because I sleep on my side now, since stomach sleeping ended a few weeks ago, or bc of the tightness, or both...I don't know what came first. In addition, my left adductors are also tight and tender again. So the right side of both legs hurts, I wonder if the right side of my pelvis is more hypermobile these days, the hip joint definitely is more hyperobile on the right.
To add to all of this, the following happened last night. This is rather graphic, and possibly better suited for the ladies only, preferably the ones who have already had children, so that those of you who have not will not be scared away. So you have been warned. If you don't like graphic, skip the rest of the post.
Way back when, when I only began to realize I had a torn labrum, I also realized that suddenly, my pelvic floor muscles were also very weak. To me, this was really bad since on top of treating orthopaedic patients, I also specialize in treating incontinence and pelvic floor dysfunction. The muscles remained weak after surgery but I never had any "real" leaking. Last night, I was lying in bed and out of nowhere got really nauseous. I realized I needed to throw up, and fast, so made a mad dash for the bathroom. Once I started throwing up, I literally peed all over myself. At the time, it was not funny, now, looking back, I can sort of smile, I know it is not permanent, but standing in the bathroom, not knowing where to go or what to do, I was certainly not laughing. When it all "ended", I sat down to catch my breath, and realized my nose was bleeding as well. Another lovely pregnancy side effect. Did I mention that this is my last pregnancy????
That said, I will begin by saying that what is happening now sucks! I think my pelvis/ SI joint is becoming increasingly unstable from the pregnancy hormones, so, like in the past with unstable joints, the muscles are tightening/ spasming in response. This time, it is not my psoas (yay), but my right IT band (revision side). It is so tight it has begun snapping. I never really understood the full implications of a snapping IT band...until now. It is a painless snapping that began a few days ago. My greater trochanter on that side is also tender to the touch. I don't know if maybe this is partly because I sleep on my side now, since stomach sleeping ended a few weeks ago, or bc of the tightness, or both...I don't know what came first. In addition, my left adductors are also tight and tender again. So the right side of both legs hurts, I wonder if the right side of my pelvis is more hypermobile these days, the hip joint definitely is more hyperobile on the right.
To add to all of this, the following happened last night. This is rather graphic, and possibly better suited for the ladies only, preferably the ones who have already had children, so that those of you who have not will not be scared away. So you have been warned. If you don't like graphic, skip the rest of the post.
Way back when, when I only began to realize I had a torn labrum, I also realized that suddenly, my pelvic floor muscles were also very weak. To me, this was really bad since on top of treating orthopaedic patients, I also specialize in treating incontinence and pelvic floor dysfunction. The muscles remained weak after surgery but I never had any "real" leaking. Last night, I was lying in bed and out of nowhere got really nauseous. I realized I needed to throw up, and fast, so made a mad dash for the bathroom. Once I started throwing up, I literally peed all over myself. At the time, it was not funny, now, looking back, I can sort of smile, I know it is not permanent, but standing in the bathroom, not knowing where to go or what to do, I was certainly not laughing. When it all "ended", I sat down to catch my breath, and realized my nose was bleeding as well. Another lovely pregnancy side effect. Did I mention that this is my last pregnancy????
Wednesday, August 13, 2008
More Summer Fun
I finally figured out how to get the blackberry pictures to show in full size, so I went ahead and changed the last pic I uploaded as well from the pool!
Sunday, August 10, 2008
Refocusing
Since this blog was started for the purpose of following my recovery from hip arthroscopy(s), I figured I should take a break from sunbathing and let you know what the story is.
Initially, I was supposed to have a follow-up appointment with Dr.Kelly this week (and Amy too) but being that my current condition does not allow for x-rays, I have cancelled and will reschedule for a later date (i.e after the baby is born). Amy and I will still try to make time for an L/ Jk outing + photo session, the plan is to go to Central Park on Thursday.
Anyway....I go most of the time without even realizing that my left hip was ever operated on. I feels great, no pain (at least not in the last few weeks/ days that I can recall as I type this). The only catch is that my activity level has seriously plummeted since the pregnancy began. I am constantly battling bone crushing fatigue so I drive everywhere. Last summer, I walked to the pool every day, this sumer we drive. The pool is across the street from the park I walked (crutched) to 6 days after my second surgery, so it is clearly not that far. The nausea still has not subsided but thanks to amazing drugs, I function! (Thank you Zofran)
The right hip is a different story. Yes, it was operated on twice, and yes, the left hip has 4 months on the right hip, but I can't help to wonder at what point my progress will plateau. Don't get me wrong, it feels great, amazing, a million times better than pre-op, but since I have a "perfect" left hip, it makes me sad to have to settle for less than perfect.
I know, my famous line is "once it is scoped it will never be the same again", I know, but one can only dream! Considering the amount of work I had done on it, I should not be complaining, but should be jumping for joy. The actual joint is great, no more FAI, no more pain in there, so yes, mission accomplished! What bothers me is more superficial pain, around the incisions, yes, the nerve pain is still there. Much diminished, but sigh, still there. My (gasp) psoas gets tight still and once again decreases my stride length. If I had the energy, I would stretch more, but every second I have to myself I am usually in bed (like now, the kids are in the living room watching cartoons and I am in bed. J is out of town for the week).
Of course, I am still anxious about the delivery. Plus, my new decision to try to go as natural as possible. I am thinking of hiring a doula, to help me during the birth. In my messed up mind, if I don't have an epidural, I will feel pain in my hip and prevent it from being put in bad positions. I had hired a doula for L's delivery and needed a c-section bc she was breech. For Jk, I couldn't even think that far ahead, all I could think about was not having a repeat c-section, I didn't care how I went about it. Also, for L's birth, I was petrified of having an epidural. I have now survived a c-section, a vaginal birth and 3 hipscopes with some form of spinal or epidural anesthesia, so the fear factor is slightly decreased, but if I can avoid it, I will. J is not in favor of a doula, he thinks it will lessen his role, but frankly, he had no idea what to do last time and I was rather pissed for a while (I think I still am a little), so thinks that I am trying to punish him by getting a doula. Whatever, next time, he can birth a child and do it his way!!!!
Initially, I was supposed to have a follow-up appointment with Dr.Kelly this week (and Amy too) but being that my current condition does not allow for x-rays, I have cancelled and will reschedule for a later date (i.e after the baby is born). Amy and I will still try to make time for an L/ Jk outing + photo session, the plan is to go to Central Park on Thursday.
Anyway....I go most of the time without even realizing that my left hip was ever operated on. I feels great, no pain (at least not in the last few weeks/ days that I can recall as I type this). The only catch is that my activity level has seriously plummeted since the pregnancy began. I am constantly battling bone crushing fatigue so I drive everywhere. Last summer, I walked to the pool every day, this sumer we drive. The pool is across the street from the park I walked (crutched) to 6 days after my second surgery, so it is clearly not that far. The nausea still has not subsided but thanks to amazing drugs, I function! (Thank you Zofran)
The right hip is a different story. Yes, it was operated on twice, and yes, the left hip has 4 months on the right hip, but I can't help to wonder at what point my progress will plateau. Don't get me wrong, it feels great, amazing, a million times better than pre-op, but since I have a "perfect" left hip, it makes me sad to have to settle for less than perfect.
I know, my famous line is "once it is scoped it will never be the same again", I know, but one can only dream! Considering the amount of work I had done on it, I should not be complaining, but should be jumping for joy. The actual joint is great, no more FAI, no more pain in there, so yes, mission accomplished! What bothers me is more superficial pain, around the incisions, yes, the nerve pain is still there. Much diminished, but sigh, still there. My (gasp) psoas gets tight still and once again decreases my stride length. If I had the energy, I would stretch more, but every second I have to myself I am usually in bed (like now, the kids are in the living room watching cartoons and I am in bed. J is out of town for the week).
Of course, I am still anxious about the delivery. Plus, my new decision to try to go as natural as possible. I am thinking of hiring a doula, to help me during the birth. In my messed up mind, if I don't have an epidural, I will feel pain in my hip and prevent it from being put in bad positions. I had hired a doula for L's delivery and needed a c-section bc she was breech. For Jk, I couldn't even think that far ahead, all I could think about was not having a repeat c-section, I didn't care how I went about it. Also, for L's birth, I was petrified of having an epidural. I have now survived a c-section, a vaginal birth and 3 hipscopes with some form of spinal or epidural anesthesia, so the fear factor is slightly decreased, but if I can avoid it, I will. J is not in favor of a doula, he thinks it will lessen his role, but frankly, he had no idea what to do last time and I was rather pissed for a while (I think I still am a little), so thinks that I am trying to punish him by getting a doula. Whatever, next time, he can birth a child and do it his way!!!!
Tuesday, August 5, 2008
Tuesday, July 29, 2008
Sometimes I Really Wonder....
There are days I am so spacey, it is a wonder how I got myself out of bed, dressed and to work, and managed to leave L and Jk safely at home, out of harms way. To make matters worse, my legs now hurt just to stand on them. Yes, I am developing cankles (let me know if that needs further explaining). I have had bouts with cankles during previous pregnancies but never this early (15+ weeks). It is so bad that it hurts to stand, which can pose a slight problem at work as I stand most of the time. My Danskos help a lot, but not enough. And I wonder if I am uncomfortable enough to go out and get (gasp) support hose, but I wake up each day and hope and pray that it will be a better day in cankle world.
On top of ankle and foot pain, yesterday, towards the end of the day, my right (revision) thigh started to hurt, in the usual sore areas. But it was a different kind of pain, it was the same throbbing I get in my feet, only it travelled to the op-site. Weird. So now, instead of just sore ankles and feet, I have a sore thigh, I wonder how it all ties together, any ideas? Anyone experience this ever?
While I am on the "sometimes I really wonder" issue, I want to add that I have a few letters after my name that I picked up from an Ivy league institute, no, I am not bragging, but I want you to understand the full implications of the stupidity that at times follows me throughout the day, and makes me (and J) wonder, really wonder what I am thinking.
My latest moment of sheer stupidity came last night, after months and months of talking, I finally decided on which type of window shades I wanted in our bedroom. So I have been price shopping around, and found them really cheap (or so I thought) on a website. I called the customer service number to place my order and the price was 3 times what I had seen online. I was shocked. It wasn't until the sales rep asked if I had actually put in my window measurements on the website that I realized that the price is based on the size of the blind (duh) and they were not as cheap as I thought.
This morning at the supermarket, the expiration date of the milk was on the back side of the bottle, so I tilted it towards me and it looked like it said 08/01, just 2 more days. And every bottle seemed to say 08/01. Until I looked at every bottle and finally actually took one out did I realize I was reading upside down and it actually said 08/10.
Have I mentioned I need a vacation!
On top of ankle and foot pain, yesterday, towards the end of the day, my right (revision) thigh started to hurt, in the usual sore areas. But it was a different kind of pain, it was the same throbbing I get in my feet, only it travelled to the op-site. Weird. So now, instead of just sore ankles and feet, I have a sore thigh, I wonder how it all ties together, any ideas? Anyone experience this ever?
While I am on the "sometimes I really wonder" issue, I want to add that I have a few letters after my name that I picked up from an Ivy league institute, no, I am not bragging, but I want you to understand the full implications of the stupidity that at times follows me throughout the day, and makes me (and J) wonder, really wonder what I am thinking.
My latest moment of sheer stupidity came last night, after months and months of talking, I finally decided on which type of window shades I wanted in our bedroom. So I have been price shopping around, and found them really cheap (or so I thought) on a website. I called the customer service number to place my order and the price was 3 times what I had seen online. I was shocked. It wasn't until the sales rep asked if I had actually put in my window measurements on the website that I realized that the price is based on the size of the blind (duh) and they were not as cheap as I thought.
This morning at the supermarket, the expiration date of the milk was on the back side of the bottle, so I tilted it towards me and it looked like it said 08/01, just 2 more days. And every bottle seemed to say 08/01. Until I looked at every bottle and finally actually took one out did I realize I was reading upside down and it actually said 08/10.
Have I mentioned I need a vacation!
Friday, July 25, 2008
Since I Can't Drink, I'll Vent
I need a drink. Really, I am not an alcoholic, but after this week, I either need a very long vacation from treating patients, or a drink. Since neither is feasible, you get to hear about my frustrations.
Most of you have read my blog previously and know my "story", and can probably tell that a)I go after what I want/need until I am satisfied with the results (in this case painfree hips) b)I can be a bit snotty about who I choose as a healthcare provider c)I feel very strongly that that this is the way to get things done quickly and well.
As you can imagine, passive people make me nuts. I am going to use some examples from my week. I know I have to keep reminding myself that not everyone is as aggressive as I am, but when it comes to your health and well being, maybe you should be.
I have a patient who clearly had a botched back surgery. From the first day I saw him, I said he needed a second opinion. I personally gave him the name of 2 VERY local surgeons to go see. Took him a week and a half to make the appt, and was told there was nothing this surgeon could do. What would I do? Start looking into third and fourth opinions, bc living in constant pain, bent over, unable to walk without the use of a cane is not acceptable, and being worse off than before the surgery is definitely not acceptable.
Another patient with arthritic knees, who I told to stop power walking on concrete for a week to see if she would feel better simply cannot stop bc she walks for her mental well being. Well, then she will have a great mental well being but a shitty physical one.
My patients are afraid to ask for x-rays or MRI's when they are clearly needed, half the time I ahve to request them on their behalf, it absolutely akes me nuts.
Patient with a probable labral tear, too passive to even think about getting an MRI, I volunteer to help find an OS who takes her (really crappy) insurance, declines the help and will think about it. Ok, so live with groin pain, I think this is something I know a little bit about and can help you figure it all out, but go ahead and be passive and let pain dictate your life.
Ok, I feel a little better. I could write a book ont his stuff.
Before I forget, there is the lady who called yesterday, she claims she is a former patient, and needs a hip replacement but is too scared to get one (I won't even go there), and she has been sitting in a chair bc she is an artist, and has put pillows under her. When she looks down at her legs, her quadriceps look rounded (WTF). So I (annoyed) say "what exactly is your question", and she continues to ramble about the chair and the pillows and how once she was in a different chair and she turned in it and her groin hurt her, again, I ask "What is your question for me", so she wants to know if I think she should use the pillows on her chair or not. Seriously? How the heck do I know? So I told her to try to take them out, and see if her pain goes away, and if it does, then she should not use the pillows. I swear, she thought I was genius!
Most of you have read my blog previously and know my "story", and can probably tell that a)I go after what I want/need until I am satisfied with the results (in this case painfree hips) b)I can be a bit snotty about who I choose as a healthcare provider c)I feel very strongly that that this is the way to get things done quickly and well.
As you can imagine, passive people make me nuts. I am going to use some examples from my week. I know I have to keep reminding myself that not everyone is as aggressive as I am, but when it comes to your health and well being, maybe you should be.
I have a patient who clearly had a botched back surgery. From the first day I saw him, I said he needed a second opinion. I personally gave him the name of 2 VERY local surgeons to go see. Took him a week and a half to make the appt, and was told there was nothing this surgeon could do. What would I do? Start looking into third and fourth opinions, bc living in constant pain, bent over, unable to walk without the use of a cane is not acceptable, and being worse off than before the surgery is definitely not acceptable.
Another patient with arthritic knees, who I told to stop power walking on concrete for a week to see if she would feel better simply cannot stop bc she walks for her mental well being. Well, then she will have a great mental well being but a shitty physical one.
My patients are afraid to ask for x-rays or MRI's when they are clearly needed, half the time I ahve to request them on their behalf, it absolutely akes me nuts.
Patient with a probable labral tear, too passive to even think about getting an MRI, I volunteer to help find an OS who takes her (really crappy) insurance, declines the help and will think about it. Ok, so live with groin pain, I think this is something I know a little bit about and can help you figure it all out, but go ahead and be passive and let pain dictate your life.
Ok, I feel a little better. I could write a book ont his stuff.
Before I forget, there is the lady who called yesterday, she claims she is a former patient, and needs a hip replacement but is too scared to get one (I won't even go there), and she has been sitting in a chair bc she is an artist, and has put pillows under her. When she looks down at her legs, her quadriceps look rounded (WTF). So I (annoyed) say "what exactly is your question", and she continues to ramble about the chair and the pillows and how once she was in a different chair and she turned in it and her groin hurt her, again, I ask "What is your question for me", so she wants to know if I think she should use the pillows on her chair or not. Seriously? How the heck do I know? So I told her to try to take them out, and see if her pain goes away, and if it does, then she should not use the pillows. I swear, she thought I was genius!
Saturday, July 19, 2008
The Ups and Downs and Then Some
Since becoming pregnant, I have stopped spinning, not bc I think in any way shape or form that it is harmful to the baby, but I have been to busy puking, lying in bed feeling nauseous, lying in bed feeling sorry for myself that I am so nauseous, or simply lying in bed bc I am too tired to move or do much of anything else. It is also unbelievably hot here, especially over the past few days, my feet have started to swell, which makes me REALLY unhappy.This has never happened to me so early in a pregnancy....but I digress.
My point is that my activity level has gone down...drastically, so my ROM is not as great as it once was and my hips feel tight on and off. This week I was at my breaking point with the tightness and succumbed to asking P for a quick PT session so I could walk like a normal person again. I have had my usual anterior tightness which limits my extension when I walk, so if I have to be anywhere quickly,I have to take smaller steps bc that bungy cord in my hip feeling is back. Not even 5 minutes of some anterior hip mobilizations and quad stretching brought me back to normal! YAY!
I'd like to resume spinning soon but I practically pass out every night once the kids are in bed, especially bc we spend all afternoon outdoors by the pool (I have not gone in for a while bc my bathing suits don't fit anymore...I ordered some this week, I hope they fit!!!)
I remember after one of my surgeries (I'd like to think it was #3, this would support my theory) I told P not to work on my scars, I wanted to see if there would be a difference long term in the appearance and quality of the scar. Given the fact that the revision scars are 4 and 8 months younger than the other scars, they look awful. I really do believe that these were the "experimental scope sites". They were worked on a little bit, P got mad at one point and said I was being ridiculous about it and he was not going to let the scars go to hell. I did let him work on them a little bit, but no where near as much as the other ones. These scars are not red and elevated, and one is pretty painful to the touch. Cosmetically, couldn't care less, trust me, no one ever sees them! And they never get sun, so that is not a problem. I wonder how that plays in with my "nerve pain"/ "invisible bruise" issue. I don't use any creams or scar therapy lotions, I think it is a waste of money, especially given how the other scars look and feel, but it makes me wonder, maybe PT really does work! hahahaha!! Just joking! It was a personal experiment, I always work on my patients scars but there is ever a way to really know of the results would be the same if I didn't, now I know and my work has been validated!!!
Quick Jeff update: He saw OS #2 who confirmed the labral tear diagnosis, despite the fact that he felt the quality of the MRI was pretty poor, and who added "we always order these with contrast". He did not see any FAI. I am concerned about this. Given my extensive personal research and "networking", I cannot think of a single person who has had surgery for JUST a labral tear who is doing exceptionally well. I wold like further investigation into the "no FAI" thing with possible a CT-scan, although my CT-scan missed my FAI.....but better to be safe than sorry.I still strongly believe he needs to make a trip to NY to have this checked out and addressed!
My point is that my activity level has gone down...drastically, so my ROM is not as great as it once was and my hips feel tight on and off. This week I was at my breaking point with the tightness and succumbed to asking P for a quick PT session so I could walk like a normal person again. I have had my usual anterior tightness which limits my extension when I walk, so if I have to be anywhere quickly,I have to take smaller steps bc that bungy cord in my hip feeling is back. Not even 5 minutes of some anterior hip mobilizations and quad stretching brought me back to normal! YAY!
I'd like to resume spinning soon but I practically pass out every night once the kids are in bed, especially bc we spend all afternoon outdoors by the pool (I have not gone in for a while bc my bathing suits don't fit anymore...I ordered some this week, I hope they fit!!!)
I remember after one of my surgeries (I'd like to think it was #3, this would support my theory) I told P not to work on my scars, I wanted to see if there would be a difference long term in the appearance and quality of the scar. Given the fact that the revision scars are 4 and 8 months younger than the other scars, they look awful. I really do believe that these were the "experimental scope sites". They were worked on a little bit, P got mad at one point and said I was being ridiculous about it and he was not going to let the scars go to hell. I did let him work on them a little bit, but no where near as much as the other ones. These scars are not red and elevated, and one is pretty painful to the touch. Cosmetically, couldn't care less, trust me, no one ever sees them! And they never get sun, so that is not a problem. I wonder how that plays in with my "nerve pain"/ "invisible bruise" issue. I don't use any creams or scar therapy lotions, I think it is a waste of money, especially given how the other scars look and feel, but it makes me wonder, maybe PT really does work! hahahaha!! Just joking! It was a personal experiment, I always work on my patients scars but there is ever a way to really know of the results would be the same if I didn't, now I know and my work has been validated!!!
Quick Jeff update: He saw OS #2 who confirmed the labral tear diagnosis, despite the fact that he felt the quality of the MRI was pretty poor, and who added "we always order these with contrast". He did not see any FAI. I am concerned about this. Given my extensive personal research and "networking", I cannot think of a single person who has had surgery for JUST a labral tear who is doing exceptionally well. I wold like further investigation into the "no FAI" thing with possible a CT-scan, although my CT-scan missed my FAI.....but better to be safe than sorry.I still strongly believe he needs to make a trip to NY to have this checked out and addressed!
Thursday, July 17, 2008
Dear Jeff Part II
To avoid any last minute, in the waiting room, phone calls, I am creating a list for Jeff (or anyone) who is going for a second opinion tomorrow for his labral tear.
To recap: Jeff, my younger brother, has been dealing with hip pain since April. He recently saw an OS who ordered an MRI which revealed a labral tear. The OS was clearly clueless about hips, so I found another OS locally for Jeff to bring his films to and get more answers.
1)What caused my labral tear?
2)Do I have FAI
3)What type of FAI, cam, pincer or both?
4)Do I have any cartilage damage?
5)Do I need surgery?
6)Can it be done arthroscopically? Can all the FAI be addressed arthroscopically?
7)If I put off having surgery, will this get worse?
8)When can I return to sports?
9)What about a cortisone injection?
I think that about covers it! Did I miss anything?
I am not including questions about the surgeon's experience and post-op protocols etc since you all know how I feel about "other"OS's and know that if he needs surgery, he won't be having it in Miami.
Let me know what you think!
To recap: Jeff, my younger brother, has been dealing with hip pain since April. He recently saw an OS who ordered an MRI which revealed a labral tear. The OS was clearly clueless about hips, so I found another OS locally for Jeff to bring his films to and get more answers.
1)What caused my labral tear?
2)Do I have FAI
3)What type of FAI, cam, pincer or both?
4)Do I have any cartilage damage?
5)Do I need surgery?
6)Can it be done arthroscopically? Can all the FAI be addressed arthroscopically?
7)If I put off having surgery, will this get worse?
8)When can I return to sports?
9)What about a cortisone injection?
I think that about covers it! Did I miss anything?
I am not including questions about the surgeon's experience and post-op protocols etc since you all know how I feel about "other"OS's and know that if he needs surgery, he won't be having it in Miami.
Let me know what you think!
Sunday, July 13, 2008
The Pregnancy Scoop
I definitely feel as if I have slightly abandoned you over the last 3 months, but if you will let me explain myself. To put it simply, I don't do pregnancy gracefully. If you will recall my post-op issues after hip arthroscopy #3, you will get a better sense of what I have been going through (I tried to add a link to one of those posts but it seems that they are either too graphic or don't capture the full picture adequately, if you so desire, read up on posts from Nov 13-21 2007). Basically, I have been REALLY nauseous. It started around 6 weeks of pregnancy, way before I was sharing the news. J went away for the weekend with L, and Jk and I stayed home. I luckily had a few Zofran (my super duper anti-nausea meds I convinced Dr Kelly to prescribe for surgery #2 and 3 after a bad experience with #1), but like the "junkie" that I am, I was nervous they would not last the whole weekend and I would be screwed. Plus, I didn't really want to bother my OB-gyn over the weekend. Luckily, I have a friend who just the week before mentioned she had Zofran left from her last pregnancy, with refills! She happened to be at the park that day and I casually pulled her aside and explained my"situation". She was wonderful, dropped off the "goods" that night plus refilled it for me. I was feeling a lot more confident about venturing out of the house and not causing a really embarrassing scene for myself.
Tuesday morning I put in a call to my doc for more drugs, plus, I was having awful acid issues in my stomach, so I needed something for that as well.Acid+nausea=terrible feeling, wishing you might die, reconsidering the whole pregnancy thing (although it was a little too late). So, a few calls to my insurance company (by me and the docs office), I was able to take 4 Zofran a day plus 2 Prevacid. It made my life manageable but by no means enjoyably or pleasant. I kept saying that this was definitely the worst pregnancy yet.
Then, by the middle of week 11, I made it until 3PM on one Zofran, this was record breaking for me. And since then, I have been down to 2 Zofran/day, still with 1-2 Prevacid/day, and feeling much more human,most of the time.
The real question is how have the hips been? Given that pregnancy is a time of hormonal fluctuation, one of which is the hormone Relaxin (I can go on and on about this as I wrote my thesis on orthopaedic issues and pregnancy)....My SI joint has been a little cranky.
Tuesday morning I put in a call to my doc for more drugs, plus, I was having awful acid issues in my stomach, so I needed something for that as well.Acid+nausea=terrible feeling, wishing you might die, reconsidering the whole pregnancy thing (although it was a little too late). So, a few calls to my insurance company (by me and the docs office), I was able to take 4 Zofran a day plus 2 Prevacid. It made my life manageable but by no means enjoyably or pleasant. I kept saying that this was definitely the worst pregnancy yet.
Then, by the middle of week 11, I made it until 3PM on one Zofran, this was record breaking for me. And since then, I have been down to 2 Zofran/day, still with 1-2 Prevacid/day, and feeling much more human,most of the time.
The real question is how have the hips been? Given that pregnancy is a time of hormonal fluctuation, one of which is the hormone Relaxin (I can go on and on about this as I wrote my thesis on orthopaedic issues and pregnancy)....My SI joint has been a little cranky.
A. ilium
B. sacrum
C. acetabulum
D. pubis
E. pubic symphysis
F. ischium
What has been happenning is that my ilium (A) will rotate ever so slightly due to ligamentous laxity.As you can see, the acetabulum is at the bottom (C), so when the ilium shifts, so does the acetabulum, making me one very unhappy camper. In the past, the SI issues used to only cause unilateral back pain. On really bad days, it also causes hip pain.
Another issue I have been having is that the right hip has been feeling extremely tight. I am not sure if it is because I have dropped my activity level drastically (see above), or I am having a build up of scar tissue. Whatever the reason, I need to do something about it, but am usually too tired at the end of the day for any self assessment, and much less stretching or the like.
Another issue that the pregnancy seems to be exacerbating is the nerve pain I have had all along, remember the invisible bruise on the front of my leg. At times it becomes pretty painful, and even more tender to the touch, and then a little while later, it will be all gone. Strange.
Other than that, the hips have fared pretty well so far. My biggest concern (which I will probably mention a million times from now until I actually give birth) is the actual delivery. Epidural+weird hip positions= me really nervous. I don't want to opt for a c-section bc of this, bc, to be quite frank, if I had a choice,I would much rather have a hip scope than a c-section (meaning, if the delivery somehow screwed up my hip), not that it would, but I REALLY don't want a c-section, been there, done that. You will get so sick of hearing about this but it is what plays on my mind all the time!
Wednesday, July 9, 2008
I Was Right
I love hearing those words, even though the other times I have heard them, it was not relating to great things (i.e hip scopes), but nevertheless, there is something "ego building" about it. The other times were here and here, relating to my non-psoas release days.
So....an update on Jeff: He has a labral tear. I have the MRI report and will share some key lines, but it has no mention of FAI. I am going to have him call and get the radiology report on the x-rays too. The OS told him to take 6 weeks and do nothing. If he still has pain, he can come back and get a cortisone injection, and maybe get the area "resurfaced" (I think he meant scoped to clean up the tear). Obviously, without a cause for the tear, he would not let him "resurface" it, and even more obviously, I would not let him have surgery with that guy.
"Evaluation of the unilateral images and the bi-lateral coronal T1- weighted sequence does demonstrate a region of irregularity and signal change within the superior acetabular labrum centrally extending anteriorly. This finding is suggestive of fibrillation and likely a focal area of tearing in this location."
Wow, I am so good I can diagnose over the phone (that must be the ego talking :-)
So....an update on Jeff: He has a labral tear. I have the MRI report and will share some key lines, but it has no mention of FAI. I am going to have him call and get the radiology report on the x-rays too. The OS told him to take 6 weeks and do nothing. If he still has pain, he can come back and get a cortisone injection, and maybe get the area "resurfaced" (I think he meant scoped to clean up the tear). Obviously, without a cause for the tear, he would not let him "resurface" it, and even more obviously, I would not let him have surgery with that guy.
"Evaluation of the unilateral images and the bi-lateral coronal T1- weighted sequence does demonstrate a region of irregularity and signal change within the superior acetabular labrum centrally extending anteriorly. This finding is suggestive of fibrillation and likely a focal area of tearing in this location."
Wow, I am so good I can diagnose over the phone (that must be the ego talking :-)
Friday, July 4, 2008
Wednesday, July 2, 2008
Today is My 1 Year Anniversary
And I am running late for work! So I will not have time to post a true update, but promise one by the end of the weekend with all the exciting things happening in my life :-)
An update on Jeff (I can't believe we are related): He had his MRI yesterday, it was only about 20 minutes (mine were all closer to 45 minutes), he did say they put a coil on his hip and taped his feet into IR. Here is the "I can't believe we are related part". The doc told him to make an appt for after the MRI to come in and discuss the results (why he can't call is beyond me). What would I have done? Once I got off the phone with MRI place, the next call would have been the docs office for an appt a few days later. Jeff's plan is to call today for an appt. I am going to try (in my sneaky way) to get the report from the imaging center this week, we'll see! Some are good about it, some are not and have rules and protocols!
Once again, thank you to J's HR dept and United healthcare for the wonderful insurance they provide us, Jeff's MRI co-pay was $400, no that is not an extra zero!!!!!
An update on Jeff (I can't believe we are related): He had his MRI yesterday, it was only about 20 minutes (mine were all closer to 45 minutes), he did say they put a coil on his hip and taped his feet into IR. Here is the "I can't believe we are related part". The doc told him to make an appt for after the MRI to come in and discuss the results (why he can't call is beyond me). What would I have done? Once I got off the phone with MRI place, the next call would have been the docs office for an appt a few days later. Jeff's plan is to call today for an appt. I am going to try (in my sneaky way) to get the report from the imaging center this week, we'll see! Some are good about it, some are not and have rules and protocols!
Once again, thank you to J's HR dept and United healthcare for the wonderful insurance they provide us, Jeff's MRI co-pay was $400, no that is not an extra zero!!!!!
Tuesday, July 1, 2008
And The Verdict Is....
Hips passed the Boston trip!!!!! Yay!
There was absolutely no pain at any time on the stairs...in the hips. My knee problem took a hit this weekend but things are beginning to calm down again. I am not interested in dealing with it...again! The pain had gotten a lot better with strengthening and is manageable at this time, so as long as it stays there, I won't bother with a cortisone injection. But the offer is still on the table (I hope) should I so desire one!
There was absolutely no pain at any time on the stairs...in the hips. My knee problem took a hit this weekend but things are beginning to calm down again. I am not interested in dealing with it...again! The pain had gotten a lot better with strengthening and is manageable at this time, so as long as it stays there, I won't bother with a cortisone injection. But the offer is still on the table (I hope) should I so desire one!
Thursday, June 26, 2008
Testing the Waters
We are off to Boston tomorrow to the in-laws. It is actually J's 10 year high school reunion. In the past, I have not done so well there with the flights of stairs and the kids all over the place. In fact, I think the July 07 trip to Boston was what sealed the deal for me in knowing I needed a revision on the right. I was about 3 or 4 weeks post-op on the left and the stairs were making the right (which was 4 months out) hurt soooooo much more, I knew something was wrong. I was also back in Boston a few weeks after the revision and seem to remember having a hard time with the stairs then to.
So, I will report back when I know. I have been having a hip-issue free period of time, with minor blips here and there, but have been taking it easy. Lets keep our fingers crossed.
So, I will report back when I know. I have been having a hip-issue free period of time, with minor blips here and there, but have been taking it easy. Lets keep our fingers crossed.
Tuesday, June 24, 2008
The Difference Between Men and Women
Today was Jeff's appointment with the local OS. Like many of you (most likely women), I had done a ton of research prior to my initial OS appointment, including journal articles, textbooks, google searches and speaking to other people in my situation. I had already self diagnosed (correctly I might add) and had a list of questions in my head. I had a plan and was not leaving the office without a script for an MRI. I was ready!
Jeff called me from the waiting room at the doctor's office and said "what should I ask him". exasperated, I asked if he had read my blog yet, he said yes, meaning the "Dear Jeff" post. So, I had to give him the 60 second labral tear/FAI lesson. It went something like this: Make sure they take an x-ray, ask him if he sees impingement. Ask him if he thinks it is a labral tear, make sure he figures out why you have a tear (I can't stress this enough) and get an MRI. Tell him exercise and PT has made you worse. Tell him you started with groin pain and now it is more diffuse throughout your leg and has radiated to your knee. Find out what he thinks is the problem.
So.....Jeff has to get an MRI, the doc has no idea what is wrong, he does not know if it is a labral tear, he said maybe a stress fracture or some inflammation and have him NSAID's to take for now. And he left in more pain than he went in with :-)
Jeff called me from the waiting room at the doctor's office and said "what should I ask him". exasperated, I asked if he had read my blog yet, he said yes, meaning the "Dear Jeff" post. So, I had to give him the 60 second labral tear/FAI lesson. It went something like this: Make sure they take an x-ray, ask him if he sees impingement. Ask him if he thinks it is a labral tear, make sure he figures out why you have a tear (I can't stress this enough) and get an MRI. Tell him exercise and PT has made you worse. Tell him you started with groin pain and now it is more diffuse throughout your leg and has radiated to your knee. Find out what he thinks is the problem.
So.....Jeff has to get an MRI, the doc has no idea what is wrong, he does not know if it is a labral tear, he said maybe a stress fracture or some inflammation and have him NSAID's to take for now. And he left in more pain than he went in with :-)
Sunday, June 15, 2008
Dear Jeff.....
Being that my life can't get any more pathetic these days, now it seems that my problems are contagious. My younger brother, Jeff, has a possible torn labrum. He called me one day in April to tell me his hip had begun bothering him during ice hockey, and he had a triathlon a few days later and didn't know what to do. Although I don't remember the mechanism of injury, it sounded like a possible acute hip flexor strain so I instructed him in a hip flexor stretch (the Susie favorite in half kneeling). He said it really helped and did it the entire week prior to the race. He did his Triathlon and I don't really remember hearing much else about the hip.
My parents are in NY visiting for a few days and mentioned that Jeff had to stop playing tennis and training for his next triathlon bc his hip has been bothering him, and he has an appointment with an OS in Miami. Obviously, an OS in Miami does not meet my "hip OS standards". Jeff things I am snobby and that this guy "does NFL and MLB players", and must be good. So, I thought maybe some of my readers could share some insight with my dear little brother and maybe share their experiences with "great OS's". I told him to make sure he a) gets an MRI (and to find out if they have the "special" MRI's that can detect tears without contrast, and if not, suck it up and have it with contrast) b) get a copy of ALL films to send off for a second opinion c)If he does indeed have a labral tear, does he have FAI d) DO NOT HAVE SURGERY IN MIAMI
He said he is going to see if the doctor can make the diagnosis without him saying anything, and if he does not mention the labrum, he will bring it up. I think this is not so easy when you are in the thick of it with a busy OS, especially if they are arrogant and busy, not that this one is, but, just in case. Do not wait to try PT then get the MRI, push for it now.
So, I admit I can be a bit snobby about hips and hip surgeons, but I think I have the experience and have heard from enough people to know at least a little bit about what I am talking about.
So please, comment, I will forward all responses to him, so he does not have to go through what so many of you have had to.
My parents are in NY visiting for a few days and mentioned that Jeff had to stop playing tennis and training for his next triathlon bc his hip has been bothering him, and he has an appointment with an OS in Miami. Obviously, an OS in Miami does not meet my "hip OS standards". Jeff things I am snobby and that this guy "does NFL and MLB players", and must be good. So, I thought maybe some of my readers could share some insight with my dear little brother and maybe share their experiences with "great OS's". I told him to make sure he a) gets an MRI (and to find out if they have the "special" MRI's that can detect tears without contrast, and if not, suck it up and have it with contrast) b) get a copy of ALL films to send off for a second opinion c)If he does indeed have a labral tear, does he have FAI d) DO NOT HAVE SURGERY IN MIAMI
He said he is going to see if the doctor can make the diagnosis without him saying anything, and if he does not mention the labrum, he will bring it up. I think this is not so easy when you are in the thick of it with a busy OS, especially if they are arrogant and busy, not that this one is, but, just in case. Do not wait to try PT then get the MRI, push for it now.
So, I admit I can be a bit snobby about hips and hip surgeons, but I think I have the experience and have heard from enough people to know at least a little bit about what I am talking about.
So please, comment, I will forward all responses to him, so he does not have to go through what so many of you have had to.
Wednesday, June 11, 2008
Close Call
Being that I am "so over" the hip hype, I occasionally wear shoes that are not befitting someone who has had 3 hip surgeries and a bad knee. Occasionally, fashion comes first. Yesterday was one of these days, the fashion required 4" heels. I have to say I did really well until the last 15 minutes of heel time.
I was crossing the street with J, when all of a sudden, I heard/ felt one of my infamous hip cracks, but I was standing on the leg, not sitting down or moving it. It was during the stance phase of gait, and then, for a quick second, my leg almost gave out on me. It happened so quickly I don't think J noticed, but for that moment, horrible thoughts went through my mind, including, but not limited to a fracture. And then, just as quickly as it happened, it was over, I made it to the sidewalk with no further incident.
Scar tissue? Psoas? Who knows. I am fine, my hips are fine, if just a bit rattled!
I was crossing the street with J, when all of a sudden, I heard/ felt one of my infamous hip cracks, but I was standing on the leg, not sitting down or moving it. It was during the stance phase of gait, and then, for a quick second, my leg almost gave out on me. It happened so quickly I don't think J noticed, but for that moment, horrible thoughts went through my mind, including, but not limited to a fracture. And then, just as quickly as it happened, it was over, I made it to the sidewalk with no further incident.
Scar tissue? Psoas? Who knows. I am fine, my hips are fine, if just a bit rattled!
Sunday, June 8, 2008
Funky Popping Going On
Every now and then, I will go sit on a low chair and POP, something (psoas?) will pop/ snap in one of my hips. It doesn't hurt but is rather loud.
Yesterday took the cake! Try to picture this. I was lying in bed, on my right side, very close to the edge of the right side of the bed. I let my right leg slowly hang of the bed (don't know what I was doing) and pop, pop. 2 pops in the hip (psoas). So I tried to re-evaluate what had happened, and came to he conclusion that I had internally rotated the right leg and then it popped. Which led me to wonder if it really was the psoas, or rather some old scar tissue.
I know, I have way too much on my hands!
Yesterday took the cake! Try to picture this. I was lying in bed, on my right side, very close to the edge of the right side of the bed. I let my right leg slowly hang of the bed (don't know what I was doing) and pop, pop. 2 pops in the hip (psoas). So I tried to re-evaluate what had happened, and came to he conclusion that I had internally rotated the right leg and then it popped. Which led me to wonder if it really was the psoas, or rather some old scar tissue.
I know, I have way too much on my hands!
Thursday, June 5, 2008
Why Didn't This Ever Occur To Me?
For those of you that can remember, before all the excitement of all of these surgeries, there were MRI's and CT scans and anxious days waiting for phone calls with the results. Many anxious days, filled with frustration and annoyance, knowing my results were sitting on my OS desk and me not knowing. So I patiently sat by the phone for days at a time, a slave to it, to ensure I didn't miss a call.
I had an appointment today at my ob-gyn's office. I was sitting in the waiting room and a woman walked in and walked to the reception desk. She announced her name and said she as there because she had already called twice and no one had called her back yet. She needed to schedule surgery. Clearly she was very anxious about it. The receptionist told her she that the reason she hadn't been called back was bc the surgery had to be scheduled with the hospital. She wanted to know when they would do it, they told her today or tomorrow. She was not happy with that, to which I can relate, but probably would not have actually come down to the office for this! They told her they would call her when they knew when, to which she replied that she needed options for dates in case she wasn't going to be around.
I know many of us have felt like this woman before but would we ever do that? Was she gutsy or a pain in the ass?? I know I have felt like doing that before, I have also felt like breaking into my OS office and stealing my films, until I got smart and just had the receptionist fax me the results before speaking to him. That was the most ingenious thing ever, less waiting, less anxiousness and me being the control freak I am!
I had an appointment today at my ob-gyn's office. I was sitting in the waiting room and a woman walked in and walked to the reception desk. She announced her name and said she as there because she had already called twice and no one had called her back yet. She needed to schedule surgery. Clearly she was very anxious about it. The receptionist told her she that the reason she hadn't been called back was bc the surgery had to be scheduled with the hospital. She wanted to know when they would do it, they told her today or tomorrow. She was not happy with that, to which I can relate, but probably would not have actually come down to the office for this! They told her they would call her when they knew when, to which she replied that she needed options for dates in case she wasn't going to be around.
I know many of us have felt like this woman before but would we ever do that? Was she gutsy or a pain in the ass?? I know I have felt like doing that before, I have also felt like breaking into my OS office and stealing my films, until I got smart and just had the receptionist fax me the results before speaking to him. That was the most ingenious thing ever, less waiting, less anxiousness and me being the control freak I am!
Sunday, June 1, 2008
11 Month Update
I am now 11 months post hip arthroscopy #2, the first and only surgery on the left hip. On most days, I would never think I had surgery on that leg. What effects me the most these days is that it is pool season and I am not thrilled with the vampire bite scars on my leg. I know last week there was the slight medial issue, I have not had it since, and I can say I am thrilled thrilled thrilled with it. I have no idea what the ROM is, or what the strength is, functionally, it is amazing and that is all that matters.I don't care if I am lacking some IR, or some flexion, there is nothing in life I currently cannot do bc of this hip.
I would love to x-ray my hips, and see what they look like now, see if arthritis is beginning to set in, what the shape is like....I have not had post-op x-rays, the closest I have come is an OR x-ray on the right side to show the "funky cam impingement" before and after! X-rays will have to wait!
All I can say is thank you Dr. Kelly!!!!
I would love to x-ray my hips, and see what they look like now, see if arthritis is beginning to set in, what the shape is like....I have not had post-op x-rays, the closest I have come is an OR x-ray on the right side to show the "funky cam impingement" before and after! X-rays will have to wait!
All I can say is thank you Dr. Kelly!!!!
Tuesday, May 27, 2008
Am I Being Ridiculous? Neurotic? Or Just Plain Naive?
My activity level has increased slighlty over the past few days in the way of walking but decreased in the way of spinning due to some other things going on (I won't get into that yet).
I have had some pain on my right side that bothered me a few days ago, and I wondered if I was going crazy. I had some medial sided pain, but the usual anterior medial, it is purely medial hip pain. It is not bad at all, but being that I am generally not in pain or discomfort, this was slightly disconcerting. It happenned Sunday, and then Sunday night, my leg felt tired, as I lay in bed. It started up again yesterday,and today,I walked about 80 city blocks and experienced it again.
Yes, 80 blocks is excessive, am I asking too much of my hip? I am not sure what is going on other than some crazy hormonal shit at the same time (not getting into it though), I did wear my Danskos all day to prevent knee and hip pain.
Obviously, I know things will never be perfect again, and I am nitpicking here bc things have been so great, I just want NO DISCOMFORT at all.
I do try to not think about the fact that this hip will eventually deteriorate into a nasty case of arthritis, but when I do, I hope and pray that this is not the beginning of it. I know, I need to chill out, but I am very "high maintenance".
I have had some pain on my right side that bothered me a few days ago, and I wondered if I was going crazy. I had some medial sided pain, but the usual anterior medial, it is purely medial hip pain. It is not bad at all, but being that I am generally not in pain or discomfort, this was slightly disconcerting. It happenned Sunday, and then Sunday night, my leg felt tired, as I lay in bed. It started up again yesterday,and today,I walked about 80 city blocks and experienced it again.
Yes, 80 blocks is excessive, am I asking too much of my hip? I am not sure what is going on other than some crazy hormonal shit at the same time (not getting into it though), I did wear my Danskos all day to prevent knee and hip pain.
Obviously, I know things will never be perfect again, and I am nitpicking here bc things have been so great, I just want NO DISCOMFORT at all.
I do try to not think about the fact that this hip will eventually deteriorate into a nasty case of arthritis, but when I do, I hope and pray that this is not the beginning of it. I know, I need to chill out, but I am very "high maintenance".
Thursday, May 22, 2008
I am Defnitely Going To Hell
Today started out like any other Thursday, I was in housewife mode, I went food shopping in the morning, and then decided to meet my sister in the city. I decided to leave my car at home and take public transportation since the car usually becomes more of a burden in the city, plus, with the price of gas and parking, I was trying to be economical and eco-friendly. See, I am also VERY lucky, I have a parking spot. It is not in the indoor, valet garage in my building. That one has a long waitlist. It is about a block away, outdoors, on a poorly paved empty lot, but it is a HUGE luxury in NY. For the 6 months that we did not have a spot, I hated going out early in the day bc I would surely home home during "alternate side" and not be able to find a spot. I also didn't like to go out too late bc then there would be no spots left on the street. Having a spot gives me freedom, plus I sleep a lot better at night knowing my car won't be ticketed (again).
So today I received a call from a woman who works at the office who manages the garage. We are being kicked out of our spot bc someone who lives in the building adjacent to the lot needs a spot. What a load of crap. I have been parking there for 1 1/2 years. Apparently, I was the last one in the lot, so I am the first to get the boot. Well, I was furious, and yelled and screamed, but to no avail. So I had J call, bc I am too emotionally involved.
J didn't know what to do, so here is what happened in the conversation between J and the man at the parking place:
Man: Look, I am really sorry but the owner of the lot also owns apartments in the building and he is renting one out and needs a parking spot for the tennant.
J: But we have been with you for 1 1/2 years, we are good tennants, and we had no idea this was a possibility, we would have had a back-up plan in this case.
Man: I know, I'm sorry, but you are tenants at will, there is no contract, we don't even bill you, you just send us a check each month.
J: Look, I work in the city, I have 2 kids and my wife is disabled
Man: Oh, she's disabled
J: Yes, she just had 3 surgeries.....
Man: Oh, I see, I'm so sorry, let me see if there is someone else we can kick out, I will get back to you
So you see, we have a little white lie going here. Yes, I had 3 surgeries, but I am far from disabled. We are sooooooo going to hell for this. But parking is such a HUGE deal for me....
Can you feel the jewish guilt????????????
So today I received a call from a woman who works at the office who manages the garage. We are being kicked out of our spot bc someone who lives in the building adjacent to the lot needs a spot. What a load of crap. I have been parking there for 1 1/2 years. Apparently, I was the last one in the lot, so I am the first to get the boot. Well, I was furious, and yelled and screamed, but to no avail. So I had J call, bc I am too emotionally involved.
J didn't know what to do, so here is what happened in the conversation between J and the man at the parking place:
Man: Look, I am really sorry but the owner of the lot also owns apartments in the building and he is renting one out and needs a parking spot for the tennant.
J: But we have been with you for 1 1/2 years, we are good tennants, and we had no idea this was a possibility, we would have had a back-up plan in this case.
Man: I know, I'm sorry, but you are tenants at will, there is no contract, we don't even bill you, you just send us a check each month.
J: Look, I work in the city, I have 2 kids and my wife is disabled
Man: Oh, she's disabled
J: Yes, she just had 3 surgeries.....
Man: Oh, I see, I'm so sorry, let me see if there is someone else we can kick out, I will get back to you
So you see, we have a little white lie going here. Yes, I had 3 surgeries, but I am far from disabled. We are sooooooo going to hell for this. But parking is such a HUGE deal for me....
Can you feel the jewish guilt????????????
Monday, May 19, 2008
Revision Hip Arthroscopy/ Failed Hip Arthroscopy
I always wonder how many other people have fallen into this predicament as well. What I have noticed is that these are key words that often bring people to my blog. I have no way to really keep track, but often I will scan my sitemeter which will tell me the search words used by readers. It doesn't always work, for example, "Landsickness" through google brings up my blog, o the top 10 (I checked), but so do other key words, like FAI, hipscope, hip arthroscopy,psoas....and my all time favorite, "Bryan Kelly hipscope", my blog is #1 on google if you put in those words. This is quite embarrassing as well as pretty funny, if you ask me! (If he knew, he probably wouldn't agree!)
So, my point is, I was curious, who has had a failed hip arthroscopy? or failed FAI surgery? or failed surgery for a labral tear? Who has retorn their labrum?And even more importantly....why...what reason were you given??
Now would be a great time for all lurkers to share their story, so we can all learn from each other.
Me? An conservative surgeon who didn't want to take down too much bone if it was unnecessary. We found out the hard way that it indeed was necessary, but a happy ending for all involved parties!!!
So, my point is, I was curious, who has had a failed hip arthroscopy? or failed FAI surgery? or failed surgery for a labral tear? Who has retorn their labrum?And even more importantly....why...what reason were you given??
Now would be a great time for all lurkers to share their story, so we can all learn from each other.
Me? An conservative surgeon who didn't want to take down too much bone if it was unnecessary. We found out the hard way that it indeed was necessary, but a happy ending for all involved parties!!!
Monday, May 12, 2008
6 Month Post-Revision Update
Wow, I can't believe it has been 6 months already. 6 months since I tossed the hip brace, 6 months since I retired my crutches, 6 months since I was praying to a higher power to either make me stop vomiting or take me out back and shoot me, 6 month since I have had an argument with a surgeon :-)
For those of you just joining my blog, here is how it all went down: In March of 2007, I had my right hip scoped for a labral tear and pincer FAI. In July, the left hip was scoped for a labral tear, cam and pincer FAI. At that point, the right hip went bad and I realized I needed surgery again. It took a lot of diagnostic tests, injections, pleading and begging, but finally, my surgeon agreed to do it, but.....there was a catch. He was convinced that my pain was from a tight, impinging psoas, I did not think so. In fact, I was so sure, I made him promise he wouldn't touch my psoas. I wouldn't even sign a consent for for it I was so sure. So, he hesitantly agreed to do the surgery with the psoas promise, and as a compromise, I agreed to let him do a psoas bursectomy, if needed. Lo and behold, I woke up with an intact psoas as well as sans bursectomy since the psoas was not the problem.
3 months of long, intense rehab, with a few blips and bumps and knee injuries along the way, as well as some intermittent PRN PT visits, here I am.
I can't believe that 6 months later, I still walk around and gleefully think to myself "whoohoo, I am no pain", with a little smile. I still feel like I am walking on clouds some days and as if this was a dream, and I will soon wake up with that dreaded groin pain. I still say to myself almost every day. "shit, I am one lucky chick to have a happy ending after so much bullshit", 3 surgeries in 8 months really takes a toll on you, physically and emotionally.
So, what is still going on? My psoas has its moments, and more than once I have had to return for a quickie PT session to have it worked on. It also has caused me to have some back pain in addition to the muscle aches. My adductors are weak and tight, and I swear I think I have had a "snapping adductor". My psoas does snap now, I am not sure if it did, or to what extent it did pre-op. My theory to why I have so much muscle pain now is well described in prior post. I have soooo much more ROM now than I ever did and my muscles are trying to compensate by tightening up. I need to continue to strengthen them, but I prefer Spinning to PT, so who knows how this will end!
All in all, muscle pain and soreness 6 months later is a good deal for me if it means I have no more joint pain! If you need a surgeon, I have only positive things to say about mine! And what can be better than a happy ending!
For those of you just joining my blog, here is how it all went down: In March of 2007, I had my right hip scoped for a labral tear and pincer FAI. In July, the left hip was scoped for a labral tear, cam and pincer FAI. At that point, the right hip went bad and I realized I needed surgery again. It took a lot of diagnostic tests, injections, pleading and begging, but finally, my surgeon agreed to do it, but.....there was a catch. He was convinced that my pain was from a tight, impinging psoas, I did not think so. In fact, I was so sure, I made him promise he wouldn't touch my psoas. I wouldn't even sign a consent for for it I was so sure. So, he hesitantly agreed to do the surgery with the psoas promise, and as a compromise, I agreed to let him do a psoas bursectomy, if needed. Lo and behold, I woke up with an intact psoas as well as sans bursectomy since the psoas was not the problem.
3 months of long, intense rehab, with a few blips and bumps and knee injuries along the way, as well as some intermittent PRN PT visits, here I am.
I can't believe that 6 months later, I still walk around and gleefully think to myself "whoohoo, I am no pain", with a little smile. I still feel like I am walking on clouds some days and as if this was a dream, and I will soon wake up with that dreaded groin pain. I still say to myself almost every day. "shit, I am one lucky chick to have a happy ending after so much bullshit", 3 surgeries in 8 months really takes a toll on you, physically and emotionally.
So, what is still going on? My psoas has its moments, and more than once I have had to return for a quickie PT session to have it worked on. It also has caused me to have some back pain in addition to the muscle aches. My adductors are weak and tight, and I swear I think I have had a "snapping adductor". My psoas does snap now, I am not sure if it did, or to what extent it did pre-op. My theory to why I have so much muscle pain now is well described in prior post. I have soooo much more ROM now than I ever did and my muscles are trying to compensate by tightening up. I need to continue to strengthen them, but I prefer Spinning to PT, so who knows how this will end!
All in all, muscle pain and soreness 6 months later is a good deal for me if it means I have no more joint pain! If you need a surgeon, I have only positive things to say about mine! And what can be better than a happy ending!
Wednesday, May 7, 2008
Woe Is Us Part Deux
My Turn!
If I ever doubted that the entire body is connected and works as one impressive chain, today would have changed my mind.
I have been having incredible muscle pain over the past few days, it hasn't been this bad in a while. Yesterday and today I have been dealing with the right side (2 scopes), I feel my psoas pulling at my vertebrae again, and then I get awful pain on medial side of my thigh, not quite groin. This is palpable too. I am so stiff and clicky as well.
Yesterday was a sore day. As I was waiting for the elevator to go down and pick L up at school, I started stretching and trying to get my hip to extend, and hopefully stretch, or possibly break up scar tissue. I got it to pop, but then it hurt. It did get better at some point, I don't remember exactly when or what happened. Which leads me to beleive it was scar tissue
Today, that side was a mess again. I felt like my hip was so tight I was losing extension again, like in the early pre-op days. I did the "stool stretch", where I put my knee on a rolling stool and stretch my leg out behind me. It felt good, I got up to walk, and my right knee was a disaster (i.e. the good knee), I was limping for a while. This too, cleared up, but the hip remains tight.
Like the uncompliant,impatient patient that I am, I had a good ride on my spin bike tonight. I know this is not helping the psoas issue since I am sitting, and spinning my legs, fast, in a small arc of motion. The psoas just winds tighter and tighter.
I have been strtetching it, still, and still doing my abductor and adductor exercises, as if this balances out the "don't spin" part.
Time to get on the floor and stretch stretch stretch!!!
If I ever doubted that the entire body is connected and works as one impressive chain, today would have changed my mind.
I have been having incredible muscle pain over the past few days, it hasn't been this bad in a while. Yesterday and today I have been dealing with the right side (2 scopes), I feel my psoas pulling at my vertebrae again, and then I get awful pain on medial side of my thigh, not quite groin. This is palpable too. I am so stiff and clicky as well.
Yesterday was a sore day. As I was waiting for the elevator to go down and pick L up at school, I started stretching and trying to get my hip to extend, and hopefully stretch, or possibly break up scar tissue. I got it to pop, but then it hurt. It did get better at some point, I don't remember exactly when or what happened. Which leads me to beleive it was scar tissue
Today, that side was a mess again. I felt like my hip was so tight I was losing extension again, like in the early pre-op days. I did the "stool stretch", where I put my knee on a rolling stool and stretch my leg out behind me. It felt good, I got up to walk, and my right knee was a disaster (i.e. the good knee), I was limping for a while. This too, cleared up, but the hip remains tight.
Like the uncompliant,impatient patient that I am, I had a good ride on my spin bike tonight. I know this is not helping the psoas issue since I am sitting, and spinning my legs, fast, in a small arc of motion. The psoas just winds tighter and tighter.
I have been strtetching it, still, and still doing my abductor and adductor exercises, as if this balances out the "don't spin" part.
Time to get on the floor and stretch stretch stretch!!!
Tuesday, May 6, 2008
Woe is Us
To even the playing field around here, J has a possible torn meniscus. You would think orthopaedic issues were contagious. He did something yesterday and heard or felt a pop, and today, he has been complaining of clicking and locking and and medial sided pain. He also has pain with palpation to the medial joint line. Tonight, he couldn't put Jk to bed bc "his knee hurt", couldn't change a diaper and had to take the car to go 8 blocks to a friend's house (to watch a basketball game). Just as a reminder (J), I never stopped my "motherly responsibility" during a year of hip shit, 3 surgeries and a crap load of PT. So, either a) suck it up b)make an appointment with an OS to have it checked out, and suck it up or c)keep complaining to me but suck it up anyway. Or maybe I can throw back some of the lines you gave me:
"Why do you have to look for problems?"
"I really think there is something seriosly wrong with you"
"Do you need surgery...AGAIN?"
"It can't be that bad, you don't even limp"
"Can you get off of the computer, stop blogging and stop looking for articles"
"You are crazy" (said in reference to many other things)
I told J to wait a week, if he does not feel better, make an appt with Dr. Kelly. He said he does not want to see Dr. Kelly bc he is afraid that I will have to contradict everything he says, and bc he is afraid he doesn't like me bc I am so opinionated. Haha
"Why do you have to look for problems?"
"I really think there is something seriosly wrong with you"
"Do you need surgery...AGAIN?"
"It can't be that bad, you don't even limp"
"Can you get off of the computer, stop blogging and stop looking for articles"
"You are crazy" (said in reference to many other things)
I told J to wait a week, if he does not feel better, make an appt with Dr. Kelly. He said he does not want to see Dr. Kelly bc he is afraid that I will have to contradict everything he says, and bc he is afraid he doesn't like me bc I am so opinionated. Haha
Sunday, May 4, 2008
You Know its Not Going To Be A Good Day When......
for starters, you wake up with pain on the inside of your ASIS, on the hip that was operated on 10 months ago. When your back feels so stiff it hurts to lean forward. When you have 3 parties within 4 hours...and you are hosting one of them...and the guest list is comprised of twenty five 4 year olds.
My psoas has been giving me issues lately, on both sides, I think. It is hard to remember sometimes, although today we are talking of the left side. Operated only once in July 2007. Last night I began to diligently exercise adductors and abductors on both sides to help my "ailing" knee and "psychotic psoas". I also have been stretching the hip flexors a lot more lately. But this morning, I felt like I made a 9 month backtrack in muscular issues (Joint is still good, you can all breathe a sigh of relief, joint is actually amazing and I am super thrilled, which is why I save my muscular issue complaints for when they are really bad). My iliacus is a mess for some reason. Iliacus is the top portion of the combined muscle called "iliopsoas", iliacus+psoas=iliopsoas. It is found posterior to the ASIS and can be palpated by bringing your fingers just under the ASIS. I have not attempted to manually work on it, but have been stretching it as much as possible (all hip flexors). I stretched before I took L to ballet, after I picked her up from ballet, while she was at a ballet birthday party, and before we left to go to her birthday party! I still have a lot of pain localized to that area. It is an improvement from this morning, I think I could almost feel it pulling on my vertebrae, and that is why my back was bothering me. The stretching seemed to have helped with that a lot.
L's party was at Gymboree and I have never seen so much chaos in my life. The 2 teachers (we had to pay extra and hire a second one bc we had so many kids) were useless. They could not run the party and it ended up being mostly free play. For some reason, walking barefoot on the mats made my bad knee crazy, and then once we got home, it starting having shooting pains.
We just unwrapped all the presents, cleaned the living room and put the kiddies to bed!
I am praying that tomorrow is a better day(probably less fun, but hopefully less pain too!)
My psoas has been giving me issues lately, on both sides, I think. It is hard to remember sometimes, although today we are talking of the left side. Operated only once in July 2007. Last night I began to diligently exercise adductors and abductors on both sides to help my "ailing" knee and "psychotic psoas". I also have been stretching the hip flexors a lot more lately. But this morning, I felt like I made a 9 month backtrack in muscular issues (Joint is still good, you can all breathe a sigh of relief, joint is actually amazing and I am super thrilled, which is why I save my muscular issue complaints for when they are really bad). My iliacus is a mess for some reason. Iliacus is the top portion of the combined muscle called "iliopsoas", iliacus+psoas=iliopsoas. It is found posterior to the ASIS and can be palpated by bringing your fingers just under the ASIS. I have not attempted to manually work on it, but have been stretching it as much as possible (all hip flexors). I stretched before I took L to ballet, after I picked her up from ballet, while she was at a ballet birthday party, and before we left to go to her birthday party! I still have a lot of pain localized to that area. It is an improvement from this morning, I think I could almost feel it pulling on my vertebrae, and that is why my back was bothering me. The stretching seemed to have helped with that a lot.
L's party was at Gymboree and I have never seen so much chaos in my life. The 2 teachers (we had to pay extra and hire a second one bc we had so many kids) were useless. They could not run the party and it ended up being mostly free play. For some reason, walking barefoot on the mats made my bad knee crazy, and then once we got home, it starting having shooting pains.
We just unwrapped all the presents, cleaned the living room and put the kiddies to bed!
I am praying that tomorrow is a better day(probably less fun, but hopefully less pain too!)
Saturday, May 3, 2008
Hmmm.....Can Anyone Else Relate Too??
Doctor Who? Are Patients Making Clinical Decisions?
ScienceDaily (Feb. 12, 2008) — Doctors are adjusting their bedside manner as better informed patients make ever-increasing demands and expect to be listened to, and fully involved, in clinical decisions that directly affect their care. In a study just published in Clinical Orthopaedics and Related Research, Dr. J. Bohannon Mason of the Orthocarolina Hip and Knee Center inCharlotte, NC, USA, looks at the changes in society, the population and technology that are influencing the way patients view their orthopaedic surgeons. As patients gain knowledge, their attitude to medicine changes: They no longer show their doctors absolute and unquestionable respect.
Demographic change, education, affluence, availability of information via the Internet, patient mobility, direct-to-consumer marketing, patient age, patient activity demands, cost pressures and physician accountability are converging to present the practitioner with a patient who is more informed and has higher expectations than any prior generation of patients.
Today's patients do not simply have a medical complaint, they desire a particular operation and sometimes even a particular implant. The doctor is no longer the sole source of medical information. Patients have enough snippets of information to stimulate a dialogue and clearly express their expectations for a particular outcome and technique to achieve that outcome. They are also demanding quicker recovery, return to higher-level sport activity and earlier discharge from the hospital.
"Patients have come to expect miracles in medicine as the norm, yet these miracles are not without inherent risk," cautions Mason.
Providing true patient-centered care relies on doctors' ability to supply patients with accurate, evidence-based information and to improve communication. However, patients are not necessarily motivated by evidence-based medicine. They are often willing to adopt the promises of direct-to- consumer marketing.
In Mason's view, the doctor's responsibility is "to maintain control of validated information sources and of the exchange of information with the patient. [Doctors] need to be interpreters and balancers of scientific information to help guide [their] patients through the maze of medical hyperbole. [They] need to discuss new treatments and technologies openly and honestly."
And crucially, they must also understand that although patients' demands are changing, the surgeon's accountability and responsibility for their patient's safety and care have not.
Journal reference: Mason JB (2008). The new demands by patients in the modern era of total joint arthroplasty. Clin Orthop Relat Res (DOI 10.1007/s11999-007-0009-2)
Adapted from materials provided by Springer.
ScienceDaily (Feb. 12, 2008) — Doctors are adjusting their bedside manner as better informed patients make ever-increasing demands and expect to be listened to, and fully involved, in clinical decisions that directly affect their care. In a study just published in Clinical Orthopaedics and Related Research, Dr. J. Bohannon Mason of the Orthocarolina Hip and Knee Center inCharlotte, NC, USA, looks at the changes in society, the population and technology that are influencing the way patients view their orthopaedic surgeons. As patients gain knowledge, their attitude to medicine changes: They no longer show their doctors absolute and unquestionable respect.
Demographic change, education, affluence, availability of information via the Internet, patient mobility, direct-to-consumer marketing, patient age, patient activity demands, cost pressures and physician accountability are converging to present the practitioner with a patient who is more informed and has higher expectations than any prior generation of patients.
Today's patients do not simply have a medical complaint, they desire a particular operation and sometimes even a particular implant. The doctor is no longer the sole source of medical information. Patients have enough snippets of information to stimulate a dialogue and clearly express their expectations for a particular outcome and technique to achieve that outcome. They are also demanding quicker recovery, return to higher-level sport activity and earlier discharge from the hospital.
"Patients have come to expect miracles in medicine as the norm, yet these miracles are not without inherent risk," cautions Mason.
Providing true patient-centered care relies on doctors' ability to supply patients with accurate, evidence-based information and to improve communication. However, patients are not necessarily motivated by evidence-based medicine. They are often willing to adopt the promises of direct-to- consumer marketing.
In Mason's view, the doctor's responsibility is "to maintain control of validated information sources and of the exchange of information with the patient. [Doctors] need to be interpreters and balancers of scientific information to help guide [their] patients through the maze of medical hyperbole. [They] need to discuss new treatments and technologies openly and honestly."
And crucially, they must also understand that although patients' demands are changing, the surgeon's accountability and responsibility for their patient's safety and care have not.
Journal reference: Mason JB (2008). The new demands by patients in the modern era of total joint arthroplasty. Clin Orthop Relat Res (DOI 10.1007/s11999-007-0009-2)
Adapted from materials provided by Springer.
Thursday, May 1, 2008
A Work In Progress
The previous 2 posts will be added to and updated as I have time and will be able to be accessed from a link on the right side of the page. I hope everyone finds this useful and helpful.
I have also added a few additional links along the right side of the page, which also gets updated periodically!
I have also added a few additional links along the right side of the page, which also gets updated periodically!
Failed Hip Arthroscopy and Revision Hip Arthroscopy Articles
Radiologic and Intraoperative Findings in Revision Hip Arthroscopy
Presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons, San Diego, California, February 2007.
Benton E. Heyworth, M.D., Michael K. Shindle, M.D., James E. Voos, M.D., Jonas R. Rudzki, M.D., Bryan T. Kelly, M.D.
Arthroscopy. 2007 Dec;23(12):1295-302.
Purpose: The purpose of this study was to identify possible causes of failure of hip arthroscopy by reviewing the intraoperative and radiologic findings in a series of patients requiring revision hip arthroscopy. Methods: We retrospectively reviewed 24 revision hip arthroscopy cases performed in 23 patients (14 female and 9 male; mean age, 33.6 years; 1 bilateral). The review included indications for surgery, intraoperative findings, and arthroscopic interventions for both the primary and revision surgeries. Imaging studies, including radiography, magnetic resonance imaging, and 3-dimensionally reconstructed computed tomography scans, were analyzed for the presence of preoperative bony impingement lesions (e.g., femoral head-neck junction “cam” lesions or anterosuperior acetabular “pincer” lesions). Results: The mean interval between previous hip arthroscopy and recurrence of symptoms was 6.1 months. In 13 of 24 cases (54%), patients had no significant improvement at any point after the primary hip arthroscopy. The mean interval between the previous hip arthroscopy and revision surgery was 25.6 months. Unaddressed or undertreated bony impingement lesions were found in 19 of 24 cases (79%) and were identified on imaging studies before revision hip arthroscopy. A tight psoas tendon and corresponding labral impingement lesion were identified by arthroscopic visualization in 7 of 24 cases, for which partial psoas tendon release was performed. Eight cases of failed labral repair were addressed with labral debridement and removal of suture material. Of these 8 cases, 6 also had bony impingement, which was also addressed at the time of the revision surgery. Conclusions: Failure to address bony impingement lesions of the hip and a tight psoas tendon are key factors in unsuccessful hip arthroscopy and may require revision surgery. Furthermore, failure of labral repairs may be the result of unrecognized bony impingement at the time of initial surgery. Level of Evidence: Level IV, prognostic case series.
Revision Hip ArthroscopyMarc J. Philippon, MD*, Mara L. Schenker, Karen K. Briggs, MPH, MBA, David A. Kuppersmith, R. Brian Maxwell and Allston J. Stubbs, MD
Am J Sports Med. 2007 Nov;35(11):1918-21. Epub 2007 Aug 16
Background: Hip arthroscopy has become increasingly popular; however, little is known about revision hip arthroscopy.
Hypothesis: Revision hip arthroscopy is associated with unaddressed femoroacetabular impingement. The purpose of this study was to describe reasons for revision hip arthroscopy.
Study Design: Case series; Level of evidence, 4.
Methods: Between March 2005 and March 2006, 37 revision hip arthroscopies were performed by the senior author. Data were collected through retrospective review of clinical and operative notes.
Results: All patients required revision surgery because of persistent hip pain. There were 25 women and 12 men with an average age of 33 years (range, 16–53 years). The average time from prior surgery to revision was 20.5 months (range, 2.9–84 months). Common findings among patients needing revision were hip pain, decreased range of motion, and functional disability. The average modified Harris Hip Score was 53 (range, 22–99). Thirty-six patients had radiographic evidence of femoroacetabular impingement at the time of revision. Revision procedures included 34 (95%) for femoroacetabular impingement, 32 (87%) for labral lesions, 26 (70%) for a chondral defect, 23 (62%) for lysis of adhesions, and 13 (35%) for previously unaddressed instability. Two patients had total hip arthroplasty after revision, and 3 patients required further revision. Of the remaining 32 patients, early follow-up was obtained on 27 (84%) at an average of 12.7 months postoperatively (range, 6–19 months). Outcomes showed patients regained some of their lost function within the first year.
Conclusion: Patients commonly required revision hip arthroscopy because of persistent impingement.
Presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons, San Diego, California, February 2007.
Benton E. Heyworth, M.D., Michael K. Shindle, M.D., James E. Voos, M.D., Jonas R. Rudzki, M.D., Bryan T. Kelly, M.D.
Arthroscopy. 2007 Dec;23(12):1295-302.
Purpose: The purpose of this study was to identify possible causes of failure of hip arthroscopy by reviewing the intraoperative and radiologic findings in a series of patients requiring revision hip arthroscopy. Methods: We retrospectively reviewed 24 revision hip arthroscopy cases performed in 23 patients (14 female and 9 male; mean age, 33.6 years; 1 bilateral). The review included indications for surgery, intraoperative findings, and arthroscopic interventions for both the primary and revision surgeries. Imaging studies, including radiography, magnetic resonance imaging, and 3-dimensionally reconstructed computed tomography scans, were analyzed for the presence of preoperative bony impingement lesions (e.g., femoral head-neck junction “cam” lesions or anterosuperior acetabular “pincer” lesions). Results: The mean interval between previous hip arthroscopy and recurrence of symptoms was 6.1 months. In 13 of 24 cases (54%), patients had no significant improvement at any point after the primary hip arthroscopy. The mean interval between the previous hip arthroscopy and revision surgery was 25.6 months. Unaddressed or undertreated bony impingement lesions were found in 19 of 24 cases (79%) and were identified on imaging studies before revision hip arthroscopy. A tight psoas tendon and corresponding labral impingement lesion were identified by arthroscopic visualization in 7 of 24 cases, for which partial psoas tendon release was performed. Eight cases of failed labral repair were addressed with labral debridement and removal of suture material. Of these 8 cases, 6 also had bony impingement, which was also addressed at the time of the revision surgery. Conclusions: Failure to address bony impingement lesions of the hip and a tight psoas tendon are key factors in unsuccessful hip arthroscopy and may require revision surgery. Furthermore, failure of labral repairs may be the result of unrecognized bony impingement at the time of initial surgery. Level of Evidence: Level IV, prognostic case series.
Revision Hip ArthroscopyMarc J. Philippon, MD*, Mara L. Schenker, Karen K. Briggs, MPH, MBA, David A. Kuppersmith, R. Brian Maxwell and Allston J. Stubbs, MD
Am J Sports Med. 2007 Nov;35(11):1918-21. Epub 2007 Aug 16
Background: Hip arthroscopy has become increasingly popular; however, little is known about revision hip arthroscopy.
Hypothesis: Revision hip arthroscopy is associated with unaddressed femoroacetabular impingement. The purpose of this study was to describe reasons for revision hip arthroscopy.
Study Design: Case series; Level of evidence, 4.
Methods: Between March 2005 and March 2006, 37 revision hip arthroscopies were performed by the senior author. Data were collected through retrospective review of clinical and operative notes.
Results: All patients required revision surgery because of persistent hip pain. There were 25 women and 12 men with an average age of 33 years (range, 16–53 years). The average time from prior surgery to revision was 20.5 months (range, 2.9–84 months). Common findings among patients needing revision were hip pain, decreased range of motion, and functional disability. The average modified Harris Hip Score was 53 (range, 22–99). Thirty-six patients had radiographic evidence of femoroacetabular impingement at the time of revision. Revision procedures included 34 (95%) for femoroacetabular impingement, 32 (87%) for labral lesions, 26 (70%) for a chondral defect, 23 (62%) for lysis of adhesions, and 13 (35%) for previously unaddressed instability. Two patients had total hip arthroplasty after revision, and 3 patients required further revision. Of the remaining 32 patients, early follow-up was obtained on 27 (84%) at an average of 12.7 months postoperatively (range, 6–19 months). Outcomes showed patients regained some of their lost function within the first year.
Conclusion: Patients commonly required revision hip arthroscopy because of persistent impingement.
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
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
Another Anatomy Lesson
L with her latest b-day gift, "Bryan the skeleton". Many thanks to Amy for finding this toddler size one! Click here to have L teach you many bones and muscles!!! Here she is pointing out the radius.Tuesday, April 29, 2008
The Week in Review
There is no place like home! We were in Miami for a week and a half, it was great but it is also great to be home!
The trip began with my (not so) quick MRI the night before, getting the results, L's 4th b-day party and a long trip home!
Last we spoke, my knee "issue" was TBD, possible MCL, as seen on MRI, or muscle imbalances, but I am to strengthen and stay off of my spin bike. I still think it is "joint related".
I have been off the bike for 2 weeks, the knee was ok, yesterday I was thinking that staying off of the bike was helping but this morning it was back to normal. So I was feeling unbelievably fat from lack of spinning and lots of eating (Jewish holidays=food) so I rode. I hurt, but I cannot directly attribute it to the bike.
L's party was great, its no wonder my kids love going to my parent's house, check out the BEST 4 year old party ever.
I never had a bounce house or ponies at my b-day parties!!!
While we were away, J had to come home for a day for work. The day before he was to leave, he received an email from the parking company where we leave our car at the airport. It turns out, they needed to move our car to an overflow lot since we were gone for so long, in the process, they left the car illegally parked for "a few moments" and it was ticketed and towed, due to some unpaid tickets (oops).
So, J had to go from the airport to one office in Queens to pay for the tow, tickets, storage fee, marshall fee and judgement fee, then go to Brooklyn to pick up the car! The parking company felt so bad they drove him to all of those places, paid all the fees minus the actual tickets, and gave us free parking for the entire duration of the trip (that is a HUGE savings here). It sucked that it happened but I count my lucky stars that J went to retrieve the car alone than with all of us in tow, especially after yesterdays adventure.
We flew non-stop, through DC (don't ask). We left Miami on time and made it to DC with time to spare to catch the connection. Initially, the flight was delayed an hour. We boarded, pulled away from the gate and were told we would have to sit on the runway bc Laguardia was slowing down traffic. We sat for 2 hours, then they pulled us back to the gate bc there were 6 kids on a 40-50 seater plane...not happy kids. We ended up arriving around 4PM (left Miami at 8AM), then I realized I left L's sweater on the plane. One more hour in the airport, we finally left, without the sweater, and all I could think was :thank goodness the car is here, waiting for us!)
The trip began with my (not so) quick MRI the night before, getting the results, L's 4th b-day party and a long trip home!
Last we spoke, my knee "issue" was TBD, possible MCL, as seen on MRI, or muscle imbalances, but I am to strengthen and stay off of my spin bike. I still think it is "joint related".
I have been off the bike for 2 weeks, the knee was ok, yesterday I was thinking that staying off of the bike was helping but this morning it was back to normal. So I was feeling unbelievably fat from lack of spinning and lots of eating (Jewish holidays=food) so I rode. I hurt, but I cannot directly attribute it to the bike.
L's party was great, its no wonder my kids love going to my parent's house, check out the BEST 4 year old party ever.
I never had a bounce house or ponies at my b-day parties!!!While we were away, J had to come home for a day for work. The day before he was to leave, he received an email from the parking company where we leave our car at the airport. It turns out, they needed to move our car to an overflow lot since we were gone for so long, in the process, they left the car illegally parked for "a few moments" and it was ticketed and towed, due to some unpaid tickets (oops).
So, J had to go from the airport to one office in Queens to pay for the tow, tickets, storage fee, marshall fee and judgement fee, then go to Brooklyn to pick up the car! The parking company felt so bad they drove him to all of those places, paid all the fees minus the actual tickets, and gave us free parking for the entire duration of the trip (that is a HUGE savings here). It sucked that it happened but I count my lucky stars that J went to retrieve the car alone than with all of us in tow, especially after yesterdays adventure.
We flew non-stop, through DC (don't ask). We left Miami on time and made it to DC with time to spare to catch the connection. Initially, the flight was delayed an hour. We boarded, pulled away from the gate and were told we would have to sit on the runway bc Laguardia was slowing down traffic. We sat for 2 hours, then they pulled us back to the gate bc there were 6 kids on a 40-50 seater plane...not happy kids. We ended up arriving around 4PM (left Miami at 8AM), then I realized I left L's sweater on the plane. One more hour in the airport, we finally left, without the sweater, and all I could think was :thank goodness the car is here, waiting for us!)
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