Hip adductor tendonitis/osis--adductor longus

[dm]

I had a PT injury while rehabbing a total hip replacement which has left me with long standing stubborn adductor longus tendon problems. It’s been 8 months and it is only moderately better with conservative treatment (steroid injections, PT, acupuncture, massage). At this point, I’m considering a surgical tendon release.

I haven’t been able to ride because of the adductor tendon pain, not because of the hip replacement (the hip itself is doing very well and has been ready to ride for a long time).

If I didn’t want to ride, I would consider just leaving the tendon as is and where it’s at with the healing and just deal with the residual pain, but I believe riding is going to put a lot of stress on the adductor and I could see it getting reinjured again pretty easily and get back to the severe level of pain I experienced during the first 6 months after the injury–not a fun time, and don’t want to have to go through that again.

I’m interested in hearing from anyone who has had either stubborn adductor tendon issues without surgery and how their rehab and future riding activities went, and especially anyone who has had a tendon release surgery and then returned to riding, and how that all went.

Thanks.

[dm]

No one??? I can’t have that unique of a situation … can I???

[tollertwins]

I have chronic psoas tendon issues. Before you go the surgery route - see if you can find somebody who does active release therapy.

Hurts like bloody h*ll, but they can get in and get the tendons loosened up.
http://www.activerelease.com/

I only went for 8 sessions, would be better if I would have done more, but it got me back to where I can actually use the leg.

What I still CAN"T do, however, is put it behind a big knee block or use a lot of leg aids on a wide horse. Some of that may be that the THR itself was anterior and that’s getting close to my ‘don’t go there’ position.

I also got a personal ultrasound from mendmeshop.com that helps when it’s really bad.

[dm]

Thanks for replying, tollertwins–sounds like you have the psoas impingement problem that can happen with hip replacements. I’ve been told that a surgical psoas release resolves that problem and there isn’t really any residual function loss afterwards. I’m just curious–Is there a reason why you haven’t had it done? I’d have that done in a nano-second if that was my problem. You may want to think about it rather than just suffering.

I haven’t had an MRI to see what the adductor longus tendon actually looks like because it’s difficult to get a clear picture with the metal from the hip prosthesis in the area, but I’ve seen 4 orthos for this and most suspect my adductor tendon is pretty badly injured, which means full healing and avoiding further reinjury is doubtful. The tendon isn’t strong and healthy any more, unfortunately.

[tollertwins]

We don’t know if it’s really impingement or chronic tendonitis.

I got the issue first after a 'scope to fix a labral tear. That surgery failed (they don’t even do it anymore on people over 40) and left me on crutches for an extended period and I had to go to a total hip.

By that time the hip was migrated partially out of the socket and I was on narcotics, and going a couple hundred feet to the mail box on crutches was an enormous task.

I be DONE w/ surgery on that one!!!

[airineek]

[QUOTE=dm;6850464]
I had a PT injury while rehabbing a total hip replacement which has left me with long standing stubborn adductor longus tendon problems. It’s been 8 months and it is only moderately better with conservative treatment (steroid injections, PT, acupuncture, massage). At this point, I’m considering a surgical tendon release.

I haven’t been able to ride because of the adductor tendon pain, not because of the hip replacement (the hip itself is doing very well and has been ready to ride for a long time).

If I didn’t want to ride, I would consider just leaving the tendon as is and where it’s at with the healing and just deal with the residual pain, but I believe riding is going to put a lot of stress on the adductor and I could see it getting reinjured again pretty easily and get back to the severe level of pain I experienced during the first 6 months after the injury–not a fun time, and don’t want to have to go through that again.

I’m interested in hearing from anyone who has had either stubborn adductor tendon issues without surgery and how their rehab and future riding activities went, and especially anyone who has had a tendon release surgery and then returned to riding, and how that all went.

Thanks.[/QUOTE]

I am a reluctant member of the adductor tendonitis club. Sorry you’re having this problem. It is a really tough area to treat. My chronic tendonitis started after I strained or tore my adductors running in college. I rested, then did PT for a long time, it didn’t help. I had chronic pain that made it really tough to run or ride for a couple years after that.

What finally alleviated the pain for me and seemed to get my hips and pelvis working more normally again was a course of prolotherapy injections, which are different from trigger point injections. I had the pubic symphysis injected as well as some tendon insertions aroung the effected hip and SI joint. It apparently tightened things up enough to alleviate about 99% of my pain. I returned to running, riding, etc. It would definitely be worth looking into before proceeding to surgery. It seems especially helpful in cases of pelvic imbalance or dysfunction where few other treatments are available.

Good luck!

[dm]

Thanks for the suggestion. I appreciate it!

[mzm_farm]

Help!

Figuring out source of hip pain. Ok, sorry to hijack, but I need help.
About a month ago I pulled my back and once that healed it got transferred to my hip area. When I tighten my abs - my hip and top/outside of knee hurt. Sleeping is a nightmare, getting up in the morning is excruciating. I can walk, carry stuff without a problem. I can NOT hoofpick - as in squat and shift weight is very painful.

What did I injure? Where can I look it up? How do I heal it?

I am tired of taking a blue “vitamin” (aleve) and not getting even any relief!

[dm]

Mzm–have you seen a doctor about this? If not, I would recommend an ortho like a sports medicine MD. That’s where to start.

Good luck

[dm]

Update: I have decided to proceed with a surgical adductor longus tendon release. Since I also have pain in neighboring areas more towards the front of my leg (probably hip flexors), I’m also going to have a hip/upper thigh/groin arthroscopy so my surgeon can physically see what things look like and correct anything else that might help with the pain, without of course compromising the strength and mobility of the leg too much. I think it will be a real balancing act in the OR that day, but I trust my surgeon a lot and I know he is very knowledgable and experienced.

I’m pretty nervous because of all the unknowns–I think it was easier to have the hip replacements because there are fewer unknowns about that. Much of this is up in the air depending on what he finds and chooses to do once he’s in there looking around. And, how my recovery/rehab will go is another unknown.

I just know I want to be able to do moderate trail riding and moderate hiking again–even just an hour or two at a time will be OK with me–and I can’t do it now. Riding puts a lot of strain on the hip adductor muscles compared to many activities, and my longus can’t take any additional strain or it’s going to be right back to the horrible pain I had for several months after the initial injury.

After 10+ months post injury with no additional aggravating injuries (I’ve been careful), it’s likely healed as much as it’s going to on its own. So, it’s either live a sedentary life with a lot of life modifications to avoid aggravating things for the rest of my life, or do the surgery and be able to do more (hopefully!).

The adductor longus release surgery seems to be done mostly on high level athletes playing football, soccer, or hockey. I saw 4 ortho surgeons and I’m the first patient who ever had this happen because of physical therapy exercises after a total hip replacement. I’m 52, certainly not in “athlete” physical shape, having had two hip replacements within 5 months of each other, so I do think my recovery will be more difficult than a 25 year old athlete, but I’m going to try to do all the right things and get as much of my former active life back that I can, especially the ability to ride!!!