Labral tear? (Cartilage tear in the hip)

[Simkie]

Laurie, based on the way you describe your pain and the improvement I’ve had since surgery, I’d say if your doc won’t order it, find someone who will.

Since surgery I have had NO sacroiliac pain. Granted, I’ve not done a lot and I’ve been well medicated, but I haven’t even had a hint of it. Find a student of this guy:

http://thesteadmanclinic.com/dr-marc-philippon.asp

When you do have your MRA, ask the doctor to block your hip when he’s in there to inject the contrast. He is going to be using lidocaine to block the tissue for the injection anyway, so it’s not a big deal to block the joint. Not only does it make the test more comfortable (they jam a lot of crap into the joint capsule) it’s diagnostic. If the block makes you feel better at all, that’s pretty indicative of a labral tear.

Something that was interesting about my pain is that manipulating the leg didn’t cause sharp, instant pain. It was sore, but not crazy. But when I walked out of the doctor’s office, I was hobbling with fairly general hip/back/i-don’t-even-know-where-it’s-coming from pain. Turns out that in addition to the tear I had, I also had a swollen, hypertrophic labrum, and it was getting pinched and blistered with movement. Explained a lot about the pain I was having.

[Laurierace]

How did they ever figure out to look at your hip if your pain was only in your SI? I feel like I am going to have a hard time convincing them that it is even a possibility due to the epidural having some effect. Not sure if the SI injection having no effect will weigh in the decision or not.

It sounds like your surgery and recovery is pretty intense but I am so tired of the pain I would operate on myself with a rusty butter knife if I thought it would help. I have gone from hopeful that this would pass to depressed that it was still here and am now PISSED.

[Simkie]

I had a doctor who suggested it following SI injections that did no good and a clean lumbar MRI. The hip MRA was the next step in her bag of tricks.

My pain was nearly all left SI, sometimes right, and when it would get really bad, it would wrap around the front of my leg and go down to the outside of my knee. At it worst, it would radiate down to the outside of my foot. Sometimes sitting was unbearable.

And my doctor used an epidural for pain control following surgery, so that does hit the hip…probably depending on where it goes. But I wouldn’t discount that they “accidentally” blocked your hip.

At this point, with you in so much pain and so little results with what’s been done, I’d say it’s darts at a dartboard. One more non-invasive (except for the IA contrast) test sounds like a no brainer.

The only tricky part of this is the labrum is difficult to image, even WITH the IA contrast. Sometimes the MRA is clean and the labrum is still in terrible shape. Gold standard for diagnosing a labrum issue is to scope the joint. I’d hope, though, that with the amount of pain you’re in something would show up on the MRA. Mine showed a tear, but not the degree of damage that was there.

[Laurierace]

Wow. I am almost afraid to get hopeful. Who would thought I would be wishing I needed major surgery?

[Simkie]

I get it, though! I (literally) feel your pain! I am even excited for you that this might be the answer

And certainly what I can tell you about the surgery: the first week sucks. It gets better after that. You’ll have some movement restrictions for awhile and PT. 5-6 months before you’re “better.” I’m very grateful that my doctor took my pain management seriously, as going home on only percoset or vicodin would NOT have cut it. And the dalaudid pain pump for the first 24 hours was really necessary.

There are several approaches to doing this surgery, and if this is what’s going on I’d recommend someone who’s studied under Philippon and who ONLY does hips. Skill and approach matter here. Shop around and find the best guy in your area.

[tollertwins]

Ditto simikes recommendations on docs. I also had really bad si pain…and when it really got ripped got pain down the outside of the leg. I could never quite figure out what there was above my ankle on the outside that could hurt!

[Laurierace]

I could take this to PMs but thought maybe it might be helpful for others to have the info too so I am going to ask here instead.

I go to the pain dr tomorrow and am going to talk to them about the MRA. When I had the MRI’s they just wrote a script and I took it to the radiology place locally and had it done. You mentioned having a dr block the joint when I had a MRA. Is that the hip dr? The pain dr? Somebody at the radiology place? I guess I need to know if I need a hip dr first before I can get the test to find out if the hip is the problem. I have a feeling the pain dr is going to balk at the idea but I am pretty sure I can get my family dr to order it if that happens. But don’t know if I need a hip surgeon first. I couldn’t sleep last night thinking that there is a chance we are finding an end to this nightmare.

[Simkie]

Laurie, you may have to have the MRI done at the hospital instead of a free standing MRI facility in order to have the doctor on hand to do the block.

The way it worked for me:

MRA scheduled at the hospital
Prior to the MRI, I was taken back to a room off the MRI room and…
A doctor (anesthesiologist?) blocked the skin
Got the needle into the joint capsule
Used flouroscopy and some radio lucent die (like the use for CT) to confirm he was in the right space (if you have any allergies to CT contrast material, let them know and push this issue. I had to go home and reschedule because I’d not done the steroid prep I need to do CT contrast.)
Injected the MRI contrast.

When I was bullshitting with the doctor before he started, I asked if he could put some lidocaine into the joint and he sort of shrugged and said why not. I do recommend as it can be diagnostic and it make the test more comfortable. This is also the FIRST thing a hip doc will do to you, so if you’ve done it and found any relief, you’re ahead.

The MRI took maybe 30 minutes.

I felt a little better with the block, but it wasn’t OMG I am cured better. Given the state of my labrum, nothing was going to make me OMG I am cured better but surgery.

Some doctors say the labrum can be imaged without contrast. Don’t believe them and push for the MRA versus MRI. It’s hard enough to see with contrast and anyone who says you can see it at all without is not up on current research.

I was just thinking of you today in PT. My physical therapist and I were talking about my pain before surgery and he says he sees this frequently. If someone doesn’t get relief in 2 - 3 PT episodes, he sends them to Denver to see the hip doc. That’s HOW common this pain complex = hip. I’m really sorry it’s taken so long for this to even be discussed as a potential reason for your pain

I’m also happy to take this to email if you would prefer.

[Laurierace]

So your hip surgeon was not present? I am starting to think I might need a hip surgeon first because even if my pain dr orders it, I don’t know that he is going to be able to do anything about it. My PT has had both of his hips replaced, I will ask him who to use.

[Simkie]

For the MRA? No, it’s totally unnecessary for a hip doc to be present for the MRA and I doubt you’ll find a single one who would be willing to do that. The good hip guys are operating 4 days a week and seeing patients in their office for the fifth.

Get the MRA, get a referral for a hip guy. Call Steadman and ask for someone who has studied with Philippon in your area. Take the disk with the MRA images with you, along with any radiography you’ve had of your hips.

My chain of events:

Pain that no longer responded to PT
Primary care doc
Referral to orthopod
Schedule SI injection
SI injections (didn’t work)
Referral to pain doc (who was the one who actually injected the SI, anyway)
Lumbar MRI (normal)
Hip MRA (abnormal)
Referral to hip guy
Visit with hip guy, surgery recommended
Schedule surgery
Second opinion at Steadman, surgery recommended with original hip guy
Surgery

And that brings us to present. We started this in February or so.

If your current doc won’t order the MRA, find a hip guy through Steadman and go see them, but I would ask for the MRA from your doc tomorrow, as that should save a considerable amount of time.

[Simkie]

Based purely on a quick google and the fact this guy is listed with Philippon, Dr Henry Boucher could be one to try:

[URL=“http://www.livestrong.com/article/139153-labral-pain/”]http://www.livestrong.com/article/139153-labral-pain/

http://www.gcoa.net/index.asp

I can’t find any sort of bio for him, so unsure who he’s studied with.

[Simkie]

Here you go. Here’s one that studied at Steadman.

http://osmc.net/directory/people/show/benjamin-petre

[Laurierace]

He looks like he is 12!

[Simkie]

LOL…why is it that as I get older, doctors get younger? That seems unfair, doesn’t it?

[Laurierace]

I like that he is a team Dr for the Orioles. I wish I could figure out where he operates out of as I assume it is at a hospital but it doesn’t say which. Most of his offices are an hour plus drive but looks like it may be worth it. Thanks!

[Simkie]

My hip doctor is an hour plus drive away. The minimally invasive technique he uses (learned from Philippon) is not common–no one in my neck of the woods even does it, much less had the background.

IOW, expect to travel

[Simkie]

Figured an update would be in order after all this back and forth.

Physical therapy is going very well and my coach tells me that my range of motion and disappearing guarding of the area is excellent. No new exercises recently, but everything we’ve got going is about strengthening the glute and hamstring while stretching the front of the hip.

Doctor today (well, his assistant) for checkup and (THANK GOD) suture removal. The stitches were really starting to pester and I was very well behaved by not pulling them out.

I am getting around on the crutches but will not be sad at all to see them go. Hoped to get time off for good behavior but the doc was very specific about 30% weight bearing for a full four weeks to ensure a good seal with the new labrum.

I’m on the level of pain medication now that I was pre surgery (10/325 Vicodin TID, 300mg gabapentin TID) and my pain feels very surgery related instead of what I had before. I don’t feel the pain I had before.

I am in love with the game ready and have spent the bulk of the last two weeks in it, icing 30 mins on/30 off around the clock–more when the pain was bad. I also have a nice fleecy electric blanket that I wear to keep from (literally) freezing my ass off. I was able to get another week of the game ready prescribed, but couldn’t talk the doctor into writing an RX to pay for the insurance company to purchase one. Total bummer on that front.

The continuous passive motion machine also went back today. While I’m glad that it helped recover movement through these two weeks, I’m also glad that I’ll be able to sleep like a normal person again.

That about sums it up. I was told pre surgery that things feel better before they actually ARE better, and I believe it. It’s very tempting right now to ditch the crutches, at least for some parts of the day, but I will be good because I never way to go through this again (especially for not following orders.)

[Bristol_Bay]

On a positive note, think of the upper body strength you are developing by using the crutches!

It’s so good to hear that you can feel the benefits of the surgery already. One day soon you will not be able to conjure up a memory of how much pain you were in before.

I bought the cold therapy machine outright. I did have a prescription, not that my cheapo HMO would have paid for it, but with the Rx, I did not have to pay tax. I also loved it, even the noise it made. It was comforting!

You are that much closer to riding again. Good for you!

[Laurierace]

Glad to hear your recovery is progressing. I hope to be able to say the same someday! Thanks again for your help.