Acetabular Labrum tear

Dear hipsters

For the past six odd years, Ive struggled with knee and (buttock) hip pain, and seen whats seems like hundreds of different docs. Finally found a physio who stuck with me, and on his advice, I hit the gym with a trainer.

Hip pain was initially diagnosed as Gluteus Medius tendonopathy. Did loads of butt work.. didnt improve. Meanwhile my patello femoral knee pain improved dramatically after a few months, but the butt kept on aching! Was doing some heavy adductor work in the gym which felt good for the knee, but one morning i woke up and there was a pain in the groin part of my hip, which hurt when i tried squeezing the knees together..

Suspected labrum tear...MRI showed a tear traversing the full width of the base of mid anterior acetabular labrum. Of course then came the injection. The anasthetic was supposed to be long acting so that i could take my time to really check it out but the doc decided short one would do "too bloody expensive" were his words, and I couldnt really tell. Pain on adduction was still there. Cortisone had a flare up effect that night and it hurt in the butt very badly.... The next few days were relatively blissfull. Felt good!! Groin pain was there butt i could live with it.

On the third day I did my ususal chores and the butt pain was back.. Now about to see a surgeon to get his opinion.

My questions are.

1) whats the chance that my tear has been with me for 6 years and been the cause of all the butt pain?

2) If its been with me for so long, why has it emerged only now?

3) My surgeon is Michael O'Sullivan in Sydney.. will see him next week, but any comments on success or failures or anything?

Cheers

You might want to ask your Orthopeadic about Femoral Impingment. This is a very undiagnosed problem that results in hip pain, sometimes in the butt. Effectively the head of the femur is ever so slightly misshaped (not visible on a standard x-ray) and over time as it 'hits' the acetabular it will finally tear the labrum. The excercises you described will have agravated such a condition. Have a look at the following link for more information.

http://www.physsportsmed.com/issues/...005/larson.htm
It can be very effectively treated with either an arthroscopy or hip surgery.

You might want to ask your Orthopeadic about Femoral Impingment. This is a very undiagnosed problem that results in hip pain, sometimes in the butt. Effectively the head of the femur is ever so slightly misshaped (not visible on a standard x-ray) and over time as it 'hits' the acetabular it will finally tear the labrum. The excercises you described will have agravated such a condition. Have a look at the following link for more information.

http://www.physsportsmed.com/issues/...005/larson.htm

It can be very effectively treated with either an arthroscopy or hip surgery.

Sounds like the same history for the athletes i have seen in the past. I have now rehab`d 8 athletes who have undergone labrum repair.

Recently, two problem cases have suffered from quite sizeable osteophytes both on the acetabular rim and the femoral neck which were butting up against each other and destroying the labrum. With arthroscopy the labrum was destroyed and was delaminating in the socket at the superior aspect (imagine between 11 and 1 on a clockface).

The surgeon i have used recently is Dr Philippon in Vail, Colorado. He is pioneering loads of hip arthroscopy work and is a fantastic man to speak too.

Good luck


Sunderland FC (UK)

thanks for the reply.... Its now exactly 3 weeks after my arthroscopy and while i'm still tender in the groin region, im quite surprised to say that the butt pain has decreased quite dramatically. Im scared to actually believe it since im loving it too much to ever go back, but there are a few factors that are making me pessimistic, which are that i've been taking it extremely easy since the op, and It might be the effects of the cortisone i had injected prior. I guess i should remain positive or at least enjoy it while it lasts

I wonder. If the tear was caused by my femur hitting it repeatedly because of its deformed shape, and the surgery removed that part of the labrum that it was hitting, do i have more space for hip flexion. the reason i ask is because im not entirely sure what debridement looks like or how much was removed.

The scope revealed that the rest of the joint was clean and undamaged but would the surgeon be immediately aware if my femur was misshaped? Or could they have missed it in the MRI because they werent looking for it?

Its early days yet, but so far im so glad its done.
Thanks for your replies again.

James,

I am currently booked in for an arthroscope early Feb, with Dr M. O'Sullivan as my surgeon.

Can you tell me a little about the operation and how is the recovery going.

thanks

Dan

Hi James,

I too have been diagnosed with your condition. I have had had a rough 6 months. After Xray, MRI and CT investigations, they found that I had not only acetabular tear but also lesions on femoral head which resulted in further investigation and delay in treatment for labral tear. Lesions turned out to be nothing to worry about however I still am in a great deal of pain. I have had 2 cortisone injections to no avail (I reacted badly to the last - flare and fever for 1week post injection) and am scheduled to see Dr Michael O'Sullivan for a surgical opinion.

Can you tell me a little about the operation? How long was it before you were up and about?

All the best with your recovery,

Amy.

Hi Amy,
I had no other chondral damage other than a great big tear in the labrum, so I believe just a straight labral debridement is easier post op than when they have to clean up the ball and/or socket as well. To answer your question, i limped out of the hospital without crutches and it took about a week before i could walk around the house without much difficulty. Two weeks later and i could walk some distance. Now its a month later and im walking up and down Bondi on the soft sand daily and it feels great. Its still painfull at the end range of flexion, (bringing knees to chest) and full extension is also a bit painfull, but this is normal. i was worried that i would be out of action for much longer than this, but I was surprised to find that a nagging pain in the buttock region had significantly reduced almost immediately, so I can basically say that I am better off almost immediately after the operation.

I am curious to know your symptoms, and others with labral tears. No one gave me a straight answer as to why a tear in the groin region would refer pain to the upper buttock region, except my physio who suggested that a the tear changed my bio-mechanics which caused weak gluteus muscles and eventually inflammation in them. this sounds good except why the sudden relief in the butt pain.

Anyone else out there with suggestions on why??

Hope it goes well for you Amy. Dr O'sullivan was very friendly and helpfull and i'm told he does this procedure very well

Ps that last post was from me... i forgot to sign in and sign my name.

James

James,

Noted your response to Amy.

Initially my condition was misdiagnosed as torn muscles, which then changed to nerve damage.

Eventually ended up with Dr O'Sullivan following successful diagnosis by another specialist.

My injury is a radial tear in acetabular labrum with incomplete tear at chondro-laberal junction. Including chondral wear at acetabular rim, possibly from femoral head rubbing.

I have suffered ongoing pain in the top of the buttock area since July last year, with associated numbness down my leg to the knee and sometimes beyond.

Had cortisone injection just before Christmas, which didn't work.

Your physio is on the right track. Prior to the correct diagnosis, I had accupuncture sessions when regular physio didn't work. In hindsight the pain must have worked its way outwards from the joint, affecting the muscles. These sessions helped deal with the local pain in greater trochanter muscles, which must have become inflamed.

regards

Dan