Acetabular Labrum tear

Hi fellow hip sufferers!

I am 29, female, surfer in the UK and also work in an NHS Cardiology dept - for my sins!

I also have a horrible story - occuring over the last 16 mths - I will try and keep it brief!

Sudden loss of use of left leg - following 2 mths lower back pain - Feb 2005.
A+E ->ambulance to royal orthopaedic hospital - T + L Spine MRI - Normal.
Brain MRI - normal.
In 5 days - under spinal surgeon whilst awaiting transfer to my own hospital where I worked, to rule out a neurological cause.

No neurological cause found - ? psychological - see psychiatrist - whilst an in patient.
I kept telling them my hip kept clicking, leg locked, knee hurt and knee gave way but it felt like it was my hip making knee unstable!! 2 neurologists and 1 psychiatrist - said no way could it be mechanical - it was stress!!!

I begged to be seen by a trauma surgeon who had seen me a few mths previously for back pain. With very bad grace they agreed.
MRI - Hips, thigh and knee - normal - March 2005. The trauma surgeon referred me back to orthopaedic hosp to an orthopaedic surgeon - to exclude a labral lesion in my hip with a view to arthroscopy! I was given a steroid injection - 2 mths relief, after initial agony for 10 days after!

The hip surgeon said it was coincidence I got better - psychological - discharged - told toget on and surf and skydive again and if my hip fell apart he would do an arthroscopy!

After 2 mths - acute hip, groin and knee pain! Trauma surgeon phoned hip surgeon to ask him to see me - he declined - told him to send me to a musculoskeletal physician.

This new doctor - ? SI joint ligament laxity - 4 mths of prolotherapy injections - to not much effect. We then had a "breakdown in patient/doctor relationship" and he refused to treat me - said I was beyond help. Nothing medically to be done - sent home. I was so upset!

Mean while - ongoing physio - muscle imbalance and trigger points - given stretches and joined a gym - got worse!

My GP agreed to send me for a second oppinion to Coventry which I paid for. Told not my back - ? hip! My anger levels raised!

He referred me to Professor Damien Griffin at BMI Meriden Hospital, Walsgrave site, Coventry, UK. Classsic mechanical history, slinical exam - strong suspicion of labral tear.
I paid £968 on credit card for an MR arthrogram (MRI with contrast injection) and 3 plain x-rays - 1 was a lateral view never done on me before!

X-rays = slight bulge in the supero-lateral acetabular rim.
MRa = extensive degeneration of the antero-superior labrum with a degenerative tear.

Paying £3700 for arthroscopy on 22nd June. Plan = debride acetabular labrum and treat any adjacent damage to articular surface, and reshape the area of excess bone in order to relieve impingement! There is also a cyst on head of femur - visible on the plain x-ray.
I AM SO SO ANGRY - AS ARE THE REST OF YOU I GUESS?! I asked why the hip sugeon would not have detected the abnormal shaped head of femur - unless they are specialised in this field it will be reported as normal

I am dreading surgery - but hoping for my life back!!!

After reading most of the messages - I gather that these labral tears are difficult to diagnose and you must have a contrast MRI (arthrogram) - routine MRI likely normal!
I REALLY FEEL MOVED TO DO SOMETHING TO HELP OTHER PATIENTS. My notes are a mess with reference that I may have a psychological problem, etc. I am going to complain and try and get my money back from both of these hospitals - including the one I work in - even if it takes years and I prepared for more debt for a solicitor if I have to - medical negligence I think!

I think there should be labral tear awarness education meeting in every hopital to the orthopaedic and trauma teams, physios, neurologists and psychiatrists! WHAT DO YOU ALL THINK? I also wonder about a patient support group - FOR WHEN YOU DO GET THE DIAGNOSIS - TO TALK ABOUT THESE BAD EXPERIENCES - AGAIN - IS THAT POSSIBLE?

WHO WOULD DO THESE TALKS TO THE CLUELESS DOCTORS AND SURGEONS? WOULD IT BE US - PATIENT LEAD - WITH INPUT FROM THE EXPERIENCED AND RARE SURGEONS?

DOES ANYONE THINK THIS WOULD BE POSSIBLE - MAYBE WITH HELP FROM THIS SITE? OR AM I LIVING IN FAIRY LAND?!

I am keen to here from anyone that feels like I do - email:
surfchick@totalise.co.uk

Take care

Amanda
xx:)

Paul,

I recommend the Philippon hip brace. See my previous posts for link. I have been wearing one at night for a couple of months and the catching pain has stopped while sleeping. Sleep can still be interrupted as it takes some time getting used to wearing the brace. Other symptoms now include numbness around the knee. Currently doing iliotibial stretches to assist.


dan

Hi - I'm am new to this, but finding a lot of interest in what you have going on. I'm starting to feel like a hypochondriac, but I know the pain is real. I have had knee pain for about 20 years - 3 ortho surgeries and IB problems for years. I have noticed over the past few years that I have been having a lot of hip & back pain. Thought was that it just radiated from the knee to the back and hip and if I could get my knee fixed, then everything else would start to feel better. Almost a year after the last knee surgery, I am not doing any better in fact everything (except the knee) are worse. I have gone back to my orthoped and he didn't want to do anything (the cartilage in my knee is 50% of the way cracked to the base of where it attaches in a few different places) I then tried to find a PT that could help with both the back & the knee & the hip. His conclusion was that I do have a possible tear in my knee, but that there were other things that are wrong, in my hip and back. He thought at one of the 1st visits that I may have a labral tear and a bulging disk in my back. Had an MRI done - negative on the hip, positive on the bulging disc& stenosis of the back and degenerative knee. Had an epidural for the back - some relief, but the hip/groin pain wasn't better. Went to another orthoped (tried the one that did surgery on my knee last July - and he didn't even look at my hip during the visit). This orthoped took an x-ray - believes there to be a possible labral tear and a growth on the femur bone- recommended I try a floral guided cortisone shot in the hip - didn't do much. He also gave me a cortisone shot in the IB area - that helped a lot with the knee pain I believe, but not with much else. I sent my pictures, MRI etc. to Dr. Philippon in Colorado - he believes that arthoscopy of the hip may help my condition. I know he is the best in the country, but he isn't in my health plan and is quite a long ways away. Has anyone heard of or Dr. John Clohisy in St. Louis or had any experiences with him. I would appreciate some feedback. Good Luck! I am a firm believer that the hip, knee go hand in hand.
Steph

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Originally Posted by damo

Thanks for the response Thihan. The problem I have at the moment is that the inflammation is so bad that I can't even ride short distances to experiment with bike position. I am looking at pedal float, saddle height and fore/aft position - have you had luck with any other adjustments?

If the knee pain is simply from overuse or bike position it seems fairly straightforward. The real nagging question in my mind however is that if the knee pain or say tight ITBs are as a result of the labrum tear, then will it recur as my training increases? For the moment I have to recover from the inflammation to do the required strengthening and then bike adjustments.

Still keen to hear from anyone who has had labrum tears with referred knee pain and in particular, lateral knee pain.

Thanks again!

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I just found this forum and it is like someone turned on the light. 20 years ago, in my late 20s, I injured my right hip. At the time, I was an active recreational bicyclist, and ran a bit. After years of misdiagnosis, no diagnosis, physical therapy, I finally all but gave up bicycling and sports of all sorts. I eventually got pain-free after about 8 years, but did not regain function. The only strenuous activity left to me was hiking. Any other strenuous activity resulted in right hip pain. For 20 years, I thought it was due to ilio-psoas tendinosis.

Recently, 2 things happened: I was diagnosed with anterior femoroacetabular impingement and started reading about it. And, 2 months ago I injured my left hip. Initial exam by my orthopedic surgeon reveals a calcified labrum on right side. I am awaiting an MRI which should clarify nature of injury on left side and extent of hip damage and possible early arthritic changes.

I am so relieved to know what is wrong with my hips and immensely joyful to find other folks who have similar problems. And I am also terrified and saddened at my loss of function and prognosis (a lot more pain and hip replacement is probably in the cards for me sooner or later). The recent injury to my left hip is really disturbing.

Here are my questions for you:
Are there other forums dealing with femoroacetabular impingement and secondary injuries, like torn labrum?
What should I be doing, or not doing, over the next few weeks till my MRI is done?

If you haven't yet torn your labrum, I think it might be possible to live with FAI by adapting activities and gear. Here is my experience that might help others with FAI: limit activities that involve extreme hip flexion. You can buy bicycle cranks (bmx) with crank arms as short as 145mm and change bicycle geometry so hip angle in as open as possible (comfort bikes, and some recumbents have this feature). Carefully, use orthotics or insoles to cant your feet to the outside: it puts a slight external rotation on the hip.


Robert

Good Luck with your MRI. Just an FYI....The doctors that looked at my MRI did not see the labrum tear and didn't see the FAI on my X-Ray although they did see a calcification or growth of some kind on the hip (neither the labrum tear or FAI are very recognized in the midwest region of the country). I sent my x-ray & MRI to Dr. Philippon in Vail and he diagnosed me with both based on the same MRI and X-ray that the Drs. in Omaha looked at. My PT was the original one that thought I had a labrum tear - they are somewhat rare and he had only seen one other one in the last 7 years. I knew my pain was real and that it was getting worse. I guess just a word of advice, that even if your MRI is negative for a labrum tear is negative by the initial Dr. that looks at it, you can send it to Philippon and have him look at it. He knows what he is looking for - Save yourself some money and don't have the MRA (if your MRI is negative) done until after you have Philippon look at the MRI. I'm so excited that someone looked at the symptoms and pictures and realizes that I do have a problem. I am scheduled for surgery in August.

Steph

Hi Damian,

Have you had any useful relpies yet? I have had hip/groin/ knee pain for 16 months. Just paid for hip arthroscopy - labral tear debridement and partially torn ligament repaired (the 1 that holds ball into socket!). Small extra bone left insitu - hope to recover without having to go back for more surgery later! My knee pain is still present. Physio says all muscles are rubish, hence knee cap not in correct alignment - they call this a "tracking" problem. I had my knee taped for 2 days - 1 week post op and I could go on ex bike without feeling grinding in my knee and without knee pain. Got loads of new exerices to do now to rehab my muscles and told eventually with my hard work - the muscles will improve and hold knee cap in correct place. Without having the tear sorted out I think exercise will be painful! Let me know how you get on.

Manda

Sorry - my last post was in response to this message!

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Originally Posted by Unregistered

Hi everyone,
I live in Victoria. I have been reading through the thread with much interest. I am a cyclist and skier. My main interest here is whether or not anyone has had chronic lateral knee pain associated with a labrum tear. If interested, please read on.

I had hip and groin pain for about 12 months. Confirmed labrum tear (by MRI) with a small cyst. I had a cortisone injection which did very little. I had two surgical opinions - one surgeon wanted to do an arthroscope whilst the second recommended waiting/rest/reduced activity. Interestingly the doctor who came recommended to me as more 'aggressive' took the more conservative approach. I opted for conservative management - ie reduced cycling. Hip and groin pain reduced dramatically but started getting knee pain when I resumed training. I now have lateral knee pain on both knees (side with confirmed labrum tear is much worse). The forced rest with knee pain has further improved my hip - now little symptoms at all.

My knee symptoms are very similar to ITB Friction Syndrome or Patellofemoral Syndrome (classic cycling overuse) but wondering if anyone with labrum tears has had accompanying knee pain?? My physio hasn't excluded that hip pathology could refer pain to the knee.

Thanks!!
Damian

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Hi Paul,

I was wondering what the name of your surgery was, do you know? I couldn't quite follow all of the technical terms and since I have been told by one group of ortho's that I need an osteotomy instead of just arthoscopy for my labral tear I am trying to sort through this and since you mention screws in your hip it sounds similar. I just think that I am too old (48) for that and would rather just move on to a new hip, than re-aligning my bones. Please share your thoughts. Thank you.

Keren

PS For those of you chronic hip pain, labral tear sufferers as myself-I have found that daily swimming, glucosamine chondroitin and naproxen helps quite a bit.

Whew! So I'm not crazy after all? My sympathies to all those sharing this painful ailment. I am thankful to all of you for sharing your stories. Having been in pain for the last two years, I am just starting down the road to a valid diagnosis. I am a 35yr old active female - doing normal stuff required of a single mom and Navy Sailor. After initial x-ray last year showed nothing, I was referred to PT with minimal relief. A year later and new set of doctors, my latest x-ray showed ossification at the lateral margin of the acetabulum. Follow up MRI indicated possible detachment of the anterior labrum and small exostosis of the superior lateral head and neck of the femur. So now I am waiting for my MR Arthrogram next week. My pain is only manageble with percocet so far - and I'm not sure I want to be on it for very long.
My questions to those in the know...1) At any point has it been clear whether non-treatment or continued activity will make the problem worse over time? 2) For those that had the surgery 6+ months ago - do you consider the surgery (arthroscopic or otherwise) worth it? 3) can anyone translate that mouthful of medical jumbo in the above paragraph? My primary care PA doesn't speak English well and I don't think she really knew. I've yet to see an ortho - appointment is pending.

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Originally Posted by Unregistered

I thikn I have a hip problem like what you guys are describing. Anyone know a doctor in melbourne, aus who specialises in this type of stuff?

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Hi Dr David Young is based in Melb, Aus and specialise in treating hips, and in particular does both arthroscopy and open to treat impingement. He was recommended as the only dr in Aus to do this type of work, he is recommended by hip specialists in Sydney and people travel to Melbourne from all over Australia to see him.