Acetabular Labrum tear

[Unregistered]

Hello,
I am a physical therapist in the U.S. and I have been experiencing low back buttock and leg pain for the past 10 years on and off. Recently, it was made worse by taking up golf. I had two sessions of physical therapy in the last 4 years, which helped temporarily and many deep tissue massages which also helped temporarily. My symptoms are now localized to the groin and buttock. I finally decided to consult an orthopedic surgeon because I am no longer able to play any sports, do yoga or dance like I used to. Preliminary x-rays and physical exam point to labral tear of the hip and I am scheduled for an MRI in 3 days. The surgeon stated that arthroscopy is only successful in 30% of cases. Is this what you all have found?? He basically said I'd have to live with it. What is your advice?
S

[Thihan]

Hi S, I'm a physio in Melbourne, Australia with a special interest in chronic hip, groin and LBP mainly because I spent years sorting out my own problems as well as my patients. The simple answer to your question about hip pathology and hip scopes is that we don't really know. If we compare the historical progression of a similar pathology and procedure in the knee, for example the first knee scopes, it took many years before sufficient evidence was avaliable regarding best practice in managing those conditions. Comparatively, hip joint pahtology (excluding OA) ia a relatively new phenomen and as such we are still exploring the best methods for both assessing severity of pathology as well as the most appropriate management. At Melbourne University they have a specialised hip study group who investigate just that. At the end of the day hip pathology is not an isolated problem, the compensations and interactions with other musculoskeletal components are complex and require sound clinical assessment and reasoning when deciding on an individualised treatment plan. As a PT a good starting point is a thorough look at a your lumbo-pelvic biomechanis and stablity as wellas looking at your aggravating activites to decide on the best ways to impove your weakness and manage your hip load. Pilates can be a good way of implementing it into a busy lifestyle (it worked for me). There's another whole thread on the surgical side of things on this forum so check that out too.
Cheers
Thihan - sorry about the long post.

[Thihan]

Quick addit: to properly answer the question about what to do, have a read of the acetabular labral tear article someone posted the link to earlier (damn .. wish I'd written that one). If the MRI is inconclusive then I would say explore all rehab and conservative measures fully before undergoing surgery. If however you have a tear then it needs invasive treatment (this may be just an injection or a full arthroscope or both). I have found this stepwise approach has saved quite a few (me included) from surgery but of course it all depends on the chronicity/severity of the problem and the pain of course.

[Unregistered]

Thihan,
Thanks for the reply. I have had two rounds of PT in the last 4 years, and I am a Pilates instructor. When I can do Pilates, it does really help, but overall the problem is getting worse. The MRI will confirm if it is a tear, but it most likely is. I read the referenced article by Shirley Sahrmann et.al. and another by Dr. Farjo from University of California. It seems that arthroscopic surgery is becoming more popular for the hip, but still very few surgeons are performing it....I will certainly seek a second and possible third opinion before signing up for surgery. And I may also try a very concentrated round of self-PT with a combo of Sahrmann muscle balancing exercises and Pilates just to be conservative first.
Thanks for the advice.
S

[Claire]

Hello All,

I am a 20 year old female who has a history of joint problems. I had a capsular shift performed on my shoulder at the age of 17.

After 5.5 months of frustration and misdiagnosis I am 7 days post op from Hip Arthroscopy + Labral Debridement.

I presented with severe pain in groin for no apparent reason. I am an active cyclist and whilst I had had a fall some months prior to the onset of pain, the sudden onset meant that there was no link to the fall.

Xray, CT and MRI investigations showed an Acetabular Labral Tear and moderate non-specific synovitis. Lesions on the Femoral Head were also shown which were possibly an indication of an Osteoid Osteoma (a benign bone tumor which causes night pain). This was later ruled out after they scared me by telling me that it might be a malignant tumor! The injury was so severe that I was basically on crutches for 5 months.

I was treated with 2 cortisone injections to no avail.

I have heard a lot about arthroscopy patients having little success after surgery and was fairly sceptical about the procedure but I have to say one week out I have no pre-op pain at all.

I was in hospital for three days (usually this is a day procedure but I had quite a lot of debride taken out).

A little about the procedure: it takes about 2.5 hours. Both legs were placed into vascular stockings and the leg that was to be operated on was placed into traction.Two small incisions are made on the outer thigh region where probes are inserted.

I walked out of hospital aided by crutches and continue to use them now one week later.

I had physio two days ago - passive movement is fantastic. I am still very sore and sorry but it is only going to get better from here in. My physio expects that I will be able to walk unaided in another week (slower than what other people have posted but we all heal differently!). The main thing that the groin pain is gone.

After months of chronic pain I now have relief and can get on with life.

To people who feel that there are no non-evasive treatment options left - I say "GO FOR IT". What have you got to loose?

[DiverDan]

Anyone interested in post-op recovery.

It is now 3 weeks, + 3 days since procedure. I've had a couple of physio sessions, including weight bearing exercises.

Still experiencing pain while sitting, with hip not taking any weight. Any change in direction, or sudden rotation of the hip causes it to "catch", resulting in sharp pain. Hopefully ongoing physio will strengthen muscles around joint, aiding recovery.

Anyone experienced similar symptoms?


Dan

[Unregistered]

Hi -
I'm a 26 year old female distance runner. After 4 months of groin pain, I finally went for an MRI. I have an acetabular labral tear in my right hip. I am scheduled for surgery on the 22nd of this month. I was wondering if any of you have had arthroscopy or have any insight as to whether or not I should follow through with it.
I have spend January and February swimming and riding the stationary bike, getting electric stim and ultra sound.
Thanks so much.
Rory

[injuryupdate]

It is interesting that the stats show that 8 times as many hip arthroscopies (per head of population) are done in Victoria than NSW. I know of some people who have flown down from Sydney to Melbourne to get one done.

I would only recommend hip arthroscopy if other management fails. I think guided injections of local into the joint help a lot with diagnosis. Still a lot to learn for the orthopods about this procedure, although like anything else, there will be some surgeons who do hip scopes to make money and others who will be selective.

[Claire]

Hi Dan,

I know what you mean. I have had other joint surgery in the past (shoulder capsular shift - very invasive) and the body takes time to heal. It took around 6 weeks with my shoulder before I stopped getting the "catch" sensation.

I am sure that once you have regained muscle stability in and around the joing that you will no longer experience that "catch" sensation.

I am finding at the moment that I am compensating for pain by overusing my glutes at the moment and as such I am unbalanced. Did you have this problem? My physio keeps telling me off for walking with a stiff leg!

All the best.

[Unregistered]

Dan,
Sounds like you are still having some difficulties, which you may want to discuss with your physician and physiotherapist. Your pain in sitting may be due to pulling of your hip flexor muscle, specifically iliopsoas, when unsupported. Use back support when sitting and try not to sit with knees below the hip as this cantilevers the joint forward somewhat. Twisting and sudden movements are probably not a good idea at this stage in your healing. Remember, the body takes at least 6-8 weeks to heal injured tissue, then you have to regain the proper muscle control and strength which can take another 6-8 weeks. Be patient, but be an advocate for your rehab, make sure you get all your questions answered.
S
PT in US