Acetabular Labral Tears

[Lernica]

Thanks, PG. The difference between you and me is that I have had hip pain for the last ten years. Musculoskeletal reasons for the pain were ruled out ten years ago, but my PT tells me that MRI technology has evolved since then to identify labral hip tears. It would suck if that's what has been impairing my hip all this time . . . My PT thinks that the condition could have even led to my PN. So we will continue down this path for awhile and see what happens. My PT also told me about the 3 T MRI being as good as the contrast MRI and not painful. I think that she has spent some time training at the same pelvic pain clinic in NY as Futterman. That's Amy Stein's clinic, no? (I just ordered her book.)

Lernica

[Lernica]

Does anyone know how the study at the Hospital for Special Surgery in New York is coming along to identify a link between PN and labral tears?

[Bridget]

Hi All,
Sorry it has taken so long to post. I am just about 1 year post surgery for a labral tear. I'm sorry to say this has not solved my problems, atleast not yet.
It was my hope that gaining range of motion in my hip would cause more stability at the SI joint. I have however not gained any additional range of motion in the hip. At a year post op I have almost the same range of motion back that I had prior to surgery. I have increased groin pain, I believe due to the psoas tendon release.
The rehab for this surgey has been very difficult, and I can't say I'm happy I did it. That said I had 13 years of hip pain prior to it, and a confirmed labral tear and hip impingement, so I guess in my case it was worth trying.
Bridget

[nyt]

Bridget, I am so sorry to hear that the surgery was not the success you had hoped for. Do you have any improvement in pain at all? Sounds like this is the type of surgery that takes a long time to recovery from, is that true? Do you know what your next step is going to be? Prayers and a hug are sent.

[helenlegs 11]

Sorry you haven't improved as well as hoped Bridget, hopefully you will recover further and soon.
How did they do the surgery,not laparoscopic if they did the tendon release too ? ? Any piriformis syndrome improvement ?
Take care
Helen

[helenlegs 11]

Thought this may be interesting for those with hip pain, from Dr Dellon's book (free) http://www.dellon.com/content/view/116/307/ posted by lottanerve.

HIP JOINT AS A SOURCE OF PELVIC PAIN
Recently Deborah Coady, MD, a Gynecologist on the faculty at New York University
-Langone Medical Center has been relating some causes of chronic pelvic pain with
intrinsic problem in the hip joint. Her work was presented to the American College of
Gynecology in 2011. Her patients all had pain in the clitoris, or vulva, or perineum and
had complaints in their hip. An MRI of the hip demonstrated a true structural problem,
usually a tear in the “labrum” associated with "impingement " (an abnormal collision of
bony structures within the hip joint). In 24 patients out of 100 who failed to improve with
physical therapy and hip injections, an Orthopedic endoscopic hip procedure was done.
At a minimum of 9 months after the hip surgery, 96% had improvement in hip
symptoms, 71% had improvement in both hip and pelvic pain, 25% had improvement in
hip but only some improvement in pelvic pain, and 4% had no benefit in either hip or
pelvic pain. Younger women with a shorter duration of pain had the best outcomes.* The
critical concept here is that if someone with pelvic pain also has hip complaints or a
history of hip injury, it is essential to obtain a workup of the hip, including an MRI and
an Orthopedic consultation. Since two-thirds of women in this report by Coady and coworkers showed improvement by addressing hip problems, it must be concluded that hip
problems should be treated before surgery on the pudendal nerve or cluneal nerves.

[amfrazi]

Hi. I am going in to have surgery for pincer form of femoral acetabular impingement and a labrum tear. I'd like to hear how others are doing after their surgery for this condition.

I have pudendal nerve symptoms. I've had pudendal nerve blocks, which helped. It's calmed down, overall, but I still have pelvic and hip pain. We've worked and worked on that pelvic floor and it's come oh, so close to being healed. The 3.5 years of pelvic floor PT has really helped. I've had a bunch of PT on the exernal stuff as well over the past 5 years or so.

I've had prolotherapy for the pelvic instability. I'm to the point where they need to do multiple treatments each week to put my pelvis in place. It slides back out right afterwards. I have a really difficult time sitting, but I think it's that impingement more than anything. My surgeon says my hip is impinged so badly that it's causing the pelvis to act weird (think pry bar to the pelvis).

Oddly enough, my pudendal nerve symptoms are worst when I'm walking. Sitting on the donut cushions makes it worse; I'm better on a totally flat surface because my pelvis is so unstable. But I get absolute fire and itching from those nerves while I walk sometimes. There is no mistaking pudendal nerve pain.

My pudendal nerve specialist has done a wonderful job treating me, but I think we've come to the point where that hip must be fixed. The surgeon is going to start with the one that's the worst.

Anyway, I'd love to hear anyone's experiences. I've cried and cried since finding this post and then finding the Debra Coady/Struan Coleman study results that have been put out there this year. My doctors didn't find my labrum tear until October 2010. I think I cracked that hip about 6 or 7 years ago and have lived with constant agony since then in the form of various muscle issues. I hope this is an answer for me!!!

[amfrazi]

Hello. I had someone email me requesting an update. I sent it to them, but wanted to post.

I went in to Stanford University for treatment on the femoroacetabular impingement (pincer impingement) and labral tear in February, 2012. Woke up in recovery and my pudendal pain was - GONE!!!!!!!

I'm presently 9.5 weeks post-op. I've only had 4 brief instances of feeling the nerve (one lasted an hour but the other three were literally seconds). My other hip is impinged, though. I see my doctor down there in May and hope to get the other hip fixed sometime this summer. The impingement prevents sitting in most chairs for long. I've made light years worth of progress on even this aspect since before the first surgery, but I don't think that sitting will be "all better" until that other hip is fixed.

Also, I've only had to have pelvic floor PT twice in the 9.5 weeks. Now, I'm a person who needed therapy on a regular basis before. My doctor says the pelvic floor and pelvic pain settled down because the hip rotators are no longer being irritated by the labral tear and impingement. There you have it!

My SI joint is starting to loosen up again. I go in Thursday for another dose of prolotherapy. Hopefully they can blast it really good to keep everything glued together until the 2nd surgery.

I'd have the 2nd hip surgery, but I have an issue with my kidney that needs fixed NOW. So I'm going in for a pyeloplasty in about a week to fix that.

In short, I'd say if you have a labral tear and/or an impingement - my experience leads me to advise to fix the problem. Just make sure you have a VERY experienced surgeon and that you have a REALLY good physical therapy program after the hip surgery.

Thanks!

[helenlegs 11]

Thanks so much for posting amfrazi. Your success with this op is phenomenal!! and must give you such confidence for future procedures, instead of wondering and worrying how, why and what to do. It's fantastic that these problems have at least been 'demoted', we can't blithely think that any invasive procedure isn't something to 'look forward too'.
I hope that your kidney problem can be sorted out and then it does sound as if you have an excellent chance of a great recovery, cure even. WOW!!
The link between laberal tears and PN has always been wondered about and mentioned on here from time to time. Your account couldn't give any better link between the femoroacetabular impingement (pincer impingement) and labral tear for your particular condition. Could your surgeon give any accurate reason for the immediate PN improvement? Or is it maybe a knock on effect of the whole pelvis reacting to this better situation?
Whichever, I am so pleased for you
Take care,
Helen

[amfrazi]

My pelvic pain specialist says the problem was obviously related to the hip rotators. The pelvic floor and hip muscles just settled down after the surgery. Yes, the pelvis is much happier.

I'm now doing a bunch of exercises that I'd never been able to do before as I make it through the post-op protocol. I can bridge, stand on one foot on a dyna disc, balance to lift myself with the good leg (the other hip is not as stable, but I'm still trying to do all the exercises bilaterally). I can't wait to get the other hip figured out. I'll let you know how that one goes. I still need to do an MRI and an arthrogram to start the process for surgery. That should be next month.

Thanks!