Did labral tear surgery reduce your PN/pelvic/perineal pain?

[Elmwood]

Have you found any doctors that work on this condition or who are aware of it? It would seem like straightening your SIJ would be the best place to start. Is that possible?

[Faith]

Elmwood, not sure I understand what you are asking. But do you mean are there any docs who work on SIJD? The only docs I've found that know much about SIJD are physical medicine and rehabilitation doctors. PTs do most of the work when it comes to SIJD. I've seen too many PTs (I lost count) and none have been able to help me with my SIJD - if that's truly the root problem. I've tried all the mobilization and strengthening exercises, but my case is not that simple due to the pelvic floor pain, hip pain, and centralized pain. The root of my SIJD seems to be ligament laxity/ligament sprain from an agressive PT manipulation so it's very hard to "repair" damaged ligaments. My hip surgeon says SIJD can't cause labral hip tears and I know another surgeon that agrees with that, but some OS don't even believe SIJD exists so I think it's a very gray area and really I probably will not know unless I just try hip surgery and see what happens. But that comes with great risk of course.

[Elmwood]

No I was asking if anybody works on lower crossed syndrome. But if you can find the cause of the labral tears than that would seem like the obvious fix no? I know websites such as this with all of these varying opinions can be scary sometimes but fixing labral tears has a very high success rate. I've come to the point where I decided that PT just doesn't work for me and that if I have labral tears than surgery is the obvious choice. I know we are two different people with potentially two different problems but for me the risk is worth it. I've had pudendal type pain for years, urinary issues and muscular issues. I've never found a doctor who's been able to shed any light onto my problems. But these labral tears seem to be the first potential clue for me. And with recent literature showing a potential link, its an easy choice for me.

Lernica does bring up a good point (as always) about finding a hip preservationist versus just a surgeon. With all that you have going on it seems that finding the cause of your labral tears is important and finding a surgeon who understands and sympathizes with your condition is even more important. Easier said than done I suppose.

Wish I could provide some insight or valuable knowledge but I really can't. I can just offer my support and hope for you.

[Lernica]

Elmwood,

You are right that labral tear surgery has a fairly good (not perfect) success rate in most cases. Where it does not help (for pain) is for advanced osteoarthritis or hip dysplasia. Also, there is a small risk of worsening pudendal neuralgia symptoms because of the perineal post that the surgeon braces you against as s/he dislocates your hip. Both Beverley and I experienced that but thankfully it was temporary.

I think that Faith's concern about risk is regarding her central sensitization, as surgery can sometimes exacerbate that condition. Faith I'm sure you will correct me if I am wrong.

I'm glad for your sake that you feel comfortable about proceeding with surgery to correct your hips and that you are taking steps to find the right surgeon to do so. I hope to see you soon on Hip Chicks Unite!

[Elmwood]

I did indeed get on HipChicks. Under the name Bren. Not as easy to navigate as this site but looks like there is lots of good information on there.

Thanks

[Lernica]

I agree about that site compared to this one. PudendalHope Rocks! We have some amazing dedicated moderators here. There is no real moderator presence on Hip Chicks, just one lady who "owns" it and approves the formation of groups from time to time. And there is no organization of the threads, such as there is here.

BTW, I sent you a "friend" request there; it is necessary to friend one another in order to send PMs. Once you accept my request you can ask me any navigation questions you like. I have found that the best way to get answers is simply to post a question under the General Forum.

[pregmom]

Hi Elmwood,

I have been seeing Dr. Coleman at HSS, but due to uninsured out of pocket expenses, I have been forced to look for another hip surgeon. I found Dr. Scott Martin as he is in my network and have an appt wtih him on 28NOV12. I am curious to know, did you enlighten him to the labral tear/PN Connection when you saw him? I plan to bring all sorts of literature with me when I go. Hopefully, since all of the legwork has been done by Dr. Coleman, we can move forward with the surgery fairly quickly. His admin did say he will want to do his own x-ray but thats fine with me. I'm just anxious to get moving on this thing!

[Lernica]

Yay, Pregmom!

[Elmwood]

Hi Pregmom. Thanks for reaching out.

I did mention the PN/Labral tear connection and his response was more or less that your body will compensate for the weakness of the hips by using other muscles and the nerve can become irritated etc., etc. Pretty much stuff we've heard before. I don't really feel as though this is true with me as my PN symptoms arose long before my hips bothered me to the point where I had to compensate with other muscles. Who knows.

As for bringing literature with you thats a good idea. But keep in mind that as good of a hospital as Brigham and Womens is and as good as he supposedly is, he sees tons of patients so you probably won't have a lot of time with him. He did have an assistant that came in prior so you may want to run things by him too. Between the two of them I probably had about 20 minutes. He also wanted me to bring in a CD with my MRI and XRays from the Lahey Clinic which is where I went originally. Hopefully you can call HSS and have them send that to you. But he did send me for an MRI anyway and I am going for Xrays next week and then another appointment with him that same afternoon. I was able to book all of these things within two weeks of my original visit.

Good luck and lets keep each other updated

[Violet M]

Here's an interesting article linking pelvic floor pain to hip pathology:

Hunt, Clohisy and Prather, Acetabular Labral Tears of the Hip in Women, Phys Med Rehabil Clin N Am 18 (2007) 497 - 520, at 503 (not available online unless subscribed to PubMed):

"Unique in women is the possible concomitant pelvic-floor pain that may occur in association with labral tears, hip impingement, dysplasia, and early and late arthritis. Because these hip disorders are more common in women, a thorough history should include the discussion of pelvic-floor symptoms. The obturator internus is considered one of the primary musculature sources of pelvic-floor pain that often presents with the complaint of deep vaginal pain. Because the obturator internus is a primary hip rotator, a hip-related cause of pelvic pain should be considered in the differential diagnosis when the pain is determined to be originating from this muscle and when other causes have been excluded."

My hips are feeling great but my OI continues to be a major "pain in the butt". I am still hopeful that it will settle over time now that my hips are fixed.

If you would like a copy of the article, please PM me.

Thanks for this, Lernica. I posted it on our related topics page on the website. http://www.pudendalhope.info/node/14