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Old 12-08-2012, 09:01 AM   #1
John Powell
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Posterior Acetabular Labral Tear

So I have moved this to a new thread given all of the different diagnoses I've received.

I was diagnosed with a posterior acetabular labral tear in my right hip via MRI arthrogram in August 2012, however when I met with the surgeon in September he wasn't satisfied with the images and ordered a 3 tesla MRI, which confirmed the diagnosis. An XRAY that he ordered also showed very mild degeneration of the hip.

Even after all of this, he is still hesitant to operate. This is in part because my symptoms have decreased significantly, due only to the fact that I now know what movements to avoid. I explained to him that I can recreate the pain by simply doing a set of weighted squats or DLs and he agreed to refer me for an anesthetic injection to my hip and then directed me to go out and do the same exercises to see if the anesthetic stops the pain.

I'm asking for any opinions from the docs out there or anyone who has been through anything like this. I swear I get the most effed up injuries
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Old 12-08-2012, 09:17 AM   #2
Mike Hopper
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Re: Posterior Acetabular Labral Tear

He is likely hesitant to go operate because you are reporting that your symptoms are improving with activity modification. Arthroscopy of the hip is pretty invasive and so he's probably trying to avoid doing so. Especially if he's not a hip specialist.
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Old 12-10-2012, 05:09 PM   #3
Sean Rockett
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Re: Posterior Acetabular Labral Tear

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Originally Posted by Mike Hopper View Post
He is likely hesitant to go operate because you are reporting that your symptoms are improving with activity modification. Arthroscopy of the hip is pretty invasive and so he's probably trying to avoid doing so. Especially if he's not a hip specialist.
It is helpful to confirm that the hip is the problem as sometimes hip pain is referred to the hip from other places
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Old 01-08-2013, 07:48 AM   #4
John Powell
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Re: Posterior Acetabular Labral Tear

So I had a diagnostic injection of Lidocaine by fluoroscopy yesterday. I did some lifts beforehand and my pain went from 0 to around 3 or 4 (has been up to an 8 and consistently a 6 or so for months- the pain has subsided over the last 3 months as I have avoided most lifts) The injection immediately dulled any pain that I had going in there. After the injection I went and did some squats, deads and cleans as the surgeon instructed. No pain at all in my hip, so I am convinced that the hip is the problem. The only odd things is that there is no pain this morning either (radiologist said that the stuff would wear off in 6-10 hrs) which makes me think it is getting somewhat better.

I also got the report from my x-ray which shows "there are changes suggestive of mild or early osteoarthritis with slight narrowing of joint space and very small osteophyte of right hip"

My question is- should I be pushing hard for surgery? In Canada, surgeons don't get paid handsomely for these surgeries so they tend to be less aggressive. My feeling is that I should push for surgery based on the x-ray, I dont want a hip replacement at 50 (I'm 33 now)

I meet with the surgeon on Friday and I'd love any feedback (Sean-wink wink, nudge nudge)
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Old 01-08-2013, 08:48 PM   #5
Sean Rockett
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Re: Posterior Acetabular Labral Tear

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Originally Posted by John Powell View Post
So I had a diagnostic injection of Lidocaine by fluoroscopy yesterday. I did some lifts beforehand and my pain went from 0 to around 3 or 4 (has been up to an 8 and consistently a 6 or so for months- the pain has subsided over the last 3 months as I have avoided most lifts) The injection immediately dulled any pain that I had going in there. After the injection I went and did some squats, deads and cleans as the surgeon instructed. No pain at all in my hip, so I am convinced that the hip is the problem. The only odd things is that there is no pain this morning either (radiologist said that the stuff would wear off in 6-10 hrs) which makes me think it is getting somewhat better.

I also got the report from my x-ray which shows "there are changes suggestive of mild or early osteoarthritis with slight narrowing of joint space and very small osteophyte of right hip"

My question is- should I be pushing hard for surgery? In Canada, surgeons don't get paid handsomely for these surgeries so they tend to be less aggressive. My feeling is that I should push for surgery based on the x-ray, I dont want a hip replacement at 50 (I'm 33 now)

I meet with the surgeon on Friday and I'd love any feedback (Sean-wink wink, nudge nudge)
In america we don't get paid handsomely either but that is ok. I would not push hard for any surgery. It is a last resort after you have modified to see if symptoms would get better on their own. A lot of people have labral tears and just don't know it because sometimes symptoms calm down from things that are torn. If you are feeling better there is always surgery if things turn around. there is no reason to believe that you are going to have hip replacement surgery in the near future based on your mri. Good luck say no more (to finish your Python allusion above)
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Old 01-08-2013, 09:21 PM   #6
John Powell
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Re: Posterior Acetabular Labral Tear

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Originally Posted by Sean Rockett View Post
In america we don't get paid handsomely either but that is ok. I would not push hard for any surgery. It is a last resort after you have modified to see if symptoms would get better on their own. A lot of people have labral tears and just don't know it because sometimes symptoms calm down from things that are torn. If you are feeling better there is always surgery if things turn around. there is no reason to believe that you are going to have hip replacement surgery in the near future based on your mri. Good luck say no more (to finish your Python allusion above)
Had to Google the Python thing...what I meant by my reference was that I'd love to hear your opinion. Certainly didn't mean anything by the "paid handsomely" thing, I just meant that public health care is very different than private health care.

I understand that the surgery should be a last resort, but what separates the US and Canada is that if I tell the surgeon this week that I'm going to hold off on surgery and my symptoms worsen next week, it is a 7 MONTH wait to get back in to see him to start the process again. Realistically that means a minimum 1 year wait if I need surgery. From a guy that has been waiting 16 months already that is hard to take.

Regardless, sorry to centre you out, just curious what you thought
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Old 01-09-2013, 09:46 AM   #7
Daniel Pope
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Re: Posterior Acetabular Labral Tear

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Originally Posted by Sean Rockett View Post
It is helpful to confirm that the hip is the problem as sometimes hip pain is referred to the hip from other places
Good point. I saw quite a few patients where hip arthroscopic surgery did not fix the problem. Surgery is invasive, costly and has its risks.

Did the doc mention anything about femoral acetabular impingement? Anything about a CAM or Pincer deformity? These are boney problems that can lead to hip labral tears and can't be fixed via therapy.

That being said, if your hip bones are normal, these tears can be caused by things like poor technique, poor mobility overuse/poor programming etc. I would personally want to know if there were any boney problems and would request going to a therapist of some sort.

I'd be careful with things like deep squats in the meanwhile (modify them, box squats/deadlifts)

I actually just posted to someone who has hip pain and I'll just repost my response to him.

Couple areas I'd begin working on to solve this problem (after you've seen a doc of course:
1) Foot stability http://fitnesspainfree.com/?p=2854
1) Ankle Mobility http://fitnesspainfree.com/?p=706
2) Hip stability http://fitnesspainfree.com/?p=265
3) Hip flexibility (Pain free stretches only - sometimes stretching can make this worse) http://fitnesspainfree.com/?p=362

Sorry its such a huge post. Usually issues like this are not easily solved by just addressing one joint. The whole system needs to be addressed.

Hope this helps,
Dan Pope www.fitnesspainfree.com
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Old 01-09-2013, 03:09 PM   #8
John Powell
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Re: Posterior Acetabular Labral Tear

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Originally Posted by Daniel Pope View Post
Did the doc mention anything about femoral acetabular impingement? Anything about a CAM or Pincer deformity? These are boney problems that can lead to hip labral tears and can't be fixed via therapy.
Thanks for the reply Daniel. Doc said bones appear normal BUT I have an extremely narrow joint space between femur and pelvis. So much so that it took 2 radiologists and 5 attempts to get the lidocaine shot in there on Monday.

My injury was sudden and acute, I am 99% certain that I dislocated or severely jarred my hip while deadlifting. I dropped the bar immediately and said "F$%^" and when I stood up everything seemed back in the right spot. I have told every doctor I've seen and they all tell me it is virtually impossible to do this.

http://www.board.crossfit.com/showth...ght=torn+glute
I linked a previous thread of mine, after one of my other diagnoses. It has the explanation of the injury

Thanks for the links, I just took a brief look, but I'll look more thoroughly later on.

Very much appreciated

John
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Old 01-10-2013, 09:43 PM   #9
Sean Rockett
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Re: Posterior Acetabular Labral Tear

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Originally Posted by John Powell View Post
Had to Google the Python thing...what I meant by my reference was that I'd love to hear your opinion. Certainly didn't mean anything by the "paid handsomely" thing, I just meant that public health care is very different than private health care.

I understand that the surgery should be a last resort, but what separates the US and Canada is that if I tell the surgeon this week that I'm going to hold off on surgery and my symptoms worsen next week, it is a 7 MONTH wait to get back in to see him to start the process again. Realistically that means a minimum 1 year wait if I need surgery. From a guy that has been waiting 16 months already that is hard to take.

Regardless, sorry to centre you out, just curious what you thought
Not a problem email does not allow us to show that i was laughing as i was typing, glad you enjoyed the Monty Python reference. Regarding your hip, what it comes down to is if you feel like you are sick of it and it has not gotten better with conservative management, then go for it. Obviously difficult to assess over the internet the severity. Good luck with it.
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Old 01-12-2013, 08:32 AM   #10
John Powell
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Re: Posterior Acetabular Labral Tear

So I met with the surgeon this week. He said that I have a very small lesion that could be responsible for the tear. He offered surgery if the pain was really bothering me. He said that given that the lesion is so small and my tear is also quite small (9mm) he was willing to do surgery but didn't necessarily recommend it at this point.

Since my symptoms seem to have improved, I told him that I would like to hold off on surgery and start returning to normal activities to see how it feels. He assured me that if things take a turn for the worse, I won't have to wait months to get back in to see him.

I'd like to do some rehab on it before testing it too much, but I can't seem to locate a physiotherapist who is versed in recovery for hip tears. I assume glute strength and gradual improvement of hip mobility would be the things to focus on. A friend of mine is a chiropractor and suggested cold laser therapy. I'll update this post with what does/doesnt help.
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