Hip Labrum Tear Update

[Dastardly]

I thought I would provide an update about my hip because I said I would! Also some details about my case are pretty interesting.

http://startingstrength.com/resource...ghlight=labrum

I got my long delayed post MRI consultation with the very busy Hip Surgeon today. His team had cancelled/rescheduled this appointment for around 5 months. When I last saw someone as detailed in previous thread, they were extremely reluctant to do an MRI. They instead wanted to do their routine procedure of a "diagnostic cortisone shot", which I have suspicions is purely to intentionally delay or indefinitely avoid diagnosis & treatment. I was extremely keen to find out what the damage was, and if it was deteriorating with daily life & especially lifting activities. But frustratingly the docs and general ortho consultants that I had seen so far, seemed to be clueless on these types of injuries in young otherwise healthy individuals. They did ineffective physical exams & denied the symptoms I showed them as meaningless. I knew for sure I had a labrum tear but did not know how much of a big deal it was.

Well in todays consultation I first saw the illusive hip surgeons assistant, and she said the MRI did indeed show some possible tearing, but I the next step to take, is again this pesky diagnostic cortisone shot! To confirm that I had an intra-articular injury rather than extra articular. I explained I didn't mind if it was necessary, but it seemed totally unnecessary and a waste of time. That I could feel in detail there was intra articular damage and I also had significant femoral acetabular impingement on both sides that they should probably deal with while in there. She, said erm.. no. The scan does not show this, but went to talk to the surgeon in another room about my reluctance to have injection. Eventually the illusive gentlemen storms in with his assistant, he introduced himself. It feels like meeting the wizard of oz. He is very rushed and very serious. He goes through the scan, schooling the assistant, and is like "oooofff! this is bad" he points out clear tearing & cysts and also says I have CAMs on both sides, so major FAI.

So there is no question I need surgery as soon as possible. Apparently, not only do I have a big ol' tear in the labrum, but also I have chondral delamination underneath. Labrum tears like I expected are repaired by merely snipping away torn parts. If you lack the chondral lamination you end up with bone on bone contact and are fucked, needing a hip replacement. I was told this might be likely for me in the future. That it largely depends on how bad the delamination is, and if it stays stable. He will cut it away to where it is secure, and perform "microfracture" a drilling many small holes to encourage blood & stem cells to flow into area, to form some kind of clotting that will hopefully act as substitute for the delamination. But it is both not reliable/robust and will require a minimum of 6 weeks of NO WEIGHT BEARING. Holy atrophy batman, this has spooked me good.

Prognosis is not great. If I am "lucky" the joint will be stabilised and will be able to cope with day to day activities like walking. I will still get soreness, and arthritic problems requiring hip replacement in future is not unlikely. But this is best case scenario, apparently it could be so bad that it is not possible. The delamination could be severe and get worse so function would rapidly deteriorate and I might need the hip replacement soon.

I replied by saying ok sure, Ill have this surgery but not till winter. I cant deal with the 6 weeks of no weight bearing right now. I am then told I need surgical intervention ASAP as the longer I leave it the worse state it will be in. Well FUCK YOU, you medical professionals are the people who kept delaying this and saying everything was fine. If I hadn't lured surgeon from his lair, the diagnostic shot procedure wouldve taken a couple months at least.

I explained that I need to maintain a level of competency at barbell lifts for coaching purposes at the very least, as I was hoping to work in the field soon. And he was pretty much "NO" you better reconsider career options.

Fucksticks.

Obviously I maintain optimism that I will exceed this bleak prognosis, Ill stick to deadlifts for now.

Now to add a little backstory of how the injury occured, which is pretty interesting. In 2008 I injured my right knee, meniscus & cruciate tear. I got into lifting at this time and used it as rehab. Over this long time I have regained full unobstructed knee function & stability. But there is limited proprioception in right leg due to cruciate damage and also the semitendinosus is in constant spasm/tendonitis trying to do extra work. The right glute however has become inactive/disconnected and does not involve itself in lifting movements or normal day to day stuff no matter how much I try.

So this stuff caused altered gait, poor control & hip asymmetry - all of which resulted in labral tear. Pre-existing FAI was a factor of course.

There is no question here, so perhaps this is a pointless post.But I think there are lessons here.

[Mark Rippetoe]

Fascinating.

[mrcosmic]

And what are those lessons? Don't tear a cruciate ligament? Have good congenital hip structure?

[OCG]

I think the more fascinating thing is that Dastardly actually trains people. And they pay him for it.

[Desp]

Are you in Canada or one of those other "free" healthcare countries?


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[b17vic]

If you receive NHS care but WANT an MRI quick be prepared to pay for it yourself!

[adnscmplx]

I also had FAI and got it fixed, hopefully in time.

The lesson is for all those people who have hip pain from activity (mostly squatting on this board) first need to go get some imaging and make sure that they don't have anatomy that predisposes them to impingement. If they do, i would recommend getting it fixed. If they don't, then and only then should they start posting detailed form checks, asking about massage, foam rolling, stretching, etc. Doing that stuff with impingement anatomy is a recipe for a hip replacement.

[bluebutton]

I also had FAI and got it fixed, hopefully in time.

The lesson is for all those people who have hip pain from activity (mostly squatting on this board) first need to go get some imaging and make sure that they don't have anatomy that predisposes them to impingement. If they do, i would recommend getting it fixed. If they don't, then and only then should they start posting detailed form checks, asking about massage, foam rolling, stretching, etc. Doing that stuff with impingement anatomy is a recipe for a hip replacement.

This seems backwards to me. I had hip surgery at 26 and started squatting at 33. I probably have less than optimal anatomy (resulting in the surgery). For safe squatting, I focus on shoving my knees out which takes care of impingement, something explained in the book.

There are many reasons for hip pain that don't involve having cartilage fall apart. Diagnosing my tear included a contrast die being injected into the socket after repeated xrays to get the needle in the right place. Are to seriously suggesting people have xrays by their reproductive organs before getting a simple form check? I don't get it.

[GingerWeasel]

Oh, man.
Dastardly, I feel for you. You just outlined my worst fears.
I have a confirmed tear on my acetabular labrum we found a couple years ago. Surgeon at that point said it was small enough that if I could manage the pain and live with it, I was ok to do so. I went to PT until I realized my insurance wasn't paying. Spent months babying it and working the exercises the PT gave me until it hurt no more, and was pain free for a long time (I could feel it, but no pain).

Fast forward to a couple months ago when my buddy got me hooked on SS, and one stupid stretch lit up my hip. Was squatting with no problems until then, and now I can't quite get it under control.
I've been revisiting my paperwork from the tear dx and debating going in for another check.
I am functional still, but if I overdo the workouts or do something slightly stupid with my anatomy, I hurt enough to warrant stopping squats (and everything else) for a week or so. If I can keep riding the knife's edge, I will do so.

Best wishes to you. Looking forward to hearing how things go for you.

[Heinous Whipper]

I was diagnosed with FAI and labral tear on 1OCT13. I had arthroscopic surgery 3 days later and it was one of the best decisions I have ever made. The procedure included labrum repair, chondroplasty, and osteoplasty. It takes about 1.5-2.5 hours and post op pain didn't require any pain meds other than what I received during the operation. I suggest plentiful ice and compression for several days post op.

I would be happy to give you more details of my diagnosis and post op recovery plan if you have any interest in hearing it.

Best of Luck.