Here's some images from my CT scan. The doctor at the Radiology center said the hip looks normal, no osseous prominence or abnormal development. I guess this means no impingement because the report said he used the FAI protocol for the scan. What do you think?

 

No images showed up, but just as well. I don't read them. I wouldn't worry too much about the impingement issue, seems to be a non-issue.

Yeah, I couldn't cut and paste them. No big deal. My hope is that my lack of impingement will speed the recovery of my labrum.

I have had "lingering" "aching" hip pain for almost 9 (it began in Aug.) months now. I can train hard and really never have pain above a 5/10 but am really more annoyed by the ache, in fact it aches as I am sitting her typing. (often my pain is worse when I am sitting and crossing my legs is a killer) I have since seen 2 doctors, the first shot me up with cortisone into by bursa which just made everything worse, the prescribed yoga which made it worse. Since then I have started PT, I am not nearly as diligent as I should be and think is actually helping. I started training intensely again and the pain is still there but at times it seems less. In the last month I have seen a new ortho that specialized in hips. He is awesome and understands my goals as an athlete. He ordered an MRI to rule out a tear even though my pain and symptoms are atypical for a tear, it hurts up on the crest of my hip mostly. MRI came back very slight labium tear. The next course of action is to make sure that the tear is what is causing the pain. After my next race (3 weeks) I am having an injection in to the joint (the administer it during x-ray to ensure the area with the tear is being treated). He said that if I feel like a new woman than it is the tear that is causing the problem, if not - we need to look elsewhere. He didn't suggest jumping right into surgery and said that I am not causing further damage by training. (Again, my tear is minimal) How awful would it be to have that kind of surgery (4-6 mo. recovery) and then still have problems, ugh. Here's hoping we all get better :)

I had surgery to repair a right hip torn labrum and impingement last fall. (Still recovering. Hope to start up running in June.) For me the PT help was marginal and the cortisone injection did mostly nothing. It seems most conservative treatment protocols have you try these less invasive methods first. If you're considering surgery, start the process sooner rather than later. My surgeon was booked out many months in advance.

Hi jockette, do you think the PT is what caused the pain to subside a little? I'm like you, my pain is not unbearable...more annoying than anything. I worry that if I start working out again, the tear will get worse. I'm surprised you doc said that training will not causing further damage. I want to avoid surgery at all costs but I've stopped training to give the symptoms time to go away and it's driving me crazy. I worry that this will never heal because every web site I read says that the labrum will not heal on its own. Did your new doctor check for impingement?

elvis, that is a long healing process. How bad was your pre-op pain? Was the impingement obvious from x-rays?

mcmric wrote:

elvis, that is a long healing process. How bad was your pre-op pain? Was the impingement obvious from x-rays?

I was warned the hip is one of the slowest healing parts of the body (low amounts of blood flow in there?) After the scope, my doc said, "if this was my hip I wouldn't try much running before June."--the surgery was at end of October '13.

The pain (and clicking sensation in hip) got progressively worse through the 2012 season. I'd have good days and bad days. Between my summer race and fall races (Olympic Dus) I was prescribed PT. This did help some, but the training volume/intensity took its toll. By spring of '13 I couldn't run a full 5k. I'd do hard 1.5 mile, then basically have to walk/limp the rest of the race.

The formal MRI results did not mention impingement:
1. Anterior labral tear with a paralabral cyst.
2. Femoral retroversion measures 5.6 degrees.
3. Mild right hip osteoarthritis.
4. Tendinosis of the right hamstring tendon origin.

But the surgeon was able to feel the impingement by manipulating the joint and the 3-d xray showed it as well.

I think PT has helped because I have less pain then before and I know for a fact that I discovered how weak I was during PT. Being a lifelong athlete and runner I can tell (and can't believe) how much weaker I am now compared to when I was younger, I'm not sure why could be age, less cross training, no more weight training, the bike?

I also took a month and a half off Dec-Jan and nothing changed if anything the pain was worse but rest is always good place to start. I'm not sure it ever will "heal" but from what I've read many people have them and never know it or that they are not bad enough to repair. My tear is very small and not in the part of my hip that where there is surface contact as he explained so he said I am not going to do any more damage training, for now anyways. I think things would be way different if the tear had pulled away from the bone or was "catching" or being pinched as other have described. (As an aside, I have torn cartilage in both knees and had definite "catching" both times, I have not felt that sensation in my hip at all)

I am not sure about the impingement I am assuming he checked? He has checked the x-rays and MRI everything else looks normal. I believe after the injection into the hip we will know a lot more. He has mentioned that there is a possibility that it may also be nerve pain.

If you're unsure about an impingement, you can always ask the surgeon and can ask for copies of the imaging reports and/or the images. The cortisone shot (usually delivered with a long-lasting local anesthetic) should really help relieve your pain if most or all of the problem is inside the capsule. There are all sorts of other injuries to that area outside the hip joint that can feel pretty horrible (e.g. a quad tendon tear) that will need to be ruled out. This is not a surgery to rush into without trying a conservative management first.

Also important with imaging is determining whether there are any arthritis, hip dysplasia, or acetabular structural pathologies. The presence of any of these has huge implications of the long-term success of an arthroscopic hip labral tear repair.

BTW, nerve pain can be totally treatable with medication if that's the issue. Nerve pain is a tingling and/or searing sort of pain. Not fun!

One thing that really hasn't been on the radar with this whole labral tear/arthritis debate is the fundamental stability of the hip. Some of the crucial structures that help control hip stability within the capsule are only seen when the hip is distracted during surgery. A lot of people who have enough pain to warrant surgery have additional damage to these stabilizing structures. The more damage inside and/or the larger the labral tear, the more unstable the hip becomes. An unstable hip will hurt more and wear out more quickly than a stable one. That's the reason why stretching (garden-variety, PT or yoga) of the hip can make everything a LOT worse.

I am definately in favor of this surgery.

I had surgery on both a tear and impingment in March of 2012. The tear was so bad that I had to have 3 anchors placed on each side of my labral tendon. I deserved that for waiting so long to get it fixed. I had some bone removed for the impingment and microfractures to help the healing. I started PT a week after surgery. With the amount of bone that was removed I had to stay on crutches for 10 weeks. During PT I was off the crutches and felt great! Once I was off the crutches for good, my PT was pretty much over and I was off and running.
Prior to ever deciding the get the surgery I had signed up for a half IM(Savageman). All along during my recovery, competing in this race was my motivation. By 6 months after surgery I completed a sprint, olympic, and that half.