Anyone here had one? If so, did this lead to a good diagnosis & outcome? I’m scheduled for one mid-next week and a little anxious…Let me know if you’ve had (or perform) this procedure. Increasing right hip pain over 6 months and nothing (PT, Chiro, pilates, etc) seems to help. Input/experience is appreciated.
Not a med pro, but have had hip injuries. What other imaging has already been done? X-ray? (Insurance often won’t cover any advanced imaging unless x-rays have already been done, and MRI is ordered by ortho.) What was explained to you about why the arthrogram was needed vs.just MRI? Will the different results change the treatment plan? I would want to know the answer to that before I let someone shoot contrast into my hip joint.
My wife has had the procedure and she is a doc. I will get her to feedback when she gets in.
I had one last feb. Was having hip pain during running and with PT, etc. wasn’t getting better. They found a little tear on the MRI. My doc did not recommend surgery (ortho at Rush in chicago) - just PT. I was able to continue training, as long as i kept my hip and muscles around it happy. My doc said my pain has to be under a “5” during my runs. (Lots of PT and ART) I did IMOO this year, but with a lot less run training. Good luck
The questions that you’re asking are part of the problem leading up to this. I’ve seen my PCP numerous times, had x-rays, had a regular MRI pre-summer (off the spot I’ve been having pain/I believe they missed it) saw an ortho (don’t see anything structurally, etc. It was described as a ‘hi-def’ kind of MRI, saying if it’s there, this will show what it is. They may be looking for a torn/damaged labrum? It’s already pre-certed, so insurance is approved.
Thanks, JayMZ, much appreciated.
My experience:
Had hip pain following a tough week of racing and training, felt like it was deep in the hip joint. X-ray: nothing MRI with arthrogram: very easy aside from the loud banging, radiologist read is two labral tears, one superior and one posterior. Orthopedic surgeon read: not as bad as reported from the radiologist. A couple of months later: hip arthroscopy under spinal anesthetic, hip tight for several weeks, then worked on range of motion. Waited 6 weeks to run, and started slow (but had no pain) did some biking before that. First full race season since: 3 HIM, 1 IM, 3 13.1’s and a couple of other things: no pain. I was 39 when this happened and had no arthritis in the joint-makes a difference. Choose the right ortho guy as very few do hip arthroscopies well.
Best of luck
Cuzifit;
How about the hip injection? Were you able to work immediately or how long til you were able to go back? What you said about surgeons & hip arthroscopies jives with what I’ve read. I’m 57, but I’ve been active & fit since marathoning in the late 70’s and first Kona in '81. I’ve done 84 marathons or longer and bucket list plan is to get to at least 100.
Steroid hip injections (or most steroid injections for that matter) are a temporizing measure, they improve symptoms-not the problem. At 57 it is doubtful you do not have some degree of arthritis, I would imagine a doctor would be reticent to do a hip arthroscopy on a masters athlete, it seems as though you have accomplished a whole bunch of stuff, relax, wait for the MRI and results and talk with more than one ortho doc to get an idea of how to proceed. I know how you can get fixed on a solution to a problem you don’t have all the information about. I have a degenerated disc with some ugly vertebrae (think bone spurs, rotation of L4, bone on bone facets) I was convinced I would need a fusion to improve my back pain (which is not a guarantee) I have been mostly pain free and unrestricted since doing the right PT exercises and flexibility.
I hear you and understand. Really, the only thing that I’m perseverating on is to get a diagnosis other than ‘I don’t see anything, so let’s try…’. Still wondering though, how was the hip injection and how soon were you able to return to work after having a hip arthrosopy procedure? I don’t know if mine will come to that but I like information. My first MRI earlier this year surprised me just a little by saying no indications of arthritis. I’ve always felt OK until this but thought my aging might show some. Just hoping for an accurate diagnosis rather than another looks good to us…Not ready to commit to a treatment without that but willing to do whatever is needed.
Radiologist (but not orthopedic specialist) answer: If you have already had a normal hip MRI the only major added benefit to doing an arthrogram MRI is a better chance of seeing a tear of the labrum. Most other major problems are usually seen without the arthrogram. The question for you is whether it is worth doing surgery if they find a little tear.
Sadly (or fortunately) many people with hip pain come in for MRI’s and end up leaving without a good explanaton of their pain. I personally had a hip injury that forced me to take a large chunk of time off and I couldn’t find anything wrong with my hip on MRI. It seems that a lot of hip pain is due to back problems, degenerative changes, or some small thing that just doesn’t show up well on a MRI.
Good luck.
Why are you anxious? Are you nervous that the scan will reveal a tear, that it won’t reveal anything, or nervous about the scan itself?
I had one last year. The contrast injection is no big deal (unless needles make you squeamish-I’ve had over 100 so for me they don’t) but there is soreness that prohibits any type of activity for the rest of the day.
Regardless of what the MR reveals, I’d do a diagnostic steroid injection as my next step. I’ve been where you are, only it’s been 3 years, not 6 months. Good luck.
Basically an arthrogram is the best way to find out whether or not you have a labral tear albeit in the shoulder or the hip. The contrast is injected under fluoro (live xray) and placed directly into the joint. Then you have a routine MR scan of the joint and if contrast is seen leaking out of the joint then you have a tear. I do lots of them and they are a piece of cake. On a non arthogram study of the hip you can still kind of see the labrum but you cannot make a definitive diagnosis of tear without it. Or shouldnt at least
So back to an important question–if the arthrogram leads to a definitive diagnosis will that change the treatment plan?
It’s an important question to ask, because the diagnosis itself may not determine the tx plan–it might be the symptoms that guide the plan.
Case in point: several years ago I had severe low back pain. After x-rays, doc told me he could order an MRI if I wanted a definitive diagnosis, but that the treatment plan would be the same: manage inflammation and pain during the acute stage; pt and other modalities during rehab; and maintenance exercises and some lifestyle changes for prevention.
In contrast, more recently with ongoing leg pain, results of MRI showing hamstring tear made a big difference in the plan. Knowing that there was a tear meant immediately stopping running and cycling and limiting swimming, instead of continuing those activities while doing rehab.
Just something to think about.
Obviously more information is better. As far as affecting treatment plan for the hip, the arthogram may absolutely change it. Say there is a suspected labral tear that was seen on a non arthrogram MRI. The extent of the tear is not going to be known in detail until it can be seen with contrast. If the tear is small enough surgery wouldn’t be required and a conservative treatment plan would be used. If the tear is large it will most certainly require a repair. Huge differences in options depending on the extent of the injury. The benefits of the exam far outweigh the minimal risks involved in a hip arthrogram.
Tri3 & adktriguy46 ; Very helpful discussion that helps to affirm what I understood and was believing. Thanks for your input and I’ll report back on this thread following the test.
Had an athrogram around June after an MRI indicated a high % that I did have a hip labral tear. I can’t talk from lots of experience but I have a feeling that the guy that did mine was somewhat new. He kept on fiddling around in my hip with the needle trying to find the right spot. Always seemed to put it somewhere, take a photo, then look back at other personnel to see if it was in the right place. He seemed to do that 6-8 times. At the end I left the place, and 1-2 days after with worse pain than when I went in. So from that it was indicated that I didn’t have a tear since it didn’t relieve the pain, although I’m not satisfied with that answer since the guy that did the injection left so much damage fiddling around the hip it was impossible to feel good after. The injection pain went away after 3 days.
To answer your question about how it felt during was that the worst part was the meds to numb it. After the area of the leg was numb it wasn’t terrible. I was just mostly stressed since I was waiting for some sharp needle pain deep in the joint when he started to get the needle into the hip which didn’t happen. Tough since the hip is a little sensitive than most when it comes to needle stuff.
Not making excuses for the guy but it can take a lot of images to get it in the right place. One because you don’t want constant live fluoro going. That just increases radiation dose. So you move the needle a little then take a picture. Reposition then take another images until its in the joint which is sometimes tough to get into. Just because it didn’t relieve the pain doesn’t mean you didn’t have a tear. Did you have an MRI immediately after the exam? I wonder if you just had a fluoro guided steroid injection. Yes they use contrast for that as well. Only an MRI arthrogram will tell you the extent of the tear. It would be common to be a little sore a day or so after but it sounds to me you had a tougher go of it than usual.
Agree with majority of above. I am an ortho sports med who does 4-6 hip scopes a month for FAI and labral tears. If there is concern about a labral tear, I always order a MRA. I standard MRI is usually a waste of time and money as an MRA is much more sensitive for detecting tears.
Regarding potential surgery if in fact a labral tear is diagnosed and you have already exhausted non-operative treatment (activity modification, NSAID’s, PT, injection, etc), the status of the cartilage (i.e. any early arthritis) is one of the biggest predictors of success after surgery. My patients in high school and 20-30s typically are my happiest patients and return to full activity. However, those in late 40s and 50s are less predictable due to early arthritis. I bring this up given your triathlon/running history as you have quite a few miles on your hips and you may fall into this category.
Good luck
I had labral tear surgery on my left hip last summer, I am 53 and had minimal arthritis and have done 50 or so marathons in nearly 40 years of running as well as 5 Ironman distance triathlons back in the 1980s (where my symptoms of something being wrong with my body started). The surgery was pretty easy. I could run within a month and did 8 miles within two months, but due to the compensations I developed over the years, I am having a hard time getting my running stride back, so I am still working on that.