I've had a lot of pain in my right hip and the MRI report says:
Extensive tearing of the right hip anterior/superior and posterior/superior labrum. My rheumy, who is great referred me to an orthopedic doctor who spent about 5 minutes showing me the mri pics and speaking Greek to me. I didn't understand anything other than the PsA caused the tear.
He said I need a guided corticosteriod shot in my hip and if that doesn't work, I need orthoscopic surgery. The appointment is scheduled at the hospital on Jan 8th. I want to see another ortho who will explain the issue to me.
The labrum is the rubbery “flange” around your hip socket that helps keep the ball in the socket. It’s made of cartilage, and with time/disease/injury can get frayed or torn.
Good reading here: http://www.cnn.com/HEALTH/library/hip-labral-tear/DS00920.html
I had labral tears, so I think I know the achy/clicky feeling, but then my hip was completely shot, and I had a replacement, so I can’t comment on a labral tear treatment.
FWIW, I would rather have a great surgeon who can’t explain things in plain English, than have some mediocre sawbones who has the gift of the gab. Much easier to find an alternative information source than to get a botched job fixed up. JMHO.
Thanks for your reply Seenie and agree with your comment about a great surgeon . . .
Seenie said:
The labrum is the rubbery "flange" around your hip socket that helps keep the ball in the socket. It's made of cartilage, and with time/disease/injury can get frayed or torn. Good reading here: http://www.cnn.com/HEALTH/library/hip-labral-tear/DS00920.html
I had labral tears, so I think I know the achy/clicky feeling, but then my hip was completely shot, and I had a replacement, so I can't comment on a labral tear treatment.
FWIW, I would rather have a great surgeon who can't explain things in plain English, than have some mediocre sawbones who has the gift of the gab. Much easier to find an alternative information source than to get a botched job fixed up. JMHO.
Thanks Lamb. The link is very helpful and I understand it ! The ortho doc wants me to get a guided cortisone shot, but everything I've read says that it only provides temporary relief. I'm getting a second opinion next week. Am I missing something about the benefit of the cortisone injection???
No. You are spot on. All of the steroid injections are temporary fixes, but there are times when people want to avoid surgery or can’t have surgery. It can also be a good “patch-up” if surgery just isn’t convenient for you, like if you need to schedule around work or getting post OP help.
Agreeing with everyone who says that having a top notch surgeon is key, but also want someone who can give you a good opinion of success odds for YOU and your particular treatment options is really important too. Someone who you find to be blunt in this situation is a good thing. Dr. Sri Durbhakula is excellent if you find any of your surgeons lacking. He is in Bethesda.
Frances said:
Thanks Lamb. The link is very helpful and I understand it ! The ortho doc wants me to get a guided cortisone shot, but everything I’ve read says that it only provides temporary relief. I’m getting a second opinion next week. Am I missing something about the benefit of the cortisone injection???
I had a labrum tear and a cyst in my right hip on my last MRI. I haven't had any steroid injections or surgery though. I've had a "funky" right hip my whole life. I've had issues with that hip popping forever, but only have pain if I stand or sit too long. I have a tendency to shift my weight to the other side and that helps. I also have to pay attention to what side of a booth I sit in at a restaurant. If I sit on the wrong side, I get stuck in the booth because I can't put my weight on my right side after sitting. It's not a pleasant thing to watch :)
I do know some great Ortho's, but they are in the Chicagoland area. Wishing you the best for your appointment on the 8th.
Thanks GrumpyCat. The first ortho didn't even discuss any other options with me. I will try to get an appointment with the Bethesda doctor. I don't want a temporary fix.
GrumpyCat said:
No. You are spot on. All of the steroid injections are temporary fixes, but there are times when people want to avoid surgery or can't have surgery. It can also be a good "patch-up" if surgery just isn't convenient for you, like if you need to schedule around work or getting post OP help.
Agreeing with everyone who says that having a top notch surgeon is key, but also want someone who can give you a good opinion of success odds for YOU and your particular treatment options is really important too. Someone who you find to be blunt in this situation is a good thing. Dr. Sri Durbhakula is excellent if you find any of your surgeons lacking. He is in Bethesda.
Frances said:
Thanks Lamb. The link is very helpful and I understand it ! The ortho doc wants me to get a guided cortisone shot, but everything I've read says that it only provides temporary relief. I'm getting a second opinion next week. Am I missing something about the benefit of the cortisone injection???
I was thinking about this after I posted. Another thing to consider is if surgery would be successful or another can of worms? That’s where injections would be a benefit. Obviously, you want the beśt fix you can get, but you need to know what in going on in the joint to get that answer. Dr. D is an excellent surgeon, will explain to you and be honest. He isn’t too hard to get in to see. Overall, the whole practice has excellent docs who specialize, which is nice since this thing will go after any joint. I’m sorry you are hurting. Hips are rough to put it mildly.
Frances said:
Thanks GrumpyCat. The first ortho didn’t even discuss any other options with me. I will try to get an appointment with the Bethesda doctor. I don’t want a temporary fix.
GrumpyCat said:
No. You are spot on. All of the steroid injections are temporary fixes, but there are times when people want to avoid surgery or can’t have surgery. It can also be a good “patch-up” if surgery just isn’t convenient for you, like if you need to schedule around work or getting post OP help.
Agreeing with everyone who says that having a top notch surgeon is key, but also want someone who can give you a good opinion of success odds for YOU and your particular treatment options is really important too. Someone who you find to be blunt in this situation is a good thing. Dr. Sri Durbhakula is excellent if you find any of your surgeons lacking. He is in Bethesda.
Frances said:
Thanks Lamb. The link is very helpful and I understand it ! The ortho doc wants me to get a guided cortisone shot, but everything I’ve read says that it only provides temporary relief. I’m getting a second opinion next week. Am I missing something about the benefit of the cortisone injection???
Yes, it is a good point. However, with my Carefirst Federal Employee Insurance I've NEVER had them reject any procedure, medicine or doctor visit. I'm hoping they won't require me to waste my time with injections.
Also, the MRI states: ( I didn't get a copy of the MRI report until I left so didn't know to ask about this)
Right hip chondromalacia and
Left Hip: suspected tear in superior labrum and adjacent paralabral cyst
The ortho never mention anything about my left hip.
I made a list of 4 orthos who specialize in hips and will call tomorrow to try to get appointment asap.
Thanks for all the advice !! Much appreciated !
Frances
GrumpyCat said:
Also a good point.
tntlamb said:
That surgery is one that normally requires per approval which won't usually come until you have done both PT and injections.............
The inections are far from a waste of time and even if you do have the surgery knocking down the inflammation speeds recovery and lowers risk of post op infection. BTW this is not a walk in the park surgery. It eequires a major commitment to some very painful PT extending many weeks. If your muscle tone is weak now, you could take months to fully recover. If you are not up to working through some substantial pain, you may never fully recover. If you can avoid it with other means, it may be worth considering. Be sure you talk to a realistic PT as part of you decusion proces.
Good point about getting the injection to reduce inflammation - hadn't thought about that. I'm committed to the P.T. and all my research indicates the only way to fix the torn muscle is arthroscopic surgery. I'm getting a second opinion asap.
Thanks for taking the time to give me your thoughts and advice.
tntlamb said:
The inections are far from a waste of time and even if you do have the surgery knocking down the inflammation speeds recovery and lowers risk of post op infection. BTW this is not a walk in the park surgery. It eequires a major commitment to some very painful PT extending many weeks. If your muscle tone is weak now, you could take months to fully recover. If you are not up to working through some substantial pain, you may never fully recover. If you can avoid it with other means, it may be worth considering. Be sure you talk to a realistic PT as part of you decusion proces.
I can understand why you’re stressed: everything about this disease is stressful. But look at it this way: it’s a mechanical problem, that in the right hands, can be made much better. You will have options, and it sounds like you are getting very expert opinions. It’s carpentry, really. Or sewing. And it’s not an emergency. Frances is in control of this one!
Good luck and let us know what happens.
Thanks Seenie. I'm concerned that my hips will be under constant construction. I really appreciate your time to respond. This is the first time I've been so depressed about my PsA. So, much so that I'm staying with my sister because being in my house alone was adding to my depression. I see the ortho at 2:30 pm EST and hoping for positive news.
Frances
Seenie said:
I can understand why you're stressed: everything about this disease is stressful. But look at it this way: it's a mechanical problem, that in the right hands, can be made much better. You will have options, and it sounds like you are getting very expert opinions. It's carpentry, really. Or sewing. And it's not an emergency. Frances is in control of this one! Good luck and let us know what happens.
Lamb made me think of something interesting: you could have an injection or two and start PT prior to surgery, or at least, some sort of exercise. If you have been in pain for a while, I would guess that you haven’t really been up to any exercise. It might help with recovery.