Hippy Chick

Yep, I'm a hippy chick.  I don't mean this as a treehugger sort of reference (even though I am that kind of hippy chick as well).

The adductor tendonitis that I'd been fighting for 6 months was finally correctly diagnosed as a torn hip labrum.  Part of the struggle with this injury is that it can act like a lot of other things - low back pain, hip pain, groin pain... The only real diagnostic tool is a magnetic resonance arthrogram (MRA), which is an MRI after a radioactive dye has been injected directly into the hip joint.

The answer is not as simple as "just" a torn hip labrum, as those who go through this quickly realize.  The bigger issue is why it tore.   Typically people will start complaining of hip/groin pain without any direct trauma or accident to blame.   The analysis turns to the hip structure itself and the myriad of issues that can cause improper alignment or improper motion within the joint such as hip dysplasia, retroversion and anteversion, and femoroacetabular impingement, or some combination of the three. Under normal circumstances, the labrum shouldn't be at risk of tearing.

In addition to the multitude of reasons why the labrum has been damaged, there is the high risk of further degradation to the hip once it has, as the labrum offers protection to the hip joint.   Damage to the cartilage is not uncommon with hip labrum tears, particularly ones that have gone undiagnosed for a long time.

And so, with the complexity of the diagnosis, so begins the quest of figuring out what to do.  There are a number of "hippy" related groups, blogs and forums out there, with a wealth of information and a wealth of ways to scare yourself silly about your prognosis.

These have been most helpful:
https://www.facebook.com/groups/FAIhip/
https://www.facebook.com/groups/579136442138901/
http://myfaihippain.blogspot.com/

Here is my MRA image showing the suspected labrum tear (in the red box).  The MRA also showed that my psoas tendon is pressed right up against the hip joint, which can also cause the labrum to tear.  There was also some cartilage damage.

And here is my x-ray showing a potential cam (too much bone on the femur) and pincer (too much bone on the acetabulum) impingements.  These bony structures eat at the labrum, eventually leading to the labrum shredding or tearing.  The x-ray also shows a slight "crossover" sign, meaning that the front of my socket is a little deeper than the back (called retroversion), causing the femur to preferentially face outwards a bit (though X-rays are not the best way to fully diagnose this).  This can also cause abnormal wear and tear on the labrum.

I met with the surgeon on Tuesday, and he was really clear that the imaging can only show so much and the damage internally can be worse or better than what the images show.   Based on my exam, the MRA and X-rays, here is what he is suggesting for my surgery:

1. Labrum repair
2. Removal of the pincer impingment (shaving down the bone so it no longer pinches the labrum)
3. Partial release of the psoas muscle
4. Microfracture, if the cartilage has been significantly damaged

Rehab will approximately take 3-4 months, but he feels the prognosis is good because, as he said, I am "young and thin".    It's a long road, but the dr believes it will only continue to get worse so it's best to take care of this now.