Hip Impingement

[xrated]

Anyone ever dealt with this before and want to share some advice?

Went to the doc today after having my hip hurt for 2 months after I felt a pop. X-rays I guess showed an impingement which is causing the pain.

He said I could consult with an ortho doc, physical medicine doc or try prescription strength anti-inflammatory pills for a few weeks.

That was all over the phone so I wasn't able to ask lots of questions but I do wonder if the pills are only going to mask the situation, I really don't like even taking aspirin for headaches so I don't want to just cover the problem to avoid fixing it. My other big question is, if this is something that will only get worse with my chosen hobbies.

I know I need to be asking him these questions, but damnit what kind of sled forum guy would I be if I didn't ask my closest thousand friends for advice first!!

 

[togwotee9]

I would ask Dr Himark, maybe he could find you something on Craigslist.

But seriously, I have broke my pelvis twice. I taken a lot of flexarol in my life. This summer I got a cortisone shot that did wonders for my back. I firmly believe in taking advantage of modern medicine. But I would go talk to your doc in person first.

 

[treemagnet03]

Did the doc share where the impingement was or what specifically was impinged? That would help greatly in deciding the cause beforehand and what to do going forward (vascular is far more worrisome than nerves, etc).

As a rule, medicine never wants to stop activity. That leads to far worse problems. Use it or lose it they tend to agree. Anyway...if it causes you pain to be active, then it's time to step in to try to help.

Depending on what the pain presents like determines whether you will have success with NSAIDS (ibuprofen, etc). If there is inflammation it can help a great deal. The big problem with extended high(er) doses of these drugs is kidney damage and stomach ulcers (too bad Vioxx caused heart problems because that one didn't). Otherwise, they really aren't too bad... One might suggest going ahead and trying it on a day you know you are going to be active to see if it makes a difference.

You are way too young to want surgery. If this is spine related impingement, you are far more likely to have long term success with PT. The ortho guys will spend more time, take more pictures, but offer similar things to the GPs. They are the ones who would inject steroids into the joint should you opt that route. Day one is great because lidocaine (short acting (24hr)pain relief for needle insertion) is working. Then a few days are bad again as the steroid begins to do its job. Just remember, steroids work for many, but some see no relief and the benefits tend to wear off after about 6months to a year. If this is a chronic condition, you will then get another shot, and another shot, etc. Eventually they get to the limit, which is one shot every 3 months, or four per year. Some guys swear by it and have success with one shot. That could be you. There really is no way to predict.

I have always shown my patients their imaging (med students see fewer pts than docs so we have more time). They might not be fluent in medical jargon, but who can't remember a picture? Call him back and ask for more details. Not sure what I whipped up here was helpful, but it is standard of care for joint concerns...best of luck man...

 

[xrated]

thanks for the info TM, I'm thinking I will get a appointment set up with one of the local orthopods....they are pretty good around here.

That and I think they will have better/straighter answers then my family med doc, in that they A) deal with this stuff every day and B)they will have a much better understanding of how my hobbies will affect this issue or be affected by it.

 

[treemagnet03]

Yeah, as long as insurance covers it, a trip to the orthopod (you do have quite the department around your general region from first hand knowledge) would be a great place to start. I recommend letting them know exactly what you mean with things like snowmobiling...this ain't yo' mamma's trail riding pardner! haha.

Best of luck with recovery. May it be a speedy route to an answer that makes sense for you!

-T

 

[xrated]

Just for fun, why not play along TM.

Here is my report from the films.

*Prominent left ischial spine. Slight acetabular crossover. Irregularity
and slight osseous prominence of the anterolateral femoral head/neck
junction. The findings could be seen in femoroacetabular impingement.
Recommend clinical correlation.

Currently on some rx NSAIDS, Refelan or some such crap. All I know is it says daily alcohol is not good, nor is prolonged sun exposure....so it ain't an option for much longer. 5 days on it so far and I have had one day where the hip wasn't hurting, and that was on my day off yesterday when I didn't do chit.

Ortho visit in a month.

 

[Sunridge Sledhead]

I haven't read all of the responses, but hip impingement is typically pinching of the synovial lining of the joint getting caught between the ball (femoral head) and the socket (acetabullum). Sometimes, the labrum (cartilage lip) of the acetabullum can be torn. Today, arthroscopic surgery is very successful at taking care of these tears, in a rather non-invasive way. I developed this problem 2 years ago, after doing a deep power turn and hitting an ice chunk in the snow. My left hip adductor (groin) muscles were strained, and my hip popped for about a year. I was certain I had torn my labrum. I have no residual problems at this point. As for impingement being visible on xray, it is not. However, the malalignment, noted in your xray reports seems to correlate to its' potential.

My 2 bits

 

[treemagnet03]

This sounds like a "classic case" of femoroacetabular impingement (FAI). Essentially an early osteoarthritis case in active young adults. I scoured the ortho books for a while and found that the radiologists had a pretty good handle on things. I couldn't put a link to the best paper I found as it requires you have access to an account or pay to see the journal, but these papers are a really good read and have some good images to go along with it.

http://orthoinfo.aaos.org/topic.cfm?topic=A00571

http://www.ajronline.org/content/188/6/1540.full

If you are wanting to move on to new treatments I will poke my nose around a bit more the next day or two and see what I can find. The first paper has a good start to the treatment from here on out. If this really is FAI you don't want to go too far without finding a way to get it under control.

-T

 

[xrated]

I haven't read all of the responses, but hip impingement is typically pinching of the synovial lining of the joint getting caught between the ball (femoral head) and the socket (acetabullum). Sometimes, the labrum (cartilage lip) of the acetabullum can be torn. Today, arthroscopic surgery is very successful at taking care of these tears, in a rather non-invasive way. I developed this problem 2 years ago, after doing a deep power turn and hitting an ice chunk in the snow. My left hip adductor (groin) muscles were strained, and my hip popped for about a year. I was certain I had torn my labrum. I have no residual problems at this point. As for impingement being visible on xray, it is not. However, the malalignment, noted in your xray reports seems to correlate to its' potential.

My 2 bits

So did you leave it untreated?

Mine started acting up in November when I went to get on the quad to give my girls a ride. Kicked my right leg up and over the seat and something went pop in my left hip. Been sore ever since.


Good news is so far the pills seem to be helping, but I have had two easy days work wise....see what today brings.

 

[xrated]

This sounds like a "classic case" of femoroacetabular impingement (FAI). Essentially an early osteoarthritis case in active young adults. I scoured the ortho books for a while and found that the radiologists had a pretty good handle on things. I couldn't put a link to the best paper I found as it requires you have access to an account or pay to see the journal, but these papers are a really good read and have some good images to go along with it.

http://orthoinfo.aaos.org/topic.cfm?topic=A00571

http://www.ajronline.org/content/188/6/1540.full

If you are wanting to move on to new treatments I will poke my nose around a bit more the next day or two and see what I can find. The first paper has a good start to the treatment from here on out. If this really is FAI you don't want to go too far without finding a way to get it under control.

-T

I will check those out. Never hurts to know more.

At this point it isn't 100% that I have that, just likely from the general exam and the radiology reports. That is why I want to see the ortho doc to find out for sure.

Then the big question besides what is it, will be if I can get by not fixing it or if by not doing something now I am just setting myself up for a butt rape of issues down the road.

I'd rather miss some stuff in the near future then wreck lots of stuff long term.

 

[Sunridge Sledhead]

So did you leave it untreated?

Mine started acting up in November when I went to get on the quad to give my girls a ride. Kicked my right leg up and over the seat and something went pop in my left hip. Been sore ever since.


Good news is so far the pills seem to be helping, but I have had two easy days work wise....see what today brings.

As a physical therapist, I treated myself. I did a lot of stretching and hip stabilization strengthening. The best exercise for hip stabilization is aggressive sledding in deep pow! But, it seriously is one of the best things I do for my lower extremities.

 

[xrated]

As a physical therapist, I treated myself. I did a lot of stretching and hip stabilization strengthening. The best exercise for hip stabilization is aggressive sledding in deep pow! But, it seriously is one of the best things I do for my lower extremities.

What all could a guy try?

I read yoga bad (which might have led to this as I did it all last winter), core strength good.

 

[Trashy]

As a physical therapist, I treated myself. I did a lot of stretching and hip stabilization strengthening. The best exercise for hip stabilization is aggressive sledding in deep pow! But, it seriously is one of the best things I do for my lower extremities.

Hmmmmmm.... I might have to get a prescription for that!!! Can't wait to see the look on my wife's face when the doc says I need to go sledding every day for a week or three....

 

[priest lake rmk]

Sorry it's late and I'm a little buzzed up but my hip had me basically bed ridden. They found a torn Labrum and did a battery of tests on me and discovered I have (spelling) Anclosing Spondalitis. That is a form of arthritis that attacks the spine and pelvis. Anyway, I had a total hip replacement when I was 34(2 years ago). Maybe ask them about it. Living life on pain pills is no life to live.

 

[treemagnet03]

Ankylosing spondylitis is a whole new kettle of fish. That gets into the "hear hoofbeats think zebras" category due to it being autoimmune (you attack yourself). Certainly there would be greater suspicion if there were a family history (HLA27 antibody positive on a serum test has a much higher likelihood of having this and a number of other related diseases). It also has a much greater relationship to the spine and sacroiliac joints than the acetabulum.

x-rated only fits the age group (20-40) and sex (male) as far as concerns. From the sounds of the report he has very localized and non-spine related concerns.

Then again, never say never...keeps you out of court

 

[xrated]

Sorry it's late and I'm a little buzzed up but my hip had me basically bed ridden. They found a torn Labrum and did a battery of tests on me and discovered I have (spelling) Anclosing Spondalitis. That is a form of arthritis that attacks the spine and pelvis. Anyway, I had a total hip replacement when I was 34(2 years ago). Maybe ask them about it. Living life on pain pills is no life to live.

I remember hearing about all your issues, I wouldn't wish that on anyone.

 

[zalez]

I just went through a care and prevention of athletic injuries class. We studied impingements of the shoulder and hips. I would see if you could find a Certified Athletic trainer that can help you out. They would be able to give you strengthening exercises and also show you how to wrap your hip (you would need someone to do it for you) to help stabilize it.

 

[xrated]

I just went through a care and prevention of athletic injuries class. We studied impingements of the shoulder and hips. I would see if you could find a Certified Athletic trainer that can help you out. They would be able to give you strengthening exercises and also show you how to wrap your hip (you would need someone to do it for you) to help stabilize it.

Don't most impingments tear hell out of the labrum, etc? TM where ya at? Cause if they do I don't see how PT or wrapping is gonna fix 2 plus months of tearing chit up.

Boy oh boy am I gonna have lots of questions for the ortho next month.

 

[zalez]

Don't most impingments tear hell out of the labrum, etc? TM where ya at? Cause if they do I don't see how PT or wrapping is gonna fix 2 plus months of tearing chit up.

Boy oh boy am I gonna have lots of questions for the ortho next month.

Yes it can tear stuff up. It's worth a look in to. the point of wrapping is to prohibit movement in the direction that causes the pain/swelling. The impingement won't get better until the swelling goes down. Like I said, worth a look in to. If you find a nice athletic trainer they may just take the 30 minutes to show you with out charging. Just an idea

 

[xrated]

Just visited the ortho doc.

Cam and pincer.

Next step is 6 weeks of PT, if it works I am fine, if it fails to improve or worsens it is on to MRI and injection of the hip.