"I have reviewed Paul today together with the MRI scan which was recently done. The MRI arthrogram is very helpful in defining the shape of the femoral head in particular. What this shows is that the femoral head is slightly oval shape, particularly over the anterior part of the femoral head, which means that he has a CAM shape femur. He does have an abnormality on the acetabular side also with a very atrophic labrum in the same vicinity as the CAM shape femur. The problem that we have is that I can’t identify an obvious tear on the labrum. This would usually be the identifiable source of pain on somebody with hip impingement, but this is not present in Paul’s case. The difficulty here is therefore I don’t have anything to directly blame as a pain source and I therefore can’t guarantee that be treating Paul’s hip impingement will also remove his pain problem.
"This is therefore a very difficult decision making process. To try and help in this process I have offered to perform a diagnostic hip block with an intra articular local anaesthetic to see whether this would temporarily relieve Paul’s symptoms. If it does, this would tend to confirm that his symptoms are from the joint itself rather than from any of the tissues surrounding the joint or a referred pain from the back, for example. I think that if the local anaesthetic injection does resolve his symptoms for 6 hours post operatively, it would be worth considering open surgery to reshape the femur and explore the hip in more detail, and repair any other damage which might have been caused.
"I will book Paul for inter articular hip injection on the right side and I will review him thereafter to see what sort of benefit he has had temporarily from that injection."
19 September 2009
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Hello Paul
ReplyDeleteIsn't the Internet a wonderful thing!
I have been glued to my PC the past few days researching about my own hip and today was given a reference to "hip impingement" and subsequently found myself here on your site.
I won't hijack your blogs with reams of detail about me but it's just so helpful to be able to share symptoms and strategies with other people who are going through the same or similar thing.
I will be following your blog to see what the outcome of the injection is for you and do hope that it does give you relief.
In short, I have an "advantage" ( if that's the right word! :-) ) over you in that I have a reason for an "Impinged hip!", as I had Perthes disease as a child which resulted in deformity of both the acetabulum and the head of femur.
I'm now 44. I've had pain and stiffness etc over the past 30 years after execessive exercise of my hip that gets relieved by rest. But it's all getting a bit much now as it takes less and less to bring on an attack!!
I was always promised osteoarthritis in later life because of the Perthes. But was becoming confused about my "worsening" symptoms. It's a sort of bizarre intermittent thing. I am not in pain ALL the time but when it's bad it's very severe and disabling.
Years ago when I had my surgery there was no mention of "hip impingement syndrome "
BUT now I have what I think is the answer, my pain is possibly not down to any severe form of arthritis as yet but this mechanical thing called "hip impingement.".
But I think that like yourself, it's the frustration and irritation and annoyance that I have to progressively limit my daily activities just to prevent an attack. It's really quite difficult to explain to other people why you have to decline invites to do certain things, when you are symptom free. Outwardly they would say, you don't seem to be in any pain or discomfort,, but in my head it's screaming... "oh no you don't.. if you do x,y or z you will pay later :-)
I'm just being referred back to the Royal National Orthopaedic Hospital in London (treated my perthes) to get my hip reviewed.
And so am starting out on the journey to find out exactly what's the prognosis for my hip.
Anyway, sorry to have rambled on, but it's great to find a recent blog to comment on that's so relevant to my situation.
All the best
Jill
Thanks for your comment Jill. Sharing information is exactly what this blog is about!
ReplyDeleteThe progressive limitation of activity you mention is the same with me. What I don't want is for it to continue in that direction so that my hip completely rules my life. I'm sure you feel the same, although it's already like that now to some extent with me.
Good luck with your appointment at the RNOH. Drop by again and let me know how you got on.
Paul :-)
Good morning Paul
ReplyDeleteI have navigated to your blog from another where you were enquiring about the specialists in Cornwall, I now see that you obviously found the Duchy! I too have had hip problems and was referred to Mr Fern in mid 2008 via the NHS - nearly 18 months later and two open dislocation hip debridements for FAI (pincer) and labral tears plus surgical metalwork removal from both hips and here we are! It also appears mine was caused due to damaging the growth plates in both femurs when I was younger - although I have no knowledge of any major trauma in my younger years.
Must say though that Mr Fern has been brilliant, refreshing to find someone as experienced in his field after years of knee trouble and a series of operations with little or no effect. I am hopeful of a decent recovery although I must admit that the pain levels are still as they were pre-op but it has been a long thirteen months since my first op and not altogether straightforward.
I hope you have as comfortable experience as is possible, if you feel like messaging me please feel free - I will help with any advice/info I can
Good luck
Hi, well be sensible, well-all described
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