MRI-A consultant diagnosis

"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."

MRI-A images

Here are two of my MRI arthrogram images showing the cam impingement:


(click to see larger)


(click to see larger)

Hip impingement diagnosis - but no labral tear?

Today I met with Mr N (my consultant) to discuss the results of the MRI Arthrogram. I was really hoping that he would be able to clearly see where the pain was coming from, but unfortunately that didn’t happen.

My MRI-A results show an impingement on the femoral head (cam shaped). It was expected that a labral tear would also be seen as this is a known source of pain with FAI, but one couldn’t be seen.

As it is not possible to identify the source of pain, Mr N said that he doesn’t know how to stop it hurting. Exploratory open surgery MAY reveal something that didn’t show up on the MRI-A, but this is not guaranteed. He said I need to think about whether I am willing to go through the operation and recovery with the possibility that I could be the same afterwards. I’m not sure how I feel about that at the moment.

As nothing was apparent on the MRI-A (apart from the impingement), it was suggested that this could, although unlikely, be a tissue or tendon issue outside of the joint, and that the impingement has nothing to do with the pain. To test this, I will be having a local anaesthetic injected into the joint… if the pain or catching stops, Mr N can conclude that the problem is from within the hip and that open surgery is worthwhile (though still with the caveat that he may not be able to fix me).

The MRI-A contrast dye irritated my hip, so this is a good indicator that the pain is coming from within the joint and not from tissue outside. Still, we’re going to do the local anaesthetic test to make sure.

After that I need to decide whether to go ahead and have open surgery. It’s a daunting prospect given that it may not improve things.