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It’s been a month since my last update and I’m in limbo until the hip block. It’s been brought forward and is now on the 6th November, so it won’t be long before I know what’s happening. Unlike the MRI-A contrast injection, this one is classed as a day op/procedure so I have to complete some pre-surgery forms and have an MRSA swab.
About 2 weeks ago I started to get the same symptoms in my left hip, which I couldn’t believe. I felt pretty unlucky to have a problem in one of my hips at 30 years old, so a bilateral complaint was all I needed! The problem in my left hip is identical to the one in my right, with exactly the same triggers and symptoms. Given my limited activity over the last few months, is it likely that I’ve torn the labrum on that side too? I’m not so sure. 
I’m now worried that I don’t have a tear on either side and that this is some other issue, but we won’t know until the hip block in a couple of weeks. On the plus side, if one side is successfully diagnosed, at least the other will be too. And at least dodgy hips didn’t stop me rolling down a hill in a giant bouncy ball last weekend! Weeeeeee!
I had the opportunity to have a coffee with a lady called Janet recently. She’s had open hip surgery for FAI, and told me about the op and how she felt in the weeks and months afterwards. Her hip problems make mine feel quite insignificant in comparison, and it was inspiring to hear her speak so positively about the open procedure, the consultant and hospital.
Janet also had a look over my scans (as a medical professional) and could decipher them far better than I could. What was interesting and confusing was that my impingement and atrophic labrum are anterior, yet the pain and discomfort is only posterior. Shouldn’t people with anterior FAI and tears have groin pain? I certainly don’t and have never felt a thing on that side. It has always been, in more ways than one, a pain in the backside.
That’s all for this post. More after the hip block in 2 weeks time. A final word to Janet to wish her well for her next operation later this month :-)
"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."
Here are two of my MRI arthrogram images showing the cam impingement:
(click to see larger)
(click to see larger)
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.
I was quite nervous on the day or the appointment (two days ago) as I’d read a lot about MRI arthrograms on the internet. Not thrilled at the prospect of having dye injected into my hip joint, I tried to forget the things I read and focus on the positive, which is getting a diagnosis.
The radiologist talked me through the procedure and asked whether or not I wanted to have local anaesthetic (What?! I thought it was always done with anaesthetic!). He said that local anaesthetic requires a series of injections, each getting deeper, whereas without there would be one injection straight to the joint and it would be over more quickly. He said most people find this tolerable but it’s my choice whether to have it or not.
I’m not usually too bothered about needles, but my stomach churned at the prospect of having one in my hip joint without anaesthetic. However, I trusted the radiologist and decided to go for the quick anaesthetic-free option.
I lay on the bed as the injection fluid was prepared at a table beside me. My heart was thumping. After a few minutes, I was cleaned and then told I would feel a scratch. The needle was pushed in quickly and fully, which made me shout out... more through surprise than pain. It certainly was painful and very uncomfortable, but not excruciating like some people would have you believe. The needle stayed in for a while and was aligned using x-ray. The contrast fluid was injected and the needle removed (I didn’t enjoy the removal much either).
The needle is injected in the front near the groin area, not the side. Here’s a picture of me showing where the injection took place (I’ve covered my man parts so as not to scare readers).
After the injection I was put in a wheelchair and wheeled through the hospital for the MRI scan. As I had the scan (which is completely painless) my hip was good. It felt a little strange and numb but nothing notable. After 30 or so minutes of banging and clunking, the scan was complete and I was allowed to go home.
After the appointment
I walked along the car park and all seemed well, until one movement made my hip hurt a lot, but it was a new sensation and not like the usual catching pain. In the car on the way home I was fine for 95% of time, but would occasionally get bursts of pain and discomfort (I'm glad I didn't drive). By the time we reached our destination about 90 minutes later, movement was pretty uncomfortable and it hurt to walk. Things were fine as long as I didn’t move, so I sat in a chair until some painkillers kicked in.
I wasn’t able to walk normally up stairs that night. I had to use my left (good) leg to lead up each step and a walking stick for balance. I didn’t have any pain during the night and I woke feeling good and agile. It still felt a little strange that day but I could walk around just fine. Today, 2 days on, it’s as though I never had it. All I have to show for it is a tiny red dot.
My experience of the MRI Arthrogram is that it’s nothing to fear. Yes, it hurts and makes you feel uncomfortable, but is it as bad as some people make out? No, not for me anyway. If you’ve had one of these yourself, please post a comment to let others know about your experience.
Only four working days after my appointment at the Duchy, I received a call to be booked in for the MRI arthrogram, which is scheduled for this coming Monday.
I’m impressed at how quickly they turned this around. The regular MRI that I had at the NHS hospital in Exeter took about 4-5 weeks from referral to scan, so this was incredibly quick!
I browsed the web for information on MRI-A’s and there are some mixed stories out there. For some it’s all pain and doom while others say it’s not too bad. However you look at it, it doesn’t sound like the most enjoyable of things but it’s something that has to be done.
I’ve been told I shouldn’t drive afterwards. That makes things slightly awkward as the hospital is 90 miles away, so someone has to spare an afternoon to come with me and drive me home. One of my brothers has kindly offered his chauffeur services for the day, which is also good as we get to spend some time together.
I’ll post my own account of the MRI arthrogram next week!
Yesterday I had my appointment with the consultant at the Duchy Hospital in Truro. It was a 90-mile drive from my office in Exeter and I was eager to see if my hip problem would be diagnosed. It was ‘orthopaedic day’ at the hospital and the outpatients’ area was bustling with people (mostly hobbling). After a short anticipative wait, I was called into the consulting room.
Following a chat about my problem and how it came to be, a walk around the room and some prodding, pulling and twisting, my consultant seemed confident that the cause of pain was a torn labrum developed as a result of a hip impingement, as suspected by the hip surgeon I’d previous communicated with. It can’t be confirmed for sure until I’ve had an MRI arthrogram, but this is the preliminary diagnosis.
I was also sent to x-ray as a matter of practice and the results were normal, which was expected. So next step is the MRI arthrogram, which I hope won’t be far too far away.
Remedy
Having read quite a lot about FAI and the two main types of surgery (open and arthroscopic), I already had a pretty good idea of the steps needed to fix the problem. However, I had convinced myself that, given the relative minority of my pain and problems, arthroscopic surgery would be the chosen path.
My consultant said that open surgery would be the preferred option as it’s more likely to have a positive outcome in the long term. I was informed that arthroscopic surgery has its limitations and is therefore preferred in older patients where the likelihood of other problems is lower than with open surgery. However, as a young man in good health without any other hip problems, I would expect to recover well from open surgery.
I was informed that a complete recovery takes about 12 months and that the operation has a 90% success rate.
Is this right for me?
I really didn’t expect that open surgery would be for me. My pain, although bad at times, is sporadic and I’m generally able to walk well. I’m unable to do most activities and sports so my life is certainly restricted, but not to the extent where I’m constantly in pain or unable to lead a fairly normal life. Since the appointment yesterday I keep asking myself, ‘do I really need major surgery and 12 months of recovery?’
The more I read about the procedure, like the trochanteric osteotomy, hip dislocation and osteoplasty, the more I’m beginning to worry. We don’t yet know for sure that this is the problem, so I should probably stop thinking about it so much until I have the MRI arthrogram.
My hip has been pretty good over the last few days. I managed to walk from my house into town (about half a mile) and back twice in that time, without any notable pain, catching or twinging.
It’s quite a contrast from last week. At the weekend I went to see a friend compete in an endurance mountain bike race near Plymouth (once which I’ve competed in previously but now can’t). A slight turn or movement irritated my hip and it caused it to flare up for a few days. This is nothing new but it brought on something else…
More troubling was the pain in my right buttock and thigh. Parts of my right buttock were very tender and sore to the touch deep in the muscle, and my right leg was both numb and painful near my groin for about 6-10 inches down my leg. My whole leg felt like a lump of wood and moving it was unnatural and clunky.
I read on some other blogs that people with hip problems (FAI etc) can get sciatic nerve problems too. Looking at the route the nerve takes, it certainly seems possible that this is what was causing the problem in my glute and thigh.
I’m glad it only lasted for about 4 or 5 days. Here’s hoping it doesn’t become a regular symptom.
Here’s the story about how I came to have a hip problem...
In April 2008 I went to London with Francesca, a good friend of mine. Her parents were visiting from overseas and we spent the day walking around the city taking in the sights. In the latter part of the day I started getting pain in my right hip – something I have not experienced before (at the time I was 29 years old, slim, fit and active).
Upon reaching St Paul’s Cathedral having walked quite a distance around the city, I noticed a more serious problem had developed, as walking up the cathedral steps was quite painful. By this point I had also developed a limp due to the pain, but never having had anything like this before, I assumed it was a one-off problem and one that would disappear in a day or two. Not so…
Ongoing problem
A couple of months down the line I still had minor hip issues. Nothing as bad as that day in London, but the odd painful spell or twinge was never far away. This gradually worsened throughout the summer to the point where the discomfort/pain meant I had to stop most activities and I was avoiding walking where possible. I also developed a problem walking up stairs where a ‘catching’ sensation would cause a shooting pain in my right hip. This has by far been the worst symptom.
Since then, pain in my hip has been up and down, sometimes very localised and other times affecting my thigh, glute and possibly my sciatic nerve. I tend not to walk too far and avoid walking up hills as much as possible, as this is sure-fire way to irritate it. It can flare up for the slightest reason… a slight turn on foot to change direction, getting in the car, stepping out of the shower, crossing my legs, and so on.
Medical advice and treatment
In the summer of 2008 I visited my GP in Exeter. After twisting my leg around and putting pressure on my joint, he was confident that it wasn’t a degenerative hip problem often found in older people. He assumed it was a gait issue and referred me to the local physiotherapy team, based at Franklin Hospital in Exeter.
The physio team initially concluded that the pain I was experiencing was due to inflammation and bursitis, brought on by a right glute that wasn’t doing its job properly. I was given numerous stretching and strengthening exercises, in the knowledge/hope that the additional muscle strength would alleviate the problem and prevent it from happening in future.
However, after 5 or so months of physio it was clear that we weren’t progressing far. The treatment had helped to improve my walking, but I wonder whether this was fixing tense muscles/weakness that had developed during the summer as a result of not walking or doing much. Ultimately, the hip pain was not improving and the shooting pain on stairs continued, despite considerable muscular improvement.
Scans
In April 2009 I was referred to the Royal Devon & Exeter Hospital for an Ultrasound scan, but it didn’t reveal anything. Later that same month I had a MRI scan at the RD&E, and I was hopeful that this would reveal the problem. A couple of weeks later my doctor called with the disheartening news that the MRI scan didn’t reveal anything untoward.
In frustration at having had the problem for a year without any improvement, I emailed about 20 hip surgeons (details found on a private health website) in the hope that someone would offer some advice about what to do or where to go next. Most went unanswered, but one replied!
Femoro what?
After reading the detailed story about my hip troubles, the surgeon suggested a possible diagnosis: “Femoroacetabular Impingement (FAI) and possibly a labral tear”.
What on earth? I had never heard of these things before! They’ve never once been mentioned by my doctors, consultants or physiotherapists. Although trying not to jump the gun, this has given me hope. Hope that we can find the cause of the problem and hope that we can fix it. I’m not saying I’d like to be diagnosed with this condition – from what I’ve read, the steps to fix it are quite something – but this is a new condition that I didn’t know existed, and researching it has revealed information on a myriad of other hip conditions.
I am now being referred to see a specialist hip surgeon in Cornwall (Cornwall Hip Foundation) through the NHS Choose and Book scheme. My initial appointment is a little under two weeks away and it can’t come soon enough!
So that’s my story thus far. This is quite a meaty blog entry as I had to get the background info down, so well done if you made it this far without nodding off. I’ve found a wealth of info on the internet from other sufferers so I hope any information I give, both above and in future posts, is helpful and informative to you.
More soon…
I’m now worried that I don’t have a tear on either side and that this is some other issue, but we won’t know until the hip block in a couple of weeks. On the plus side, if one side is successfully diagnosed, at least the other will be too. And at least dodgy hips didn’t stop me rolling down a hill in a giant bouncy ball last weekend! Weeeeeee!
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