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Pain management

Discussion in 'Hip Replacement Pre-Op Area' started by donnaglo, Jul 10, 2018.

  1. donnaglo

    donnaglo new member
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    Why am I in so much pain?

    I had an injection in my piriformis muscle on the right side on Friday. I feel worse. The pain is more acute. I’ve had one previously in the hip joint. The pain relief was very temporary. The right side groin pain and radiating pain around my right hip into my buttocks is terrible. I started taking Tramadol every 6 hours yesterday. The anxiety I’m having from the pain being worse is terrible.

    In May I had an MRI of my right hip due to increasing but still manageable right hip pain. The results show
    no fracture of the bony pelvis
    Degenerative change of pubic symphysis
    No hip fracture or a vascular necrosis
    Joint effusion
    Illio-psoas is intact
    No bursitis
    Gluteal tendinopathy
    No bursitis
    Fat planes around the sciatic nerve are normal
    Hamstrings are intact
    7mm degenerative subchondral cyst in the posterior medial femoral head
    Degeneration and tear of anterior superior labrum and posterior superior labrum
    Normal contour at the femoral head-neck junction

    I have been told I shouldn’t be in this much pain with these results. An MRI of my lumbar spine did not show too much. I am very upset being in this much constant pain. I’m contemplating a right THR but want to know if this is what I need to do to resolve this pain. Does anyone have any thoughts on my predicament?
     
  2. dlp

    dlp member

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    Not sure anyone here can say for sure that you need a THR. @Josephine can probably work some magic and give you some advice, though!

    In my non-medical expert opinion, though, it seems to me labral tears are a pretty good recipe for hip pain.

    Do you trust your physician? Have you been seeing the same doctor for all of this work you are having done? If so, have you sought out a second opinion - especially by someone who specializes in Orthopedics?
    Not saying you have a bad doctor, but doctors are only human - and you have to look out for you.
     
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  3. donnaglo

    donnaglo new member
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    Thank you @dlp for your non-medical opinion I would love to hear from @Josephine if she might have some insight and ideas. I’ve been seeing an orthopedic PA. I was told by the ortho MD in the practice when I first had the MRI that the subchondral cyst in the femoral head could be cause for a right THR at some point.

    It is my understanding there is no cartilage left at the place where the cyst formed. I do have significant right side groin pain but the pain in the right side buttocks is constant and maddening and has me confused which is why I tried the piriformis injection.

    I called and left a message for the PA and was told he was with patients and unable to speak with me but that I need to give it a week. If I didn’t have Tramadol to help manage the pain I would be in tears all day.

    I did call a different orthopedic surgeon who does anterior THR for a second opinion. My appointment is in mid August.
     
  4. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Donna, I find these issues in your MRI report most concerning and am at a loss as to why your surgeon should have said you "shouldn’t be in this much pain with these results". Is he blind?

    My take on these is that the bone cyst is a precursor of arthritic changes and arthritic changes can also result in damage to the labrum. You should read this article Femoro-Acetabular Impingement (FAI).
    We have another couple of articles you might fine interesting
    FIA - a review of diagnosis and management
    FIA: Femoro-acetabular Impingement. Does Physiotherapy Improve Symptoms

    FIA is a recent addition to the possible conditions identified in hip pain and as a result, the knowledge of surgeons and GPs, has been slow to reach good practice levels. It wasn't so long ago that GPs knew nothing about it and only a very few hip surgeons did as well! Some even poo-pooed it as a figment of the imagination!

    However, there comes a point where labral repairs are just not possible and the only answer is a THR and it seems to me that you have already reached that point now. So I recommend your next action is to look for a really good hip surgeon and for that, you need to read this Choosing a surgeon and a prosthesis.
     
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  5. donnaglo

    donnaglo new member
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    Thank you very much Josephine. Especially for validating that the pain is real. I have read the articles you linked and am starting to look for a good hip surgeon. The list of questions to ask the potential surgeon is great and I’m printing it out. I scheduled 2 appointments with surgeons. One does anterior THR the other posterior. I’m not sure if this may be FIA or not. I have resting pain not just pain after activity. I am very limited physically and the pain is constant. I am nervous as this will be my first surgery but I’m looking forward to not being in pain.
     
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  6. Mojo333

    Mojo333 FORUM ADVISOR Forum Advisor

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    Hope you get some answers.
    I certainly got my life back...no more hip pain...via BTHR.
    Everyone deserves to live without chronic pain if there is a remedy!
    Keep us appraised @donnaglo
     
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  7. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Once you get to the stage of having a replacement, the cause is then irrelevant.
     

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