Labral Tear Ruling out other causes of pre-op butt pain

Tndmbk42

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Hello, I am new to the forum. I'm 62, have always been very athletic, and an avid tandem cyclist and walker. I have bilateral mild-moderate OA, some labral tears, and osteophytes. The left hip started doing the typical groin pain off and on when cycling but was tolerable. Over the past several months I've been dealing with butt pain that frequently is so bad I can hardly walk for a solid day, usually the next day after having walked several miles for exercise or strangely, after taking a bath with my weight on my sacrum. Over the last 3 years, I have fallen on the lower end of my sacrum (but not the coccyx thankfully) due to missing a chair (eyeroll), and in the last year I fractured my left ankle, took a fall onto my hips and a few weeks later, crashed landed onto my knees, which drove some force into my left hip. I have sub-titled 2021-2022 as the year of orthopedic injuries! All of this has complicated trying to sort out what's going on with my hip. I have no doubt I will need a THR at some point, but right now I'm trying to figure out if the hip joint is the primary pain generator, or if it could be piriformis syndrome, or if it could be coming from my low back. I did have one diagnostic shot to the hip before July last year and it did get rid of most of the butt pain but not all of it. My surgeon is thinking the hip may be the cause of it but I'm still not completely convinced. Sometimes I get the butt pain in the right hip now, since I crash landed on the floor onto my hips. I have never had the pain there before that. That makes me suspicious of the low back. Has anyone here gone down a similar road of trying to diagnose where pre-op butt pain is coming from? I am going to go get another diagnostic shot in a couple weeks and if the pain still exists, I am going to go see a physiatrist. I've been doing piriformis stretches and sometimes it helps but if I do too much of it it aggravates it. I'm also trying to do some low back exercises to see if that helps. Maybe I'm just prolonging the inevitable, but I'm terrified of having a THR and still having this butt pain after I've recovered.
 

djklaugh

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@Tndmbk42 Welcome to BoneSmart! :welome: You have a complex situation going on and alas the answer might not be just an either/or. It could be that your hip is deteriorating more than you realize - which in and of itself could cause piriformis syndrome or exacerbate that condition. Could also be some type of lower back issue involved. How recently have you had x-rays taken of your hip? Any lower back pictures done? Given that you said the first shot did not take the butt pain away completely I suspect the base problem is the hip - those shots generally work best on soft tissue problems rather than bone problems.

IF the issue stems from the hip joint doing PT and/or additional shots would probably have little effect on the pain. On the other hand, if you went ahead with the hip replacement and did still have the butt pain - then PT ( slow, gentle) could help fix the other issues.

Best of luck to you and do keep us aware of what you decide.
 

Jaycey

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@Tndmbk42 As a person who has suffered from lower spine issues for many years, you have my sympathy! My bad hip was diagnosed as lower back pain for many years. In fact no one was really interested in doing an x-ray of my hip until the joint finally collapsed. Believe me, you don't want that pain!
Maybe I'm just prolonging the inevitable, but I'm terrified of having a THR and still having this butt pain after I've recovered.
My suggestion is go straight to an x-ray. Then you will know what you are dealing with. Yes, we were all terrified of THR. I was especially concerned as I had already had spinal surgery and had no idea how I would cope with a new hip on one side and a bad back on the other.

What you are feeling now is most likely bone on bone pain. I can confirm that first step post op will not include that pain. Sure there is post op discomfort. But unlike pre-op pain, post op pain can be managed.

I wouldn't bother with another injection. As you say, it is only prolonging the inevitable. THR is not a life sentence - it's a new beginning. Get that diagnosis and get on with living again.
 

subie2021

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@Tndmbk42
My story is a bit like yours. I slipped and fell while gardening on a steep slope and wound up with all sorts of aches and pains in my hip/butt. Because past imaging had shown that my back is a mess even though it rarely hurt, it was difficult for my healthcare providers to get past looking at my back as the cause. After tons of PT, meds, and anything else they could think of, I was sent to pain management. After a few simple tests which took about 3 minutes, that doctor recommended an injection into my hip joint as a diagnostic aid. If it relieved the pain, we'd know my hip was the problem; if not, it was probably my back.

The hip injection via "live" xray gave me complete relief. The hope was that it would last relatively long term, but I got only 18 days from it. But that was enough to prove where the pain was coming from. Subsequently I saw an OS who sent me for a hip MRI and scheduled replacement surgery exactly 3 months after the injection. I've been pain free on that side ever since.

So maybe a joint injection is something you could look into. The procedure took a few minutes, was only mildly uncomfortable, gave me immediate relief, and served as a definitive diagnostic tool.

Good luck with finding answers to your pain; wishing you all the best.
 

kare

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I can totally relate to what you're going through. And my advice is DO NOT rush into having a THR.

I too have butt pain on my right side with occasional sharp groin pain. The butt pain often makes it impossible to sleep. And standing for any period of time becomes agonizing. In my case I had assumed the butt pain was because of right knee bone-on-bone arthritis with severe knee flexion contracture and the gait issues resulting from it. After a TKRR two years ago, for many months the butt pain disappeared. But then as my knee healed and I began to do more and more, the butt pain came back with a vengeance.

Both MD and PT assumptions were hip. But xray showed mild arthritis. Next diagnostic, ultrasound, showed tendinosis of glute tendons at greater trochanter bursa. My doctor was going to inject cortisone into the bursa but upon palpating the area she could not reproduce the butt pain. Her assumption now is an irritated nerve, most likely sciatica without the usual radiating down-the-leg pain.

So I'm now awaiting referrals for a lumbar MRI and to a physiatrist for possible injection into one of the low back nerve sites.

I've done the piriformis & IT band stretches with little relief.
I took OTC anti inflammatories and tylenol. Doctor switched me to lyrica and celebrex. I stopped the lyrica because of weight gain. Celebrex takes the edge off but doesn't stop the pain.

My secret sauce for immediate relief is voltaren gel and then sitting on a frozen gel pad making sure it targets the painful area for at least 10-30 minutes. Helps me to fall asleep every time.

My takeaway is how difficult it is to diagnose pain when you don't present with typical symptoms. My doctor said butt pain is not usually associated with hip pain.

By the way, my sister who is the same age as you and an avid horse rider has a labral tear. She gets stiffness and sharp groin pain. Keyhole labral repair surgery has been recommended. In the meantime, she copes using pain meds as needed.

It would be awful to have your hip replaced only to discover the butt pain persists. In fact I've delayed knee replacement on my other knee until my butt pain is resolved.

Best of luck to you.
 
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Tndmbk42

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Thank you everyone who replied! I really appreciate all your advice and experiences you've shared. I have had hip x-rays (sports med doc) and back x-rays (chiropractor) within the last year, and my sports med doc said the amount of arthritis I have in the hip is not enough to warrant THR. I am not bone on bone, but there are a few osteophytes that show up as well. I've been told that butt pain is not the normal presentation of hip issues, but then I've heard that it can happen. I haven't had an MRI of my hips in years and the hip surgeon I see doesn't think he needs to do one based on exam and my complaints. He might change his mind if I talk to him about it further. Interestingly mentioning horse riding, I used to ride horses my entire life but several years ago I had to stop because after I'd ride, I could hardly walk due to hip and low back pain. It was a choice of either/or, so I sadly quit riding and that made walking and cycling okay for a long while. I think I definitely have some combo thing going on here with the low back and hip joints. I think at this point I need both x-rays and an MRI of my low back and then move on from there. I have done PT for years over this problem and what help I get is temporary. Usually my pelvis is rotated and my PT fixes it, but it never seems to stay put, as I have always had a chronically tight body and I'm terrible at doing consistent stretching. My sports med doc and I talked about this a month or two ago and we decided to have me do another diagnostic hip shot when ready and then if it doesn't improve things, to go see a physiatrist he really likes to sort out other realms. I think I need to go down both paths since, as you guys have said and demonstrated, this seems like a really complex thing. I'll post more after I get some info. Thank you for the support. I'm sorry for those of you who have been dealing with similar things. Bodies are a pain sometimes (but as my hubby likes to say, it's better than the alternative :) )! Kathy
 
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Tndmbk42

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So here's an update on my situation. A week ago Thursday I went and got another diagnostic shot to the hip joint capsule. He used 2 cc of methylprednisolone and 2 cc of marcaine. At first I hobbled out after the shot, but by the time my hubby and I got home (30-40 minutes later?) I could walk without pain. I would say over the next two days the pain was 90% gone in the butt. So I think that's pretty conclusive that the joint has a lot to do with my butt pain. Sadly, though, the pain relief didn't last past day 3. I think most of the benefit I got was from the marcaine. By day 4, I was limping around again. I'm taking Meloxicam for a week to get some relief and the stuff always works, so I'm walking mostly fine again now, but I don't like taking it long term as it's been known to whack out my kidney labs. I'm going to talk with the doc first week in May about surgery. I still am keeping the appointment with the physiatrist in the first week of June, just to get his take on things. I went to my knee doc and he thought they are improving and offered to do a hip x-ray since I hadn't done it since my last fall. Basically, no fractures, just moderate OA with bone spurs evident. My long time sports med doc also looked at those x-rays and he still thinks based on the x-rays my hip is not bad enough to replace the joint. Clearly if I'm in this much pain, there is more to it than what the x-rays are showing.
 

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I never had hip pain until this past December. I turned and thought I partially dislocated my hip. After that happening a few times I went in to get it checked out. They did an X-ray which showed a bone spur and some osteoarthritis but not bad. When the doctor manuvered my hip it didn’t seem too bad so he said let’s just do PT I don’t think things look bad enough yet for a hip replacement. Well it only got worse. So we did an MRI. Things were much worse looking then the X-ray showed. Torn labrum in two places with fraying in the rest of it.
The bone spur was fraying my labrum. I’m almost 70 so hip replacement is in 2 weeks. I think with continued pain an MRI with contrast is good because it shows both hips and the lower back. I have a torn labrum in the other hip as well but doesn’t cause problems. It also showed I have mild osteoarthritis in my lower back. Just thinking that might be a much better diagnostic tool for you.
 

subie2021

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I think Mar nailed it.

MRI tells a better story than radiographs.
Here is a copy and paste of my reports, months apart, as an example

xray -
COMMENT: 2 views. The bones of the left hip appear normal without evidence of fracture or dislocation.

MRI -
Left hip: Moderate area of full-thickness cartilage loss involving the superior weightbearing aspect with extensive subchondral cystic changes within the acetabulum. No evidence for fracture. Degenerative signal/tearing in the labrum. No joint
effusion.

Sometimes you need to jump through hoops to access the more thorough diagnostics, but the hassle is worth it when you get answers.

My OS has told me that he believes it's more about patient quality of life than about imaging results, so pain and loss of function overrules lack of apparent severe issue on xrays or MRI.

Good luck!
 

Elf1

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@Tndmbk42 I totally agree with @Mar and @subie2021 xrays don't always give the full picture. Also, radiologists don't always put everything in their reports, especially if they don't think it pertains. Some check for only what the referring doc requested and don't comment on anything else that may be there.

And if you want to get your spine checked out you could also have a diagnostic "live" xray guided injection there as well. My pain management doc had done one with just the marcaine which only lasted for maybe 2 days. His reasoning being it was diagnostic only. And he didn't want to put a bunch of steroid in there for the surgeon to have to work around in the case it worked. It did work and I ended up having spinal fusion of my L5/S1 a couple months later. Injection site was determined from my xrays.

Took a while when I was having hip and surrounding pain to get folks to take me serious, they all assumed it was my back still acting up. Again pain management was doing their best to keep me mobile and in as little pain as possible. It finally got to the point where he looked at me and said you need an orthopedic surgeon that specializes in hip replacement. He sent his notes to my primary care who recommended someone and about 3 months later I had my hip replaced.

Really recommend you have a consult with an Orthopedic surgeon that specializes in hips and does tons of them. If you eventually decide to have your back/spine checked out my personal experience was that I needed to see a Neurosurgeon.
 
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Tndmbk42

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Thanks everyone for the replies. It's so helpful to hear your experiences. Been a busy week so just now reading what you all wrote. I had a fantastic and unexpected thing happen a few days ago, which makes me feel vindicated as to my suspicions of my SI joints contributing to my butt pain. I only took meloxicam for about 4 days and stopped, then the day after I was taking a hot bath, floating and stretching, and all of a sudden my right SI joint adjusted itself. Then a second later, the left SI joint adjusted! And since that point, the awful butt pain on both sides is mostly gone! What a relief! I think that since the first fall that I took around Dec 28, where I landed on my right side, my SI joints have been jammed. My body has been guarding so much, my chiropractor has been unable to get the right side of my bod to adjust. I guess after 4 months it took the body to feel it was ready to release, or perhaps the hip shot and a few days of meloxicam helped things to relax. I also have been lifting myself up into the air on my kitchen counters to decompress my low back. I think all of it contributed. So I am in MUCH better shape now. There was clearly some hip joint involvement since I got temporary relief for a couple days with the marcaine. My left hip still is not completely happy (still feel it laterally at times and sometimes more anterior or in the groin) and I will keep my appointment with the surgeon on May 5 to discuss. However, the pain I am having is greatly lessened and I'm currently testing out my ability to take long walks and get on the bike trainer. At this point, I just want to make it through to the fall without needing surgery as it would be more convenient for me to do it then.
 
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