Femoral Acetabular Impingement (FAI) Pincer type and Labral Tear.
Labral tear and FAI hip impingement - there it is, just like that a diagnosis after 5 years and 6 months of pain and partial disability. Its taken over 20 health professionals to finally arrive at the door of a consultant who is knowledgeable enough to spot what is wrong with me!
THANK YOU lord! I have FAI hip impingment (pincer type) in both hips and at least one labral tear.
Its has been a long journey to this diagnosis. I have seen EVERYONE from top consultants to chakra alignment spiritualists and spent thousands, probably over £20,000. I have seen doctors, physios, osteopaths, chiropractors (lots), acupuncturists, prolotherapists, spiritualist healers (anything when desperate!) and 6 consultants and for what it was worth may as well have consulted one of the checkout girls from Waitrose! At best I had temporary pain reduction and worst I was mislead down the wrong route with foundation-less diagnosis.
My FAI hip symptoms: (10 of the symptoms below are typical FAI hip pain symptoms, I've starred them for you.)
1. Deep ache mainly in right buttock.*
2. Pain down leg. (common complaint on hip impingement forums)
3. Pain around sacroiliac area and just above.*
4. Groin pain.*
5. Hip pain.*
6. Muscular spasm pain (lots). Mainly in QL and buttocks, multidifidus and also feels locked in thigh with tense TFL and iliotal band.*
7. Pain intermittent, worse on activity.*
8. keeps me awake most nights.*
9. Really hurts to sit.*
10. More recently limits walking to half hour on a good day.*
11. Hip clicks when flexed.*
Had to give up job as journalist/producer and curtail almost all sitting activities, driving (live in a village so hard to stop), cinema, meals over hr long at best, most social activities; and sport...as if, no more horse riding, swimming etc. and can't lift heavy stuff well.
Misleading diagnosis I have had:
in date order.
Sept 03 GP: muscular back pain. Told pain back as hip pain can't refer into back, but back can refer into hip - Here begins a trend!
Oct 03 physio: mild muscular spasm lower back. Told do pelvic floor. Surprised as pelvic floor strong... I thought!
Oct 03 GP: postural problems
Feb 04 GP: suppressed depression, when I said I wasn't depressed!?
March 04 Osteo: bit out of alignment. Do pelvic floor.
April 04: consultant neurologist:
MRI shows nothing bar "very mild dehydration at L5, unremarkable MRI" and so mild myelitis diagnosed.
May 04 chiropractor: (quote) you've got real problems. Told back pain refers into hip and groin hence symptoms! Do pilates.
July 04: Fell pregnant for 1st time, and in the absence of any cure, sort good bed as a cure.
In the space of 6 months bought a firm cheapish mattress, followed by a tempur 20inch, followed by an inflatable £18.99 mattress from Argos that I could alter night by night to help. Sleep on the Argos mattress for 3 and a half years - yes v sexy!
Was for some reason generally better during and shortly after 1st pregnancy, though did resume some tablet taking post pregnancy.
July 04 acupuncture: Low energy.
March 05: 1st baby born.
May 06: Symptoms suddenly much worse (prob from carting weight of 28lb toddler around.)
May 06 GP: Same old, "who knows, but take some of these" approach, (given up with GP now)
May 06 Osteo: questions twisted pelvis, v temp relief.
July 06 Pilate's tutor: back too curved, but Pilate's makes it worse.
Sept 06 muscular skeletal specialist: mild anterior pelvic tilt, glutes not firing, otherwise unremarkable. Told do Pilate's/pelvic floor (yawning now!) Have 2 caudal epidurals, cause more pain. Refers me to pain specialist.
Sept 06 Pain consultant: *Its my discs, so performs discography, but I'm fine.
*So it must be my facet joints, so have steroid injections. *Not sure if have some relief, so think best action is denervation (burn the nerves away) of area. Am in agony for weeks!
*Must be sacroiliac joint, steroid injections. Again didn't seem to work.
*Check for inflammatory illness high ANA's come back, told bad news, now scared, more tests, takes week to finally come back and is negative.
Am so glad will not be dying within next 10 yrs pain pales! Told can't be fixed, told don't know why got pain in groin, told to learn to live with it at pain clinic.
Feb 07 Podiatrist: Twisted pelvis, lower back too curved refers to Chiro before treatment.
Feb 07 Chiropractor: Twisted pelvis, though eventually thinks back 'too flat'. Stay with this chiro for 18 months as temporarily helps and he keeps trying and trying. Told can't be my hips as hip pain doesn't refer into back. told do pelvic floor.
March 07: consultant muscular skeletal: Told sacroiliac dysfunction need prolotherapy in ligaments. probably 3 sessions of 20 odd injections. But I have 11 sessions over many months = about 250 injections. Means I can now sleep on a flatter bed as all ligaments accidentally support hip area I now think. Told to walk for 2 miles each day, I do for one yr; and do pelvic floor, but PFE doesn't help as doing pelvic floor exercises always hurt.
Jan 08: fall pregnant again, but this time at around 26 weeks I lose ability to walk for more than 10 mins, told symphasis pubis. I accept that and start seeing lady chiro
July 08: Lady chiro: says pubic symphasis and pelvic girdle pain been the problem all along even though started before ever pregnant. Does a lot work on hip flexors, TFL and illiotal band, but insists, as all others, can't be hip problem. Says twisted pelvis, do pelvic floor.
Oct 08: Have baby and symptoms worsen considerably. Now struggle to shuffle round 3 or 4 isles in Waitrose. Can't sit again. Leg gives way whilst shopping. Desperate.
Nov 08 Obs Physio: post baby. Says hips stiff, recommends Pilate's and pelvic floor. I point out everyone says that and it hurts to do PF exercises, I ask for internal check rather than blind diagnosis of pelvic floor. To her surprise and not mine she finds pelvic floor in spasm and abs pinged back, says must be compensation for back. Refers me to pain clinic.
Dec 08 new Chiro: the best: Says maigne syndrome and twisted pelvis, do pelvic floor arrrrgggghhh! Says back too flat and told legs uneven length due to twisted pelvis. I ask for standing xray and I do have 8mm discrepancy, but is actual, not pelvis related. Had been told many times previously about leg length, hence my insistence to clear it up.
Jan 09 Another post baby physio: internal work to relax pelvic floor, obturator internus real problem. Given hip strengthening exercises..
Jan 09 new physio: (for external stuff) Does trigger point work, gives relief of muscular pain, starts to question hips and triggers reoccurring. Start getting pain both sides now, identical.
[march 09 my baby daughter has leg length discrepancy, I google and decide she qualifies as hip dysplasia, I take her to my chiropractor for confirmation as doc appointment a week away. They say sacroiliac/pelvis twisted no dysplasia. As does Doc, but this time I insist on scan! Scan confirms hip dysplasia.. she is treated with 12 wks in pavlik harness and it works, just... but I am now furious at how it was nearly missed and the subsequent consequences; and doubt both doc and chiro have a clue!]
April 09 physio: writes to my new Doc (one that listens) asking for her to refer me to hip specialist and to MRI whole area. Physio suspects labral tear, as despite working on me for a few months I do not improve (at last someone picking up on my symptoms). Thank you Louise Grant at Cookridge Hall, Leeds, Physiocure. She also looks further into labral tear/hip problems and literally finds that 5 more of her patients with vague, changing unrelenting pain have this problem. She is proved right within subsequent weeks as these patients undergo MRA scans. I later wonder if there is a silent epidemic! (Adding this 2 years on and Louisa Grant at Physiocure has now found over 100 patients with FAI, within a small suburb, within the city of Leeds... it is a silent epidemic and I wonder how many people are out there misdiagnosed and suffering like I was.)
April 09 specialist pain consultant: (this NHS appointment arrives 2 days before my private hip diagnosis) : Told not sure of my diagnosis, but that it CAN'T be a hip problem as I'm too flexible. So it must be my sacroiliac joint, even though when pushed he told me I don't test positive for sacroilliac problems, however this must be the problem as he can find nothing else?? To live with condition and medicate with stronger stuff, anesthetic patches or try coccyx steroid injection for sitting disability.
April 09 Consultant private hip specialist in labral tears: Thinks most symptoms match labral tear symptoms. Says xray completely normal, but MRA shows labral tear (MRA not actually painful to have, just uncomfortable, I'd been dreading it so much I almost didn't go ahead with it!). I don't remember a tearing incident, but he says many don't. I'm grateful at last for a diagnosis.
May 09: I raid google 'labral tear' sites and look for top top top specialists as I learn 3 things:
1. Get THE best specialist you can - and there's only a small handful in the UK.
2. Find the cause of tear - else you'll likely re-tear and need revision surgery.
3. Rehab, rehab, rehab
I seek out the best consultant in my area. From my X-ray alone he sees I have Femoral Acetabular Impingement (pincer type) Hips should be around late 20's/30 degrees, (average presenting patient at 37 degrees) but my bad hip is at 50+ degrees, good one at 43 degrees and of course one labral tear on tested side, a suspected tear on other. Thank you lord, I am home!
...But I am not am I?! I have all this hip arthroscopy surgery ahead of me, so this is where I am at and how I got here.. Its an end in one sense, as I have a diagnosis at last, but here begins the cure (I HOPE!) and I will be blogging as I juggle life, my kids, crutches in a 3 story house, my frustrated, but ever patient husband and these scary ops and believe me I'm scared!
So feel free to follow this recovery blog and I hope in some way I can help, because I know out there are many more people suffering like I am with FAI hip impingement, that don't even have their diagnosis yet it!
Updated from 2013:
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