Re: Help me work out what the surgeon is looking for!
He wants to know if the labrum (a ring of cartilage around the hip socket) is being damaged by the hip joint ball not fitting or "impinging" on the socket. In other words he is checking out the mechanics of your hip joint. Hope this helps, Sera
Location: San Francisco, California, United States
Posts: 701
Re: Help me work out what the surgeon is looking for!
To expand on Seraph's excellent explanation, impingement occurs when two bones within a joint come too close together during motion. This damages the soft tissues which normally have enough room. The soft tissue gets pinched between the bones and can wear away or tear over time.
Make sure that your doctor takes X-rays as well. Femoroacetabular impingement can often be best diagnosed and measured on X-rays.
Location: San Francisco, California, United States
Posts: 701
Re: Help me work out what the surgeon is looking for!
The MRI may include a procedure for a marcaine injection, which is a longer acting numbing agent similar to lidocaine. If this is an MRI with arthrogram, the MRI will be done with an injection of a dye to help visualize the joint space. Since the injection is not fun, the doctor often includes marcaine to verify that the pain is coming from within the hip joint itself. Hip pain can also be referred from other areas (usually the back), so the doctor may want to verify the origin of the pain. Otherwise, you may have a diagnostic marcaine injection later.
Typically, the doctor will order physical therapy for a labral tear. This will not fix the underlying problem that caused the tear (usually an impingement), but you may be able to change up some mechanics and build muscles to support the hip joint. In my view, physical therapy is not a waste because even if you need surgery ultimately, the physical therapy will build muscles that will help your recovery.
If the injury doesn't respond to physical therapy and you don't have widespread arthritis, hip arthroscopy could be in order. The surgeon, through small incisions, can trim the damaged cartilage, reattach flaps of cartilage, remove inflamed tissue, perform a microfracture to fill in any small holes in the cartilage and even shave down bone to eliminate impinging areas. (I should know -- I've had three!) The hip arthroscopy is designed to prevent further damage to the joint and preserve your natural joint.
I would highly recommend finding a surgeon who performs only hip arthroscopes. My first surgery was performed by a general orthropedic surgeon who damaged the joint forcing the instrumentation into the socket. If your current doctor finds a labral tear, I would push for a referral to a hip specialist right away, since it could take some time to receive a referral and get in for an appointment. You can always make the decision not to have the surgery, but good to have the option of seeing a qualified surgeon.
