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Old 02-08-2013, 10:34 AM   #1
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Question Sudden: Intense Anterior Left Hip Pain: Post Laminotomy

Hello,
I posted a similar thread on the "back board." I thought I post here too.

History: (2 left ankle surgeries, 3 knee surgeries, bilateral PFJR-patella femoral joint replacements, left calf double compartment release surgery, lumbar laminotomy...(NOT laminectomy) on L3, L4-with facet "clean out" on L3,L4, and L5).

I am 9 weeks post Laminotomy & facet work. I was doing fine till about 2 weeks ago. I get INTENSE anterior left hip pain. The rating is like an 8 on the pain scale. The pain pattern is odd though. It only happens after I've been standing for 5-10 minutes..like after taking a shower or working in the kitchen. When I go to take my first step with my left leg...the pain is INSANE...it almost feels like it's catching or something. The pain feels like it's coming from the sartorius tendon or the rectus femoris tendon...but then it also feels like it's in the groin at times. I can "work through it" after I sit down for a minute and then I'm good to go.

Before I had my lumbar surgery, among the obvious symptoms with stenosis, I had weird left hip tightness. I could relieve it while standing and doing a "tree pose" type of stance...but then I would "crack" my outer hip and then it would release. Also, while walking my left hip would crack, snap, pop..when I walked. I could feel that all over the left hip: outer, anterior, medial. I thought this was all because of my ortho history with my left side having gone through so much.

I've had x-rays of my hip (that don't show arthritis). X-rays don't show soft tissue damage. I'm thinking that maybe I have one or a combo of the following: iliopsoas bursitis, "snapping hip sndrome", or maybe a labrum tear??

My lumbar surgeon doesn't think it's related to my spine. He thinks it's a hip problem. Does anyone have any suggestions? I'm seeing my sports med doc on Tuesday. I want to be as informed as possible. (The thought of now having a hip issue really depresses me......)

Thanks,
Let Me Walk

 
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Old 02-12-2013, 11:54 PM   #2
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Re: Sudden: Intense Anterior Left Hip Pain: Post Laminotomy

Hi there -- I have been off-line since you posted; sorry if this post is after your appointment. X-rays are usually a solid indicator of hip impingement, a major risk factor for labral tears. (If you have never had a significant injury to the hip and have no impingement, then probably not a labral tear. Fingers crossed!) However, you will probably need an ortho/sports medicine specialist to read the X-rays, perhaps even a hip specialist.

After three hip scopes to deal with impingement, a labral tear and labral delamination, I am still dealing with a similar catching and pain, which is relieved when my hip pops. My hip doctor seems to think it might be muscular, but we have decided to see if the pain continues to improve.

At my first thorough examination by a sports medicine doctor, he spent over an hour, checking range of motion of both hips, measuring for leg length discrepancies, testing strength of both legs, and attempting to recreate pain. The pain was recreated with a recumbent straight-leg raise with resistance. (Lie flat on back, lift one leg with knee straight, with someone pushing down.)

Short of surgery, I had an injection for bursitis, which was a side-effect of the joint issue. I also went through tons of physical therapy, which I think ultimately helped with surgical recovery. As you probably know, an MRI with simultaneous gadolinium and marcaine injection is typically the best diagnostic tool. The marcaine numbs the joint for 8-12 hours, and if the pain is relieved, then the source of the pain is definitively coming from the joint.

The injection is not fun; if this procedure ordered for you, be sure that the facility uses lidocaine to numb the skin surface. My first two injections were performed by a surgeon who used a plastic stylus looking device to "desensitize the skin" before the injection. I guarantee he's never had the procedure performed on him. Look for another facility if they use this technique. With the lidocaine, there's uncomfortable pressure but much better than the alternative.

I hope your appointment went well today.

 
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Old 02-18-2013, 11:53 AM   #3
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Re: Sudden: Intense Anterior Left Hip Pain: Post Laminotomy

Thanks for responding SweetPeainSF! I had my appointment last week Tuesday and x-rays were taken. I have very minimal arthritis in both hips (“normal amount for someone my age,” which is 49). My diagnosis is “hip snapping syndrome and iliopsoas bursitis." I start formal PT this week (was given 3 exercises/stretches to start after my appointment last week). My sports med doc said that: “If I do not improve within a month he will order an MRI of my hips.” The ball of my hip joint looks great…but the joint space looks questionable to me (but I’m not well versed with hips). When I compare my x-ray (based on memory from my appointment), to that of “normal hip x-rays on line” I guess, mine is similar. (I don’t understand why standing x-rays weren’t taken…wouldn’t that show the true state of my weight bearing joint? I am still not convinced that I don’t have issues with hip arthritis or SI joint or that it IS from my recent spinal surgery). Hopefully, it is really just soft tissue trauma and I can work it out through PT.

Anyway, I will start my official PT on Tuesday and hopefully improve. I learned from my most recent sports med appointment that the deep stabilizing abdominal muscles totally SHUT DOWN after spinal surgery. That makes sense to me. And while they have been SHUT DOWN, my hips have been doing a lot of overtime in trying to stabilize, I guess.
Thanks,
Let Me Walk

 
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