MRI arthrogram- pictures!

I've already written about arthrograms once here (I go in to way more detail about the process of the procedure, flouroscopy and the MRI scan )Yesterday I had an arthrogram on my left hip to check for a labral tear. (a tear of the gasket-like rim of cartilage on the hip joint called the labrum. The contrast injected into the hip joint during the procedure makes the labrum much easier to see on the MRI scan that follows the procedure.) I sometimes feel like I've had so many hip procedures in the past three years, but when I thought about it I realized that this was only my second arthrogram. All I can say is that I was a ball of nerves before the procedure and there was nothing to be worried about. The initial injection of the number stings a bit but the best part was I couldn't even tell that the contrast needle went into my hip. If you've never had a hip injection before  I'll admit it can be scary. Everyone's experience will be different but the best thing to do is trust your radiologist. From start to finish it tends to only take about 20 minutes and if they inject some numbing agent into the joint with the contrast (which they usually do so you can lie still and pain free for about an hour in the MRI scanner) you'll be pain free for a bit after the procedure. It's a win-win. By all means I'm not saying it's a walk in the park, but it's best to look at things in a positive light. It also really helps to have something fun to look forward too after the procedure (for me, that's ice cream). Bring on the five inch needles!

muscles ligaments and tendons oh my

I do not have a good relationship with my IT band. In fact I think it may borderline on an abusive relationship. Oh  well. Since I've had hip surgery I've learned quite a bit about hip anatomy. More than sometimes I'd like to know. The biggest thing I've learned is that there are a lot of muscles, tendons etc. in your hip that you might not even know exist until they decide to go on strike. About 1/2 of my hip problems caused by FAI have bee joint (bone or cartilage) related. The other 1/2 have been muscle and tendon problems related to FAI. In fact I spent 6 months on crutches due to muscle atrophy and tendinitis. Pretty crazy to think that even though now my joints are now normally shaped (yay!) the various problems related to being on crutches, having surgery, suddenly changing the shape of my bones and simply growing are tremendous and that I still deal with them today. The iliotibial band runs from your low back to the outside of your knee. It's pretty darn big. Because of many causes mine (left only) is much too tight to the point of needing surgery to release it. The moral if this little story is that you should never take your muscles and tendons for granted. I would only think about my bone and cartilage and labrum but it is equally important to take care of all of your hips. Ice and physical therapy are great but sometimes rest is the best. Happy New Year!

diagnosing FAI

When it comes to diagnosing FAI things can be tricky and take a very long time. I was undiagnosed for 14 months which in the grand scheme of things isn't too bad; some people live with the pain for years and years. FAI hasn't come onto the radar of most doctors yet and that may be why it is often overlooked when a patient presents hip pain symptoms. It wasn't until over a year after my symptoms started that an arthrogram was suggested to look for labral tears. (it just so happened that I had labral tears caused by FAI) It is my hope that as more and more cases are diagnosed, more doctors will learn about FAI and the need to find and treat it early in order to reduce joint damage. I am very lucky that my joints are in pretty good shape and that my surgeries were able to help me! During that year I was told some pretty interesting things that make me smile as I look back on them :)
Ty's Laundry List of possible chronic hip pain causes
Juvenile Rheumatoid arthritis
reflex sympathetic dystrophy
pain loop
endometriosis
fibromyalgia
angry chis (pronounced "angry cheese")
herniated lumbar disc
lyme disease

steroids for band geeks?

Yesterday I had my steroid shots at the sports medicine clinic. (no I don't play sports, I think the staff was slightly disappointed!) First, I had a complete evaluation with various motion tests done on my hips. Everything from knee to chest (ouch!) and left knee to right side of chest (double ouch!) plus some resistance tests thrown in for fun. After that and some chatting he decided to inject the bursa on the trochanter (side of hip) and also do an intra-articular injection (inside the joint.) First my hip was cleaned with iodine and alcohol and I was positioned on my back because the inra-articular injection was first. Next, a number was injected in to my joint. This burned and stung quite a bit. After that a very large needle was used to inject the steroid into my hip. This stung as the the needle went in and then there was pressure and discomfort as the steroid was injected which took about 45 seconds.
I have had a similar procedure done before in the OR with anesthesia. I think it may be that sports med likes to do it outpatient with ultrasound guidance no sedation and general ortho prefers OR sedation and flouroscopic (x-ray) guidance. There are definite pros and cons between the two procedures. The outpatient procedure is more painful but it only takes about 24 hours to recover from. I prefer the OR procedure because you aren't awake for the procedure but you do need to fast, have an IV and the anesthesia may leave you feeling off for a 3 days or so.
After that my bursa (fluid filled sac) was injected and I was flipped onto my right side and my hip was cleaned. Again, I felt the burning but it only took about 10 seconds to inject the medicine. Usually there is little discomfort after with a bursa injection. However, for about a few days or so after intra-articular I usually have a slight limp and some groin pain. This is due to having something (fluid) put in the joint that wasn't there before! Sometimes the steroid crystallizes which can be painful but frequent icing can usually help.

MRI arthrogram

An arthrogram is usually the best way to diagnose labral tears (and in turn FAI) because it can show cartilage damage that a regular MRI or X-ray usually can't. There was a 14 month gap for me between symptom onset and my diagnosis of FAI and during that time I had multiple X-rays and MRIs of various parts of my hip and back that were all strangely normal. It wasn't until the arthrogram that everything became clear and we knew within minutes what was wrong with my hips! First I was lay down on a table similar to that of an operating table and my hips were cleaned. Then they brought the fluoroscope over the table. A fluoroscope is pretty nifty, it's essentially " real time X-ray " which means instead of still pictures it's a video of your bones. Which, I admit isn't all that nifty if all you're doing is lying on a table. BUT you do get to see the needle go into your joint and release the contrast fluid. First, you get a bit of number injected so you don't feel the needle (They told me it was just like getting Novocaine at the dentist. I had never done that before, so I was completely terrified the first time I got a filling after the arthrogram! In my opinion the number is the worst part as it can sting, but after that the hard part's over) Then the put in the contrast (BIG needle) which just felt like pressure to me. After that it was off to the scanner which is noisy (think woodpeckers with construction equipment) but painless. My joints felt a bit wobbly for a few hours after but that was about it.