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So we all know RICE as a general guideline to at least begin the recovery process from injury. Well, I've done that. I haven't been for a run in months :-(. Reason, I've had this terribly nagging hip ache that just wouldn't let up. The ache turned into a sharp stabbing catching pain when I get in and out of the seated position and walk up stairs, hills, or on uneven surfaces. So I brought myself to the doctor. She thought PT would be best but wanted to do an X-RAY to make sure I didn't break anything. X-RAY came back clear. I asked for MRI. Ended up with arthrogram and turns out I've got a torn labrum. She referred me to ortho who I met with yesterday. I was informed that my tear was coincidental and that my pain and that excruciating catching/locking up feeling are not my hip but my back and he couldn't treat me. I dont even think he read the MRI disc I brought in.I'd read up prior to going in and found some docs will diagnose using a cortisone shot. So I asked if even though he thought it was my back could he do the cortisone to rule out the tear being an issue. He told me it was kind of a big production to go through when it wouldn't help me anyways and I'd be wasting everyone's time. I didn't respond to anything he said after that. I was holding back tears and a slew of unkind words that would have most likely gotten me escorted out by security. Needless to say I promptly called another ortho for a second opinion. Has anyone else on here had any similar experience with a doc that just doesn't get it? Anyone with labral tears, and how have you managed them?
Thanks in advance for any response.
There are a couple of large threads covering this subject. The one below seems to be the most recent. I think a lot of people have had similar problems, with hip and doc. You may have to be logged in to see the whole thing.
They are correct to suggest that the tear visible in your image study, and the pain/dysfunction you feel may be unrelated. Many with such tears have no symptoms, and many with such symptoms have no tear. There are plenty of soft tissues in you core that produce excruciating pain and appear to "catch" with movement. These problems can take a lot of time to discover or rule out. The relationship of a visible flaw to pain is not direct.
It is still wise to explore a possible tear-related causation, but with many aspects of healthcare, it often boils down to a money or insurance thing. Medicine and insurers are under increasing pressure to allow probability rather than possibility to govern their approach. For this reason, PT and other avenues are explored before surgical interventions are attempted. This is partly because the results from labral tear surgery are mixed, and there is tremendous potential for creating more problems with such an invasive approach.
The opinion among many doctors is that labral-tear surgery is simply cosmetic surgery done under the skin. A similar fixation can occur when presented with internal images, as occurs in those who seek facial reconstruction, with similarly tragic results. The desire to perfect an internal structure can take on a life of its own, in which the patient refuses to accept that this flaw, now visible thanks to a scan, is the only potential cause for pain. Again, it is only a potential cause, and in more ways than one, an expensive one to pursue. It is always best to explore all other options before taking on the risks of cutting up skin and muscle enroute to repairing a structure that in itself, does not register pain. This is because the possible complications of turning to the knife can include making the real problem even worse. The notable exception is when the tear directly interferes with the physical integrity of a nerve. If this cannot be determined by thorough image studies, it's healthiest to dismiss the tear as coincidental, and pursue every other remedy first.
Good luck in your search for information and an exhaustive diagnosis. Please do not overthink the information you have at this time, since it is incomplete. In my opinion, which many share, a mature attitude and understanding on the part of the patient is the most important aspect of medicine. While it can also be a liability, it is my hope that you can make it work in your favor. Good luck, and don't give up yet!
Thanks for the feedback. While I do not disrespect or undermine his suggestion that my symptoms could be unrelated to my tear, I do find fault that he dismissed me with no regard to my suggestion to rule out the tear as the source of my pain/symptoms first. Getting to the bottom of my discomfort and obvious 'mechanical' problems are in my opinion not a waste of time since I am the one dealing with them day in and day out. The fact that he considered it would be a waste of everyone else's time was all I needed to know from him that I would not ever deal with him again for any ortho issue nor would I refer anyone I knew to him. 2nd opinion time. That to me is not immaturity, but rather self preservation.
Ajbriss, I hope I did not offend you with my mention of a "mature attitude." What I meant by that statement, is that a seasoned medical professional will not jump to conclusions based on an imaging study unless the evidence is compelling, while many patients without such experience often do.
Physicians know the importance of downplaying inconclusive evidence in order to avoid setting up a psychosomatic complication. It is as important for patients to "buy in" to a recommended therapeutic strategy in order to ensure the best possible outcome, as it is for them to avoid placing bets on false positives.
The maturity I mention is the willingness of the patient to "play along" with the doctor's preferred order of tackling the differential diagnosis. Since this is how he makes his living, he wants a good track record for results. If he puts his money on something other than the tear, it's likely to be more than a wild guess, even though he, like many doctors, is not very good at articulating the thought process leading to such a conclusion. His apparent dismissiveness is hard to take when the subject of his mentations is a real person with feelings, but what seems like rudeness in medicine, in other professions is valued as decisiveness.
If only one thing is clear about the state of medicine today, it is that there are too few doctors out there, and the ones who are have too little time. If he simply sends you to a surgeon to repair the tear, his credibility is at stake. Ditto for cortisone, which has side effects and contraindications not well-known. His best shot is to draw a straight line past distractions to probability. Even if he turns out to be wrong, it is the safest way to go, and in your best interest.
To show you the pressure your doc is under, a wrong turn was made when corporations were allowed to directly market medicine to consumers. Every day, doctors are confronted with patients who tell them what they need to feel well, based on the psychology of advertising. The tables have turned in the doctor-patient relationship, so the patient wants to call the shots based on a minimum of fact and a boatload of hype. The doctor, on the other hand, has to consider things like malpractice suits.
The data on surgical repair is not as good as the public would like to believe. Look deeply into the community of patients out there, and you will find sharp divisions between good and bad results, often chalked up to "good" and "bad" doctors. While it is widely assumed that the best doctors do the most, the worst results can be obtained the same way. This isn't the case with settled science. A smart doctor will do the least possible and rely heavily on the placebo effect. A happy patient is a healthy one, regardless of actual pathology.
Please consider the possibility that something else is responsible for your symptoms. I invite you to see the world inside your hip as your doctor does. It may not be as easy as looking at a picture of one possibility. If the guy says it's not the problem, allow yourself that chance, as the doctor is required by medical ethics to do.
The sad fact is, that medicine today can no more afford for patients to know too much, as it can for them to know too little. The turmoil that would ensue if patients knew how many expensive procedures were unnecessary, could throw many practices into bankruptcy. While I would not give this guy good grades for tact, I have to give him props for bravery. He said no to a determined patient, and to the big bucks.
This is what I am talking about... http://trainoutpain.blogspot.com/2012/10/misleading-mri-information.html
If you were just asking fora cortisone injection I can’t see any reason why the doctor wouldn’t trythat 1st if you were asking for it. My doctor did for my knee pain before doing expensive or invasive testsor treatments. I know others who havehad shots before moving on to MRI’s. Sometimes it works, sometimes it doesn’t. For me it worked after months of pain. Hurt like nobody’s business getting itthough. Hips are different I guessbecause when my husband had hip pain they went straight to expensivetesting. In his case his problems werewith the blood supply to the bone. Icould understand if they didn’t want to do surgery without checking out otherpossible causes, but it doesn’t sound like you were asking for that unless Iread something wrong.
My feeling is that if you have a badfeeling about a doctor find another one ASAP! Doctors who are condescending often don’t seem to care about a personenough to actually look past their narrow ideas of what could be wrong. I hope your next doctor is one who listensand helps you to stop hurting.
The problem with cortisone is it's temporary, it doesn't really fix the problem, and it doesn't tell you what caused the problem. It reduces inflammation and relieves pain, but when it wears off you're back to square one. So I can understand why doctors may be reluctant to use it, particularly where the problem is not well defined.
When evaluating physicians, it's important to distinguish between caring and coddling. A doctor who truly cares may seem cold and indifferent at times, and may drag you kicking and screaming down the straight and narrow path to safer healthcare, but a physician who coddles will tell you what you want to hear, ask what you want done, and shield you from every possible pain, regardless of outcome... because they make more money that way, both in referrals and repeat business.
Some food for thought regarding even a single steroid (cortisone) injection...http://www.surfacehippy.info/cortisonedangers.php
Most doctors I have met or worked with are pretty smart. Heck, all the ones who are legit should have to be smart to get through med school, but brains and bedside manner are two entirely different expressions of "smart." A patient has to set priorities. Will the physician's intelligence be directed toward getting me to trust him/her, or to being trustworthy? Great when you can have them both, but given a clear choice, I'd gladly forego the touchy-feely for somebody focused on the state of medical art. Most of us can detect niceness right away, but brains? You almost have to be a doctor to understand what your doctor knows. However, you can easily sense when your doc is pandering. Which approach respects your intelligence more?
Trust doesn't always come easy in this world, yet we tend to trust airline pilots right away even though we see them for a split second while boarding a plane. Would that trust deepen if they strolled the aisles shucking and jiving with us? I doubt it. When our lives are in their hands, we have no problem giving niceness a back seat to competence. I think that's a great model for medicine. Let the nice guys battle for your affection, but leave the decision-making to the one whose judgement is not clouded by your feelings. Yes, healthcare is a marketplace. Let the buyer beware what he/she is bargaining for.
Back again. Thanks for all the insight. I did end up finding a sports ortho and saw him last week. He agreed to send me for the shot in the hopes that it would determine whether or not the issue was in my joint. Had the wonderful shot Monday. Took most of the pain away. Still having instability and catching in the joint which is causing discomfort. Shot is starting to wear off but the good news is this doc agrees it is my hip now and not my back. He also did agree that the MRI confirms a tear and a 'blister' in the labrum. I am hoping I am on the right track here. My insurance is so tricky though that if I am a candidate for arthroscopy, I may have to find a surgeon that operates at the Hospital I work at which may delay treatment that much longer.