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Hidden tear may cause lasting mystery pain

January 3, 2010 12:00:00 AM PST
Professional athletes are shining a light on a pain problem that impacts everyone from all stars to weekend warriors. They are young, active people plagued by hip pain, yet nearly 60 percent of them are misdiagnosed when they go to the doctor. That's because they've torn a piece of cartilage hidden deep within the joint that's hard to see on scans.

On the basketball court, Costen Irons is king.

He's a stand-out athlete, but his star power was tarnished by 15 years of chronic hip and groin pain.

"I'd play through the pain, but the rest of my life, I was always looking, where can I sit down?" Irons said.

He had surgery on his groin, but the pain persisted.

"I went back to the surgeon and he said you're crazy, this is great and you shouldn't have any pain," said Irons.

"A lot of our patients have had symptoms for many years. They many times have had other diagnoses for their pain," explains Dr. Allston Stubbs, an Orthopedic surgeon.

The answer for many is a hip labral tear. The cartilage that seals and stabilizes the hip joint breaks away and gets pinched in the socket.

"The analogy I often use is the thorn in the lion's paw," said Stubbs.

The area is buried beneath muscles, tendons and ligaments deep inside the body, so it's often overlooked or misdiagnosed. Many times, it leads to unnecessary surgery.

"In the female population, they may have had hysterectomies," said Stubbs.

Stubbs makes two dime-sized incisions and shaves the bone and socket so they fit together without pinching. He reattaches the cartilage with stitches that promote new bone growth. This year, the surgery helped Yankee's star Alex Rodriguez and Philadelphia Phillie Chase Utley.

Irons is grateful he finally found a solution to his pain.

As soon as I had the surgery, there were movements I could do," said Irons.

He may never make it to the pros, but this elementary school gym teacher is just happy to do his job pain-free.

The surgery is reserved for those who don't improve with physical therapy and injections. The procedure is a two-hour outpatient surgery, and patients are often on crutches for about a month afterward. There is a risk the pain persists after surgery and doctors have to go back in and scope out the area again.

More information about Labral Tears:

BACKGROUND

The labrum of the hip is a form of cartilage that lines the rim of the hip socket. Like in the shoulder, tears of this cartilage can cause chronic pain. Symptoms of a hip labral tear include sharp groin pain following physical activity and thigh pain. This type of tear can also cause episodes of deep clicking and the feeling that the hip is giving out.

Hip labral tears have recently come into the spotlight as an under-diagnosed cause of hip or groin pain in high school athletes, according to an article in the journal Physical Therapy. On average, patients experience symptoms for two years before a diagnosis, and studies show 22 percent of athletes with groin pain and 55 percent of patient with hip pain of unknown cause had a labral tear.

CAUSES

Trauma from car accidents or falls can cause labral tears, whether or not the hip is dislocated. Other causes include participation in soccer, hockey, golf and ballet, all sports that require frequent external rotation. A large percentage of tears aren't associated with any known specific event or cause.

Experts speculate that repetitive microtrauma may cause these tears. Some factors put certain people at higher risk of labral tears, including hip dysplasia, a condition that causes the head of the femur to fit improperly in the socket, and aging.

DIAGNOSIS

As many as 60 percent of patients with labral tears of the hip are misdiagnosed, according to the National Athletic Trainers Association. While radiography, CT and MRI have not been helpful in identifying the injury, MRI combined with gadopentetate dimeglumine has been reported to have 90 percent sensitivity and 91 percent accuracy in diagnosing hip labral tears.

TREATMENT

Surgical treatment of hip labral tears may involve debridement, which is trimming or removal of tissue. In a technique called hip labral repair, surgeons use sutures to reattach the torn cartilage to the rim of the socket. One surgical approach to labral tear treatment is hip arthroscopy, which the North Carolina Sports Medicine Institute says has been available for many years but limited in use because of technical demands and the fact that it is much more difficult to perform than shoulder or knee arthroscopy. Despite its technical difficulty, according the American Academy of Family Physicians, the surgery is the "gold standard" for both diagnosing and treating labral tears of the hip. During the procedure, a special table, camera, light source and flexible tools are used in the hip joint to repair the problem area. In addition to general surgical risks like infection and bleeding, patients are at risk of damage to the sciatic nerve because of the stretching required to perform the procedure. Other risks include damage to blood vessels and cartilage, calcification of normal tissues and dead bone in the hip.


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