I've been busy researching dry needling in NYC and writing letters to any organisation that might have a clue as to what direction to point me, since none of my doctors are familiar with it. I just sent this email to the International Myopain Society:
"Hi. I was recently in Holland visiting a friend and she took me to her physio as I was in a lot of pain. Recently I had an MRI that showed disc bulging, herniated discs and stenosis in my cervical spine. I was sent to a neurologist who sent me for the MRI because I had constant pins and needles shooting down my right arm.
I also have EDS - hypermobility, fibromyalgia, TMJ, mild scoliosis and more things I probably can't remember at this moment. I have also had 4 reconstructive hand surgeries, and hip surgery to deal with a torn labrum, psoas release and FAI.
Anyway, I went to see this brilliant physio, Remco, in Den Haag and he did some traction on my neck, adjusted C2 for the TMJ and also adjusted my lower back and did dry needling in my trapezius muscle. It was the first time since the constant pins and needles started that I had relief. I didn't have them for 4 days, and it is still much less than it was.
The thing is, I really need to find someone who can work on me here. I have a chiro, but he's not allowed to do much else other than electric stim and massage and stretching. That helps, but only mildly. I was hoping that you would be able to recommend someone in Manhattan that works with my kind of mess of a body and does dry needling.
If you would I'd so appreciate it.
Thank you very much for your time."
Yes I am desperate! I am hoping someone will respond from one of my cries for help and tell me they know someone in the area. I did find this Dutch-trained physio who would be perfect, but of course he A) is in Bethesda, MD and B) doesn't take insurance. Part of me wants to go down to see him anyway, and he lives close to my aunt and uncle, so...I may just have to. I think I will send him an email as well. His name is Jan Dommerholt and he sounds brilliant.
I go for the EMG test on Monday, my mother is coming with me. Yes, I'm a baby, but I don't fancy someone sticking needles into me and then electrocuting me. We shall see what the darling neurologist has to say about my reports then as well. I have no faith in her at this point, but will bring my research and show her, after she says her opinion.
At present, the neck and back hurt, plus the usual "it's high humidity and low pressure" fibro crap, so going to go to the PT pool after work and hopefully it will be quiet and empty and I can just relax in there for a while.
Showing posts with label psoas release. Show all posts
Showing posts with label psoas release. Show all posts
13 November, 2008
07 October, 2007
The Surgical Record
The HSS Operative Record
Patient Name: Me Date: 17 September 2007
Attending Surgeon: Dr. Kelly
Operating Surgeon: Dr. Kelly
Preliminary Diagnosis: Right hip labral tear with snapping psoas, Synovitis, Combines Cam and Pincer Impingement
Postoperative Diagnosis: Same
Name of Operation: Right hip arthroscopy, Labral tear, debridement, synovectomy, partial psoas and acetabular rim decompression with labral re-fixation and a cam decompression.
Anesthesia: spinal
Estimated blood loss: less than 20cc
Inoperative fluids: one liter of ringer's lactate
Drains: none
Indications: The patient is a 37 year-old female with progressive right hip pain, right worse than left. The patient had combined Cam and Pincer impingement with snapping psoas and inflammation. The patient had persistent symptoms despite non-operative measures and given these persistent symptoms, the patient was indicated for right-hip arthroscopy and associated procedures.
Procedure:
The patient was correctly identified in the Holding Area and the patient was brought to the Operating Room. The spinal anesthesia was administered. The patient was placed in supine position and approximately 10mm of distraction was achieved from the acetabular joint. The right hip was prepped and draped in the standard surgical fashion.
The lateral portal was established under fluoroscopic guidance using the Seldinger technique. A distal lateral accessory portal and a posterior portal were both established under direct visualization. The arthroscopic examination of the central compartment demonstrated a labral tear anteriorly with a significant synovitis with areas of early delamination of the anterior and superior cartilage consistent with Cam impingment and crushing of the synovium and labrum anterior, superiorly consistent with Pincer impingement. There was also extensive tension on the psoas anteriorly consistent with psoas impingement.
The cartilage on the femoral head was otherwise in good condition. The ligamentum teres was in good condition. The patient had a (looks like a word was whited out) injury posteriorly. At this point, a wide synovectomy was performed using the Tac-radio frequency probe starting posteriorly and working our way anteriorly. The labrum in the front where it was torn was debrided gently preserving the majority of the labrum. A capsular cut was then made connecting the anterior and anterolateral portals for elevation of the capsular tissue off the acetabular rim lesion.
The acetabular rim lesion was identified and then a 5.5 mm high speed bur was used to recontour the acetabular rim. The fluroscopy confirmed the appropriate resection. At the completion of the acetabular rim decompression, the psoas was partially released over the front of the joint where it appeared to be compressing the labrum anteriorly. The labrum after it was debrided was stabilized through the transition zone cartilage using the radio frequency probe but no suture anchors were required.
All cartilaginous loose debris was evacuated from the central compartment at the completion of the synovectomy. A partial psoas release, acetabular rim decompression and labral debridement. The scope was placed in the peripheral compartment as the traction was released. The hemi hip joint was placed back in the socket. A Cam lesion was identified and then a Cam decompression was performed using fluoroscopic guidance to confirm the appropriate resection.
The dynamic arthroscopy was performed demonstrating the absence of any residual impingement. At the completion of the Cam decompression, no further pathology was identified. The instruments were removed from the joint and the arthroscopic portals were closed with 3-0 nylon sutures and a marcaine cocktail was placed into the joint. The wounds were cleaned, dried. Sterile dressings were applied. The patient was awakened from anesthesia and brought to the Post Anesthesia Care Unit having tolerated the procedures well.
Patient Name: Me Date: 17 September 2007
Attending Surgeon: Dr. Kelly
Operating Surgeon: Dr. Kelly
Preliminary Diagnosis: Right hip labral tear with snapping psoas, Synovitis, Combines Cam and Pincer Impingement
Postoperative Diagnosis: Same
Name of Operation: Right hip arthroscopy, Labral tear, debridement, synovectomy, partial psoas and acetabular rim decompression with labral re-fixation and a cam decompression.
Anesthesia: spinal
Estimated blood loss: less than 20cc
Inoperative fluids: one liter of ringer's lactate
Drains: none
Indications: The patient is a 37 year-old female with progressive right hip pain, right worse than left. The patient had combined Cam and Pincer impingement with snapping psoas and inflammation. The patient had persistent symptoms despite non-operative measures and given these persistent symptoms, the patient was indicated for right-hip arthroscopy and associated procedures.
Procedure:
The patient was correctly identified in the Holding Area and the patient was brought to the Operating Room. The spinal anesthesia was administered. The patient was placed in supine position and approximately 10mm of distraction was achieved from the acetabular joint. The right hip was prepped and draped in the standard surgical fashion.
The lateral portal was established under fluoroscopic guidance using the Seldinger technique. A distal lateral accessory portal and a posterior portal were both established under direct visualization. The arthroscopic examination of the central compartment demonstrated a labral tear anteriorly with a significant synovitis with areas of early delamination of the anterior and superior cartilage consistent with Cam impingment and crushing of the synovium and labrum anterior, superiorly consistent with Pincer impingement. There was also extensive tension on the psoas anteriorly consistent with psoas impingement.
The cartilage on the femoral head was otherwise in good condition. The ligamentum teres was in good condition. The patient had a (looks like a word was whited out) injury posteriorly. At this point, a wide synovectomy was performed using the Tac-radio frequency probe starting posteriorly and working our way anteriorly. The labrum in the front where it was torn was debrided gently preserving the majority of the labrum. A capsular cut was then made connecting the anterior and anterolateral portals for elevation of the capsular tissue off the acetabular rim lesion.
The acetabular rim lesion was identified and then a 5.5 mm high speed bur was used to recontour the acetabular rim. The fluroscopy confirmed the appropriate resection. At the completion of the acetabular rim decompression, the psoas was partially released over the front of the joint where it appeared to be compressing the labrum anteriorly. The labrum after it was debrided was stabilized through the transition zone cartilage using the radio frequency probe but no suture anchors were required.
All cartilaginous loose debris was evacuated from the central compartment at the completion of the synovectomy. A partial psoas release, acetabular rim decompression and labral debridement. The scope was placed in the peripheral compartment as the traction was released. The hemi hip joint was placed back in the socket. A Cam lesion was identified and then a Cam decompression was performed using fluoroscopic guidance to confirm the appropriate resection.
The dynamic arthroscopy was performed demonstrating the absence of any residual impingement. At the completion of the Cam decompression, no further pathology was identified. The instruments were removed from the joint and the arthroscopic portals were closed with 3-0 nylon sutures and a marcaine cocktail was placed into the joint. The wounds were cleaned, dried. Sterile dressings were applied. The patient was awakened from anesthesia and brought to the Post Anesthesia Care Unit having tolerated the procedures well.
23 September, 2007
pain is getting worse
I am not sure why the pain is getting worse, but it seems to be. Yesterday I took it easy and barely did anything other than my rehab routine. I iced with the GameReady for a while, did the CPM for two hours and then after dinner did my PT. The exercises hurt even more than the first day I had to do them. Agony was an understatement.
After watching telly for a bit with my mother I did another hour of the GameReady hoping to numb my leg up before bed. We then decided I should take a second pain pill, hoping this would help me sleep through the night, or at least most of it.
I passed out about 11.30 pm and then at 12.30 am woke up with a start! I have no clue what woke me but whatever it was made me jump, which is not good for my hip at all. I have been getting leg spasms, supposedly from the psoas release, and it's driving me mad. I fell back to sleep and then slept till about 4.45 am. After I go up to go to the loo I was in pain so decided to take two more pain pills hoping I'd pass out again. Sadly this was not the case. I would sleep for a few minutes and then wake up again, this went on till about 8 am. I was feeling (am still actually) incredibly wonky from the pills so just vegged for a bit and finally just ate something. I'm now thinking the two pains pills wasn't the best idea. I think between the pain and not being able to move around whilst I sleep is what is keeping me up at night. Normally I sleep like a wild woman, all over the place and wake up in pretzel-like positions. Sleeping on my back is just making me ache all over even more. I tried sleeping on my left side again with a pillow between my legs but that doesn't seem to work for me.
After watching telly for a bit with my mother I did another hour of the GameReady hoping to numb my leg up before bed. We then decided I should take a second pain pill, hoping this would help me sleep through the night, or at least most of it.
I passed out about 11.30 pm and then at 12.30 am woke up with a start! I have no clue what woke me but whatever it was made me jump, which is not good for my hip at all. I have been getting leg spasms, supposedly from the psoas release, and it's driving me mad. I fell back to sleep and then slept till about 4.45 am. After I go up to go to the loo I was in pain so decided to take two more pain pills hoping I'd pass out again. Sadly this was not the case. I would sleep for a few minutes and then wake up again, this went on till about 8 am. I was feeling (am still actually) incredibly wonky from the pills so just vegged for a bit and finally just ate something. I'm now thinking the two pains pills wasn't the best idea. I think between the pain and not being able to move around whilst I sleep is what is keeping me up at night. Normally I sleep like a wild woman, all over the place and wake up in pretzel-like positions. Sleeping on my back is just making me ache all over even more. I tried sleeping on my left side again with a pillow between my legs but that doesn't seem to work for me.
20 September, 2007
update
Arianna, Dr. Kelly's PA rang me on Tuesday evening and we reviewed a bit of what was done in surgery. I wrote down as much as I could. I will add the post-op report when I receive it, hopefully at my appointment with him next week.
Arianna stated the following:
Impingement was bad. Acetabulum had too much bone and was shaved down. The femur was also shaved down.
Labral tear was not as big as thought and the frayed portion was debrided. The rest of the labrum was intact so no sutures were needed.
There was a lot of inflammation and very red inside the joint, he debrided what he could.
Psoas release - area was very red, 10% was cut. Because of this I will be a bit weaker for the first 3 months but should eventually get back to "normal" strength.
I was also told that I should be on crutches 2-3 weeks depending on how my strength is and if I am able to walk without limping. But as with everything else, it's a 'wait and see' thing.
I also checked with my genetic doctors office and was told that my biopsied tissue is growing and when they have enough it will be sent to the research lab in Seattle. Still no word on my Echo, but they were following up and hopefully will have that by tomorrow.
So that's the medical bit of the update.
Yesterday I went to PT for the first time. I have to say it definitely helps that I know the guys I am working with there as it made me much more comfortable. We did some small movements with the green band which wasn't too bad. I was not able to do bridges, too painful for me. I went on the bike for a bit but at first could not to a full rotation as it was too painful, so after doing a semi back and forth for a few minutes was finally able to do a full rotation for about 5 more minutes, which was a huge accomplishment. As my little nephew says "I did it!". All in all they thought I did pretty well.
After PT was when the nightmare started though. We left the office, which is on 56th, about 5 pm. We were not able to get a cab on that street, it was the worst time as most were off duty, and the others all taken. I was told not to walk more than a block for a week or so, but my mum and I thought perhaps we could find a cab on 3rd Avenue. After crossing the avenue and waiting for a while, we realised this was not going to happen either. We walked up to 57th, and thought the other side looked more promising. This was not to be either. Eventually we crossed back to the other side of 57th and were going to ring my dad to come down with the car, but there was a bus that had arrived which goes up York near my apartment. I did not have my metrocard which is why we hadn't tried this sooner. I was desperate so sent my mum over to ask the man if he would kindly let me on sans metrocard. Bless his heart as he took pity on poor gimpy me and let us on. I thought I was going to pass out at this point. After 2 hours of PT and then standing for at least an half hour on the pavement was just too much. I still had to walk from York to First Avenue when we got off the bus, and that was very slow going. Every part of my body was killing me at this point. Thankfully we finally made it to my flat and I put the GameReady on immediately, took another pain pill and put on my ipod to try to rest.
Today I wanted to take it easy, but we had to come out to the island, so there was a lot of packing to do. Unfortunately this fell mostly to my poor exhausted mother, who needs an holiday after this for sure! Thankfully the drive was only an hour as I was so nauseous from the pain meds. As soon as we got home I went straight to bed for a bit, and when I woke up was in a lot of pain. I used the GameReady for about an hour and took (reluctantly) another pain pill. I am now wonky again. The less I move when I'm on the drugs the better as even walking makes me queasy. I know this doesn't sound promising but I am foregoing my PT exercises today as I just couldn't do it for all the money in the world. I promise tomorrow I will do it!
Arianna stated the following:
Impingement was bad. Acetabulum had too much bone and was shaved down. The femur was also shaved down.
Labral tear was not as big as thought and the frayed portion was debrided. The rest of the labrum was intact so no sutures were needed.
There was a lot of inflammation and very red inside the joint, he debrided what he could.
Psoas release - area was very red, 10% was cut. Because of this I will be a bit weaker for the first 3 months but should eventually get back to "normal" strength.
I was also told that I should be on crutches 2-3 weeks depending on how my strength is and if I am able to walk without limping. But as with everything else, it's a 'wait and see' thing.
I also checked with my genetic doctors office and was told that my biopsied tissue is growing and when they have enough it will be sent to the research lab in Seattle. Still no word on my Echo, but they were following up and hopefully will have that by tomorrow.
So that's the medical bit of the update.
Yesterday I went to PT for the first time. I have to say it definitely helps that I know the guys I am working with there as it made me much more comfortable. We did some small movements with the green band which wasn't too bad. I was not able to do bridges, too painful for me. I went on the bike for a bit but at first could not to a full rotation as it was too painful, so after doing a semi back and forth for a few minutes was finally able to do a full rotation for about 5 more minutes, which was a huge accomplishment. As my little nephew says "I did it!". All in all they thought I did pretty well.
After PT was when the nightmare started though. We left the office, which is on 56th, about 5 pm. We were not able to get a cab on that street, it was the worst time as most were off duty, and the others all taken. I was told not to walk more than a block for a week or so, but my mum and I thought perhaps we could find a cab on 3rd Avenue. After crossing the avenue and waiting for a while, we realised this was not going to happen either. We walked up to 57th, and thought the other side looked more promising. This was not to be either. Eventually we crossed back to the other side of 57th and were going to ring my dad to come down with the car, but there was a bus that had arrived which goes up York near my apartment. I did not have my metrocard which is why we hadn't tried this sooner. I was desperate so sent my mum over to ask the man if he would kindly let me on sans metrocard. Bless his heart as he took pity on poor gimpy me and let us on. I thought I was going to pass out at this point. After 2 hours of PT and then standing for at least an half hour on the pavement was just too much. I still had to walk from York to First Avenue when we got off the bus, and that was very slow going. Every part of my body was killing me at this point. Thankfully we finally made it to my flat and I put the GameReady on immediately, took another pain pill and put on my ipod to try to rest.
Today I wanted to take it easy, but we had to come out to the island, so there was a lot of packing to do. Unfortunately this fell mostly to my poor exhausted mother, who needs an holiday after this for sure! Thankfully the drive was only an hour as I was so nauseous from the pain meds. As soon as we got home I went straight to bed for a bit, and when I woke up was in a lot of pain. I used the GameReady for about an hour and took (reluctantly) another pain pill. I am now wonky again. The less I move when I'm on the drugs the better as even walking makes me queasy. I know this doesn't sound promising but I am foregoing my PT exercises today as I just couldn't do it for all the money in the world. I promise tomorrow I will do it!
16 August, 2007
Answers
The doctors PA rang me and we were on the phone for half an hour! I truly appreciate all of her time and patience on the phone. I did have quite a list and did get some answers. I tried to write down everything but it was hard so here are the q's and what her answers were (I've made them short and to the point though she was quite specific)...
In general she said the surgery should help with the pain, and also asked if I had ever been tested for a collagen disorder (not that I am aware). She is going to check w/ the dr to see if he thought I should and to recommend a rheumatologist that could do the testing. My main issue she said is the laxity I have.
Will these procedures help to “tighten” the tissues and muscles supporting the joint so that it will not be so lax? Will they help my “hyper mobility” in this joint? to an extent it will help but you cannot cure laxity.
What could have caused the labral tear? lax patients are more prone over time to develop tears. she said b/c of my laxity i can move my joints into positions that don't seem over extended for me, but over time it could wear on them.
Is FAI degenerative? yes
Is the underlying femoral neck misshapen and also causing the impingement or a result of the impingement? my FAI is believed to be mild, but I still have impingement. they can shave down the bones if they need to and get rid of any bony abnormality
For the PSOAS release, what is exactly done? Is it the muscle or tendon that is released? Would ART help rather than surgery for it? they release (cut) the tendon portion and only 10% of muscle, the part that is snapping over the acetabulum. Patients tend to do well and not snap after, but b/c of my laxity it is tricky b/c it is a stabilizer for my joint. the dr will decide in surgery, but if it is done i can expect to be weaker than patients that don't have laxity, and they will work on that in rehab. The ART is not recommended for me, again b/c of the laxity, and it would only be a temporary fix, so surgery in my situation is the way to go.
Is my IT band tight? Do you anticipate having to do a release for me? Would you lengthen the tendon or remove a section? my IT band is probably tight if it snaps, which it does. they will check this in surgery as well and if necessary will release it with a knife cut through the IT band, lengthening it.
Re: the trochanteric bursitis debridement, are you definitely removing the bursa or will it depend on what it looks like when you go in? if inflamed they will remove it, and there is a pretty good chance it will be removed. she said i should be ok w/o it because now it is only causing pain from inflammation as it's located between the bone and IT band.
Can you tell if I have any large chondral lesions? they can't really tell this on the MRI so will observe when in there. This is the articular cartilage (the type you have in your knee that is affected when you have chondromalacia), which is different from the labrum which is more like a meniscus cartilage.
Could the PT have made the FAI worse? yes it could hurt the tear, not the FAI, if the pt has been really working you hard and moving leg in extreme positions. i haven't been doing anything extreme so hopefully it didn't make it worse. basically so long as you listen to the pain and not do what causes you pain - though at this point walking and sitting cause pain!
What is the success rate you have had with these procedures? hard to say in a number value, but she feels most people who had a labral tear were glad they had the surgery, but it also depends on what caused the tear. The five categories are laxity, degenerative (arthritis), trauma, psoas and fai. She feels that I am in the laxity category which is one of the worst to be in, and that I will most likely not have 100% improvement, maybe 80%. At this point I'll take the 80! Also, b/c of my situation I really have no choice but to do surgery b/c w/ laxity the options are limited. I am not the best candidate, but at the same time forced into it b/c of the lack of other options. And this surprises me why?
How long for a full recovery, on average? four to six months, but up to 12 months.
After recovery, are there any restrictions? Can I ever ride again? granted the thought of riding at the moment is extremely unappealing, i would eventually like to be able to do this, and happily, she said that they do have patients that have gone back to riding, so after about 4 mos it should be fine. I'll wait longer but glad that i will be allowed to. on the other had, she said riding probably didn't help the situation, and though i haven't done it very much in the last few years, i did it a lot when i was younger, so i could have affected what is happening now.
What are the chances the surgery will need to be repeated? Dr. Kelly does not like to do surgery again, unless, in some cases, it's a revision b/c the tear did not stay repaired after they repaired it, as opposed to debridement it.
Does this surgery increase the chance of needing a hip replacement in the future? there's no data out there b/c this procedure is relatively new. A hip replacement would only help if there was an arthritic condition.
In general she said the surgery should help with the pain, and also asked if I had ever been tested for a collagen disorder (not that I am aware). She is going to check w/ the dr to see if he thought I should and to recommend a rheumatologist that could do the testing. My main issue she said is the laxity I have.
Will these procedures help to “tighten” the tissues and muscles supporting the joint so that it will not be so lax? Will they help my “hyper mobility” in this joint? to an extent it will help but you cannot cure laxity.
What could have caused the labral tear? lax patients are more prone over time to develop tears. she said b/c of my laxity i can move my joints into positions that don't seem over extended for me, but over time it could wear on them.
Is FAI degenerative? yes
Is the underlying femoral neck misshapen and also causing the impingement or a result of the impingement? my FAI is believed to be mild, but I still have impingement. they can shave down the bones if they need to and get rid of any bony abnormality
For the PSOAS release, what is exactly done? Is it the muscle or tendon that is released? Would ART help rather than surgery for it? they release (cut) the tendon portion and only 10% of muscle, the part that is snapping over the acetabulum. Patients tend to do well and not snap after, but b/c of my laxity it is tricky b/c it is a stabilizer for my joint. the dr will decide in surgery, but if it is done i can expect to be weaker than patients that don't have laxity, and they will work on that in rehab. The ART is not recommended for me, again b/c of the laxity, and it would only be a temporary fix, so surgery in my situation is the way to go.
Is my IT band tight? Do you anticipate having to do a release for me? Would you lengthen the tendon or remove a section? my IT band is probably tight if it snaps, which it does. they will check this in surgery as well and if necessary will release it with a knife cut through the IT band, lengthening it.
Re: the trochanteric bursitis debridement, are you definitely removing the bursa or will it depend on what it looks like when you go in? if inflamed they will remove it, and there is a pretty good chance it will be removed. she said i should be ok w/o it because now it is only causing pain from inflammation as it's located between the bone and IT band.
Can you tell if I have any large chondral lesions? they can't really tell this on the MRI so will observe when in there. This is the articular cartilage (the type you have in your knee that is affected when you have chondromalacia), which is different from the labrum which is more like a meniscus cartilage.
Could the PT have made the FAI worse? yes it could hurt the tear, not the FAI, if the pt has been really working you hard and moving leg in extreme positions. i haven't been doing anything extreme so hopefully it didn't make it worse. basically so long as you listen to the pain and not do what causes you pain - though at this point walking and sitting cause pain!
What is the success rate you have had with these procedures? hard to say in a number value, but she feels most people who had a labral tear were glad they had the surgery, but it also depends on what caused the tear. The five categories are laxity, degenerative (arthritis), trauma, psoas and fai. She feels that I am in the laxity category which is one of the worst to be in, and that I will most likely not have 100% improvement, maybe 80%. At this point I'll take the 80! Also, b/c of my situation I really have no choice but to do surgery b/c w/ laxity the options are limited. I am not the best candidate, but at the same time forced into it b/c of the lack of other options. And this surprises me why?
How long for a full recovery, on average? four to six months, but up to 12 months.
After recovery, are there any restrictions? Can I ever ride again? granted the thought of riding at the moment is extremely unappealing, i would eventually like to be able to do this, and happily, she said that they do have patients that have gone back to riding, so after about 4 mos it should be fine. I'll wait longer but glad that i will be allowed to. on the other had, she said riding probably didn't help the situation, and though i haven't done it very much in the last few years, i did it a lot when i was younger, so i could have affected what is happening now.
What are the chances the surgery will need to be repeated? Dr. Kelly does not like to do surgery again, unless, in some cases, it's a revision b/c the tear did not stay repaired after they repaired it, as opposed to debridement it.
Does this surgery increase the chance of needing a hip replacement in the future? there's no data out there b/c this procedure is relatively new. A hip replacement would only help if there was an arthritic condition.
13 August, 2007
Descriptions of (possible) procedures
I've gone and done a ton of research about the "possible" things the dr may do to my hip. I appreciate that they have to request all the possibilities for approval from the insurance company, but hey, inquiring minds want to know what could happen in there!
Here is what I came up with. If anyone has better descriptions then what I found on the web, please let me know.
Vastus-Psoas release for acetabular exposure in revision hip surgery.A technique is presented for wide exposure of the acetabulum for revision total hip arthroplasty surgery in the presence of a solidly fixed, modular, or monoblock femoral component without the need for trochanteric osteotomy. The technique involves release of the proximal portion of the vastus lateralis, vastus intermedius, and vastus medialis muscles and the iliopsoas tendon form the femur and placement of the femoral head/neck posterior to the acetabulum. The exposure afforded by this release usually precludes the need for trochanteric osteotomy and/or removal of a well-fixed femoral component in revision surgery that is being done for isolated loosening of acetabular components, thereby decreasing operative time, morbidity, and the risks of complication of trochanteric osteotomy.
Arthroscopic psoas tenotomy. Wettstein M, Jung J, Dienst M
Department of Orthopaedic Surgery, University Hospital, Homburg/Saar, Germany.
Tenotomy may be indicated for psoas tendinitis or painful snapping if conservative treatment remains unsuccessful. Because of significant complications with open techniques, endoscopic operations have been developed. We present a new arthroscopic technique to access and release the psoas tendon from the hip joint. This procedure can be performed in addition to other arthroscopic procedures of the hip joint or alone. To exclude additional hip disease, a diagnostic round of the joint should be completed. After hip arthroscopy of the central compartment has been performed, traction is released and the 30 degrees arthroscope is placed via the proximal anterolateral portal lying on the anterior femoral neck. The medial synovial fold can be identified. This fold lies slightly medially underneath the anteromedial capsule at the level of the psoas tendon. The arthroscope is turned toward the anterior capsule. Sometimes, the tendon shines through a thin articular capsule, or it may even be accessed directly via a hole connecting the hip joint and the iliopectineal bursa at the level of the anterior head-neck junction. If this cannot be done, an electrothermic probe is introduced via the anterior portal to make a 2-cm transverse capsular incision. The tendon is released with the back side of the electrothermic device turned to the iliacus muscle that lies anterior to the psoas tendon. A complete release is achieved when the tendon stumps can be seen gapping at a distance and the fibers of the iliacus muscle are visible. The first 9 patients who underwent surgery performed according to this technique developed no complications, and their hip flexion strength was restored to normal within 3 months. Published 14 August 2006 in Arthroscopy, 22(8): 907.e1-4.
ITB release (Iliotibial Band Release Surgery)
What is iliotibial band syndrome? Iliotibial band syndrome (ITBS) occurs when there is irritation to this band of fibrous tissue. The irritation usually occurs over the outside of the knee joint, at the lateral epicondyle--the end of the femur (thigh) bone. The iliotibial band crosses bone and muscle at this point; between these structures is a bursa which should facilitate a smooth gliding motion. However, when inflamed, the iliotibial band does not glide easily, and pain associated with movement is the result. ITBS can also occur where the IT band connects to the hip, though this is less likely as a sports injury. Cause: ITBS can also occur where the IT band connects to the hip, though this is less likely as a sports injury.
Title: Endoscopic iliotibial band release for external snapping hip syndrome.
Author(s) Ilizaliturri VM, Martinez-Escalante FA, Chaidez PA, Camacho-Galindo J
Institution Department of Adult Joint Reconstruction at the National Rehabilitation Institute of Mexico Orthopaedics Institute, Mexico City, Mexico. vichip2002@yahoo.com.mx
Source Arthroscopy 2006 May; 22(5) :505-10.
Abstract PURPOSE: The external snapping hip syndrome is caused by slippage of the iliotibial band over the greater trochanter. Most cases are treated conservatively but if this fails, open surgical treatment is commonly performed by Z-plasty or by creating a defect on the iliotibial band. We present a series of 11 hips that were surgically treated by an endoscopic technique. TYPE OF STUDY: Prospective consecutive series of patients.
METHODS: Diagnosis of external snapping hip syndrome was clinical in all cases and anteroposterior pelvis radiographs were taken to evaluate the hip joint. Endoscopic release was performed with the patient in the lateral decubitus position without traction using 2 portals, the superior trochanteric and inferior trochanteric. A standard 4-mm, 30 degrees arthroscope was introduced at the inferior trochanteric portal over the iliotibial band. A needle was placed at the proximal trochanteric portal and visualized endoscopically. The portal was then established and subcutaneous tissue resection was performed with radiofrequency (RF) probes and a shaver until the iliotibial band was identifiable and released with a vertical cut made using an RF hook probe. The arthroscope was introduced into the space created under the iliotibial band and a transverse cut at the middle of the vertical release was then made, creating a cross-shape. Next the 4 resulting flaps were resected to make a diamond-shaped defect.
RESULTS: Between September 2001 and December 2003, we treated 11 patients, 9 female (1 bilateral) and 1 male with an average age of 26 years, for external snapping hip syndrome using an endoscopic technique. At an average 2-year follow-up, we had 1 patient with nonpainful snapping. The rest of the patients in the series had no complaints and returned to their previous level of activity.
CONCLUSIONS: We present a reproducible endoscopic technique for the treatment of external snapping hip syndrome. Our results are comparable to those reported for open procedures.
Excision of heterotopic ossification
Heterotopic ossification (HO) is the abnormal formation of true bone within extraskeletal soft tissues.
Debridement trochanteric bursitis
definition: SURGICAL DEBRIDEMENT - The surgical removal of dead tissue, debris, and contaminants from a wound.
What is hip bursitis? Hip bursitis is a common problem that causes pain over the outside of the upper thigh. A bursa is a fluid filled sac that allows smooth motion between two uneven surfaces. For example, in the hip, a bursa rests between the bony prominence over the outside of the hip (the greater trochanter) and the firm tendon that passed over this bone. When the bursal sac becomes inflamed, each time the tendon has to move over the bone, pain results. Because patients with hip bursitis move this tendon with each step, hip bursitis symptoms can be quite painful. In those few cases where surgery is needed, this can be done through a small incision, or sometimes it can be performed arthroscopically. Either way, the bursa is simply removed (called a bursectomy), and the patient can resume their activities. The surgery is done as an outpatient, and most often crutches are only used for a few days. Patient's do not need a bursa, and therefore there are few complications from this type of surgery. The most common complications are anesthetic-related complications, and infection.
Acetabuloplasty
ac·e·tab·u·lo·plas·ty (s-tby-l-plst) n. Surgical repair of the acetabulum; plastic surgery on the acetabulum intended to restore its normal state (as by repairing or enlarging its cavity)
Osteochondroplasty
Osteochondroplasty is an arthroscopic removal of excess bony osteophyte that affects the geometry of the hip. Treatment for FAI.
Labral Debridement
remove a tear in the hip cartilage
Labral Repair
repair a tear in the hip cartilage
Here is what I came up with. If anyone has better descriptions then what I found on the web, please let me know.
*************
Psoas releaseVastus-Psoas release for acetabular exposure in revision hip surgery.A technique is presented for wide exposure of the acetabulum for revision total hip arthroplasty surgery in the presence of a solidly fixed, modular, or monoblock femoral component without the need for trochanteric osteotomy. The technique involves release of the proximal portion of the vastus lateralis, vastus intermedius, and vastus medialis muscles and the iliopsoas tendon form the femur and placement of the femoral head/neck posterior to the acetabulum. The exposure afforded by this release usually precludes the need for trochanteric osteotomy and/or removal of a well-fixed femoral component in revision surgery that is being done for isolated loosening of acetabular components, thereby decreasing operative time, morbidity, and the risks of complication of trochanteric osteotomy.
Arthroscopic psoas tenotomy. Wettstein M, Jung J, Dienst M
Department of Orthopaedic Surgery, University Hospital, Homburg/Saar, Germany.
Tenotomy may be indicated for psoas tendinitis or painful snapping if conservative treatment remains unsuccessful. Because of significant complications with open techniques, endoscopic operations have been developed. We present a new arthroscopic technique to access and release the psoas tendon from the hip joint. This procedure can be performed in addition to other arthroscopic procedures of the hip joint or alone. To exclude additional hip disease, a diagnostic round of the joint should be completed. After hip arthroscopy of the central compartment has been performed, traction is released and the 30 degrees arthroscope is placed via the proximal anterolateral portal lying on the anterior femoral neck. The medial synovial fold can be identified. This fold lies slightly medially underneath the anteromedial capsule at the level of the psoas tendon. The arthroscope is turned toward the anterior capsule. Sometimes, the tendon shines through a thin articular capsule, or it may even be accessed directly via a hole connecting the hip joint and the iliopectineal bursa at the level of the anterior head-neck junction. If this cannot be done, an electrothermic probe is introduced via the anterior portal to make a 2-cm transverse capsular incision. The tendon is released with the back side of the electrothermic device turned to the iliacus muscle that lies anterior to the psoas tendon. A complete release is achieved when the tendon stumps can be seen gapping at a distance and the fibers of the iliacus muscle are visible. The first 9 patients who underwent surgery performed according to this technique developed no complications, and their hip flexion strength was restored to normal within 3 months. Published 14 August 2006 in Arthroscopy, 22(8): 907.e1-4.
ITB release (Iliotibial Band Release Surgery)
What is iliotibial band syndrome? Iliotibial band syndrome (ITBS) occurs when there is irritation to this band of fibrous tissue. The irritation usually occurs over the outside of the knee joint, at the lateral epicondyle--the end of the femur (thigh) bone. The iliotibial band crosses bone and muscle at this point; between these structures is a bursa which should facilitate a smooth gliding motion. However, when inflamed, the iliotibial band does not glide easily, and pain associated with movement is the result. ITBS can also occur where the IT band connects to the hip, though this is less likely as a sports injury. Cause: ITBS can also occur where the IT band connects to the hip, though this is less likely as a sports injury.
Title: Endoscopic iliotibial band release for external snapping hip syndrome.
Author(s) Ilizaliturri VM, Martinez-Escalante FA, Chaidez PA, Camacho-Galindo J
Institution Department of Adult Joint Reconstruction at the National Rehabilitation Institute of Mexico Orthopaedics Institute, Mexico City, Mexico. vichip2002@yahoo.com.mx
Source Arthroscopy 2006 May; 22(5) :505-10.
Abstract PURPOSE: The external snapping hip syndrome is caused by slippage of the iliotibial band over the greater trochanter. Most cases are treated conservatively but if this fails, open surgical treatment is commonly performed by Z-plasty or by creating a defect on the iliotibial band. We present a series of 11 hips that were surgically treated by an endoscopic technique. TYPE OF STUDY: Prospective consecutive series of patients.
METHODS: Diagnosis of external snapping hip syndrome was clinical in all cases and anteroposterior pelvis radiographs were taken to evaluate the hip joint. Endoscopic release was performed with the patient in the lateral decubitus position without traction using 2 portals, the superior trochanteric and inferior trochanteric. A standard 4-mm, 30 degrees arthroscope was introduced at the inferior trochanteric portal over the iliotibial band. A needle was placed at the proximal trochanteric portal and visualized endoscopically. The portal was then established and subcutaneous tissue resection was performed with radiofrequency (RF) probes and a shaver until the iliotibial band was identifiable and released with a vertical cut made using an RF hook probe. The arthroscope was introduced into the space created under the iliotibial band and a transverse cut at the middle of the vertical release was then made, creating a cross-shape. Next the 4 resulting flaps were resected to make a diamond-shaped defect.
RESULTS: Between September 2001 and December 2003, we treated 11 patients, 9 female (1 bilateral) and 1 male with an average age of 26 years, for external snapping hip syndrome using an endoscopic technique. At an average 2-year follow-up, we had 1 patient with nonpainful snapping. The rest of the patients in the series had no complaints and returned to their previous level of activity.
CONCLUSIONS: We present a reproducible endoscopic technique for the treatment of external snapping hip syndrome. Our results are comparable to those reported for open procedures.
Excision of heterotopic ossification
Heterotopic ossification (HO) is the abnormal formation of true bone within extraskeletal soft tissues.
Debridement trochanteric bursitis
definition: SURGICAL DEBRIDEMENT - The surgical removal of dead tissue, debris, and contaminants from a wound.
What is hip bursitis? Hip bursitis is a common problem that causes pain over the outside of the upper thigh. A bursa is a fluid filled sac that allows smooth motion between two uneven surfaces. For example, in the hip, a bursa rests between the bony prominence over the outside of the hip (the greater trochanter) and the firm tendon that passed over this bone. When the bursal sac becomes inflamed, each time the tendon has to move over the bone, pain results. Because patients with hip bursitis move this tendon with each step, hip bursitis symptoms can be quite painful. In those few cases where surgery is needed, this can be done through a small incision, or sometimes it can be performed arthroscopically. Either way, the bursa is simply removed (called a bursectomy), and the patient can resume their activities. The surgery is done as an outpatient, and most often crutches are only used for a few days. Patient's do not need a bursa, and therefore there are few complications from this type of surgery. The most common complications are anesthetic-related complications, and infection.
Acetabuloplasty
ac·e·tab·u·lo·plas·ty (s-tby-l-plst) n. Surgical repair of the acetabulum; plastic surgery on the acetabulum intended to restore its normal state (as by repairing or enlarging its cavity)
Osteochondroplasty
Osteochondroplasty is an arthroscopic removal of excess bony osteophyte that affects the geometry of the hip. Treatment for FAI.
Labral Debridement
remove a tear in the hip cartilage
Labral Repair
repair a tear in the hip cartilage
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