Snapping hip syndrome...psoas release surgery good or bad idea?!


Question: Snapping hip syndrome...psoas release surgery good or bad idea.?
Sorry in advance. This one is a bit extensive. a lot of questions and issues. Thank you for your time.

I am in the United States Navy and (unfortunately) we don't have the best medical care. I started having pain/snapping/grinding in my left hip August 2006. I thought it was muscle pain from overuse and didn't go to medical to get treated for it. Finally, in January 2007, I decided to go and get it checked out. They took x-rays and didn't find anything, so they gave me Motrin and sent me on my way. The pain continued and worsened so I went back to get it checked out June 2007. They took new x-rays and compared them to the x-rays from January and noticed a possible "calcium buildup" which they referred to as "callusing" on the interior part of the femur. Which they thought may have been a small fracture that the first x-rays didn't catch and over time had calcified. But, being on a ship, the doctors aren't really specially trained to read the x-rays so they put me on crutches and sent me to the local Naval hospital Balboa for a second opinion on the "lump". At Balboa, they told me that "the bump was not convincing enough." and completely ruled out that it was the source of the problem or that it was even an issue at all and took me off the crutches.

I began physical therapy (but in the military, you don't get appointments right away. I waited weeks in between all of my appointments.) I attended 2 sessions and was then sent on a seven month deployment in November 2007. They were obviously somehow convinced that I could treat myself while away. Keep in mind that there are no physical therapist on board. I did the stretches and exercises that I could but had to deal with the lack of equipment available. So, I spent everyday guessing what I should be doing to fix my hip. also, there is 8 flights of "stairs" (which are really more like ladders) from my berthing (living quarters) to my work space. So, you can only imagine how many stairs I was climbing on a daily basis. So, needless to say, it was not any better when I got back from deployment.

We got back June 2008 and I made the soonest appointment with the major joint orthopedic specialist that I could get. It was a month wait. I seen him July 2008 and restarted physical therapy at the end of July. I was designated "not fit for shipboard duty" and have been put on shore duty (working in an office on shore not on a ship) until February 2009. It is now September and I just got reevaluated again and they said that my strength is increasing but my symptoms are not changing at all and would like to try surgery. They said that the cortisone shot was only a temporary pain relief. And would mask the pain rather that get rid of it completely.

This is the information that I have found online:
"Recurrence of snapping, weakness, and numbness were the most common complications of surgery for internal snapping hip, and some patients required further surgery"
and
"Most do not do well after this surgery."
So, I have been rather discouraged to elect this surgery option.
I can't find many positive statistics about this.
And finally, the questions:
1. Is there a website or does anyone know of statistics or success rates and helpful information of the psoas release surgery.?
2. Do I have any other options.?
3. I REALLY REALLY REALLY do NOT want Naval doctors operating on me. If I do elect the surgery, how can I go about finding and being operated on by a civilian doctor of my choice without having to pay out of my pocket and using my Tricare medical insurance from the Navy.?
4. If I elect not to do the surgery, can they kick me out and not give me benefits (G.I. bill etc.).?

Any good information is helpful and greatly appreciated. Thank you for your input.Health Question & Answer


Answers:
Hi there, sorry to hear you are having such problems, hip injuries are nasty and I do hope you feel better soon.
The previous answer was not correct in saying the psoas cannot cause snapping hip. The iliopsoas tendon can snap over the iliopectineal eminence causing 'internal snapping hip' as opposed to the 'external snapping hip' of the IT band snapping over the greater trochanter.
Another thing I think you should consider is that 'bump' you talk about. You should see an orthopaedic HIP specialist, not just a regular OS as they are more experienced with picking up things that regular OS aren't quite as knowledgable about yet, such as hip impingement and labral tears. They should be sending you for an MRI Arthrogram to rule out other issues. Your bump sounds as if it could be what is called a 'cam impingement' which can in turn cause a labral tear in the socket that causes a snapping sensation as well. The labrum is a fibrocartillage that surrounds the socket to add as a seal for the fluid in there and to provide depth to the socket. When it is torn, a flap of the tear can get 'caught' in the joint causing pain and snapping.
I have this problem myself and had hip arthroscopy to debride my tear in June last year. However it now appears that the underlying cause, a possible impingement was not addressed so i am still having problems. Please take a look at my homepage as I have written my whole story there and kept a blog. There are a lot of support groups and other blogs that I have linked to as well.
Good luck and I hope you feel better soon! If you want to do more research on this, just do a google search for Femoroacetabular impingement (FAI) or hip labral tear.

Jess
www.jessmcb.com


Oops...after all that I just read about your arthrogram at the bottom lol...keep in mind though that these tests aren't always 100% accurate and if you continue to have symptoms a second opinion and/or test may be needed.Health Question & Answer

Snapping hip syndrome is from the Iliotibial band jumping over the greater trochanter and has nothing to do with the psoas. If they are going to work on that muscle then I would want someone that does a lot of that procedure. Based on what information has been given I am not convinced that a surgical intervention is the right approach. My questions are going to be centered on the physical therapy. What are they doing.? Are they working on strengthening the entire hip musculature. If they are not then this is not going to work. An imbalance in the musculature creates problems that need to be addressed. Stretching is not going to answer this problem. It will make the muscles longer but not stronger and certainly not balanced between muscle groups. Have they done gait studies to see where in the movement or stride there is a problem. Once they have that answer then it is easier to correct. How have they determined the strength levels have improved.? Have they done any isokinetic studies to see how one side is against the other and how are the strength ratios.? Again it is hard to evaluate a muscle grade by hand if it is done by hand. I know that is the standard way all muscles are tested by if one has normal strength then it is somewhat dependent upon the testers strength and position that the test is done. If you have access to any universities that have a medical school they will have a department of orthopedics. Talk to them or if there is a hospital teaching school around you talk to them. One would hate to see you undergo a procedure and not have it work out. As for payment systems outside of the Navy I just don't know. Don't jump to the conclusion that the surgery will cure the problem. You may not have been given enough time in therapy to recover. By my calculations you have had only two and a half months of treatment after almost two years of having the problem. There are patterns that have developed in the muscles that have to be overcome. Muscle has a memory and once it learns an incorrect pattern it takes time to relearn the correct pattern. I hope this is of some help to you. Good luck! Health Question & Answer



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