Thread by @UntoNuggan

Gonna do a quick 🧵 on hip labral tears, since I recently got diagnosed with this

There's frequently a long diagnostic delay for these types of injuries

They are also relatively common in people with EDS, hypermobility, and/or connective tissue disorders

#NEISvoid

First, what the heck is a "hip labral tear"?

Ok so the hip joint is a ball and socket joint, which is what lets our hips rotate in multiple directions

There's a layer of cartilage lining the joint acting kinda like the shock absorbers on a car

It helps protect the hip bones

The cartilage lining your hip joint is called the "labrum"

And it basically wraps around the top of your femur (technically the "femoral head") inside the ball and socket joint of the hip

This cartilage can tear, and that is called a "hip labral tear" or "torn labrum"

There's a standard physical exam that's supposed to indicate "maybe a labral tear"

It also can indicate iliopsoas tendonitis

physio-pedia.com/Anterior_Labra…

The iliopsoas is a really deep tendon that helps with both hip stabilization and rotation

Tendonitis just means it's inflamed basically

With EDS, our tendons work harder to help compensate for lax ligaments

So tendonitis is also super common with EDS

physio-pedia.com/Iliopsoas

I don't know how common this is

But the physical exam that's supposed to show a possible torn labrum doesn't register as painful for me 🫠

I don't know if I'm just acclimated to the pain or if it's a hypermobility thing

https://twitter.com/UntoNuggan/status/1626627576738226178?t=x5jipoFqYvmVB_bkvnxPyQ&s=19

This is part of why my physiatrist and I were both really surprised when imaging showed that I have a torn hip labrum

Because the textbook exam for a torn hip labrum seemed to rule it out

Diagnostic imaging for a torn hip labrum typically involves an MRI, because cartilage is soft tissue and doesn't show up on x-ray

I have looked at my imaging and it really looks like a tiny grey smudge

There's a special MRI where they inject contrast into the joint

Which sometimes shows a torn hip labrum if it doesn't show up on a regular MRI

These tests are obviously expensive and some insurance companies/national health services are reluctant to pay for them

Love this for us

Here's some information on imaging and labral tears

radiopaedia.org/articles/aceta…

What does a torn hip labrum feel like?

Well I don't seem to match the typical presentation, so I don't know if my symptoms are necessarily common?

But I'll try to share what it feels like for me

1. I can't sit on hard surfaces anymore. Like, even a toilet seat is pushing it sometimes.

I have a memory foam cushion and basically I put it on top of whatever I'm going to sit on

I even have one for medical appointments, because otherwise I'm in pain for days

2. The pain isn't constant for me. It tends to flare whenever I do too many "forbidden movements"

Unsurprisingly, these all involve rotating my hip in its socket (which the labrum is supposed to help protect):

Stairs
Swinging my leg forward when walking
Single leg raises

Bending forward at the waist is also a big pain trigger for my poor torn cartilage in my hip

Some common triggers for me include:

putting cat bowl on the ground

getting something from the lower rack of the dishwasher or a low shelf

getting something from the washer/dryer

4. I have a couple work arounds for these types of activities, including:

Stair lift

Sliding my leg behind me when I bend forward so my hip doesn't have to bend very much

Grabber tools

Sitting when loading the washing machine or dryer

5. Standing is also a pretty big trigger for my hip pain

I have reconfigured my kitchen so that I can mostly cook sitting down, because otherwise I am often in pain for days from stuff like "rinsing one dish at the sink" or "using the stove"

Taking a break, I'll be back

6. According to a specialist I saw, in folks with EDS the hip labrum often helps stabilize the entire pelvis

...And the pelvis helps stabilize the spine

This means labral tears are more common in EDS, and they can cause more complications/symptoms

This part is more personal anecdata than hard science, but in the past the thing that has helped my neck pain and associated doom headaches most has been doing exercises to help stabilize my core

(Which I currently can't do, because exercise intolerance)

I am seriously wondering if my torn hip labrum is contributing to all my SI joint issues and cervical spine problems and doom headaches

The specialist I saw mentioned this is something he's seen in other folks with EDS

Possibly relevant for others with #CCI or #MEspine?

7. Again according to the specialist I saw (and also my own reading), there are not very many treatments available for a torn hip labrum.

Options are:

a. do nothing
b. PT to build core strength and help stabilize the pelvis
...

c. a one time cortisone injection to help reduce pain so it's easier to do PT to stabilize the core

(repeated injections can potentially cause joint degeneration)

d. arthroscopic surgery to repair the tear

any surgery is risky, and especially so with EDS

e. Hip replacement

see above about surgical risks, plus hip replacements usually need to be replaced again every decade or so IIRC

(I'm also pretty convinced my mast cells would freak out about any kind of permanent "foreign object" in my body, but this is just a hunch)

Cartilage doesn't repair itself, so there's no way for the body to fix this problem solo

That being said, there's a lot of debate in medical journals about whether surgical repair is helpful/necessary, and I think it really depends on the individual

f. I have seen some people mention prolotherapy for this. Prolotherapy is basically where they inject something to trigger your immune system in a specific joint, so that your body makes scar tissue to stabilize the joint

It's still a relatively new treatment and being tested

This means a few things:

We don't have data about the long term outcomes or complications from prolotherapy

Insurance doesn't pay for it

In the US, it's available as self pay for $600-$1k+ per injection (usually six injections minimum per joint)

I don't know about prolotherapy outside the US, either costs or availability

I for one have an overactive immune system, so I'm not sure if intentionally triggering inflammation inside one of my joints is a good plan. (Again: limited data available)

8. What does a torn hip labrum feel like?

So pain is pretty individual, but I'll try to describe what it's like for me (in addition to all the things that are hard because of this, outlined above).

My pain fluctuates a lot, probably due to inflammation or something? Idk

On a good day, I'm always aware of my hip and there's always a sort of deep ache no matter what position I'm in

But it's ignorable enough that I can easily push myself too hard by doing things like "taking long strides when I walk" or not using my rollator or something

On a moderate day, I have very limited mobility. I typically hobble to my daytime nest of pillows, wrap my pelvis in a heated blanket, and prop my joints up with a lot of pillows.

If I'm careful, I can ignore the pain enough to concentrate on other things like audiobooks

I usually need assistance with things like getting food, bathing, getting water, etc

I can walk for short distances with my rollator, but there's a limited number of times I can do this. So I really have to plan every trip to the bathroom etc

On a bad day... it's bad. I can't really rate it against all the other chronic pain I deal with and tell you what's worse?

But bad days I can't really distract myself from the pain. Getting to the bathroom at all is hard, and I often need assistance

Especially because on bad days my hip does this thing where it kind of locks up or just kind of catches on the tear or something?

So basically I end up kind of dragging my leg behind me, or not moving my hip with the tear and majorly overcompensating with the other side

Typically by kind of standing on my tip toes so I can move forward without moving my right hip, and only stepping forward with my left side (the more cooperative side)

Also sometimes I don't have the physical strength for this, so I will get stuck halfway across a room and have to sit or lie down

Times I have dragged myself back from the bathroom using mostly my upper body and gasping from pain: more than zero

Do not recommend

An important point to note here is that I don't actually know when I tore my hip labrum

I've had chronic hip pain and SI joint issues for over a decade at this point, and I only *just* got an MRI of my hip

The pain and mobility issues have definitely gotten worse over time

And ironically, I knew that labral tears were a thing...I just thought I couldn't possibly have one because my pain wasn't "that bad"

Not realizing I should maybe be looking at the pain on painsomnia nights, not like...days when I'm more mobile

So it's entirely possible I have had a torn hip labrum for awhile, but it was mostly manageable when I was able to do the kind of physical therapy that helps stabilize your pelvis

And once that was not a thing (yay exercise intolerance 🫠), it "suddenly" got a lot worse

Regarding the painsomnia, it's the same general flavor of painsomnia I've had for years

(Although it was definitely worse before I got my adenomyosis diagnosed and evicted)

Basically I'm a side sleeper, which is...hard when your pelvis is wobbly

Usually I can support my joints with a lot of pillows and it's fine

But on bad pain nights, I have to lay on my back with my legs propped on one million pillows and use a heating pad for relief

Personally when I sleep on my back, I end up with a lot of nerve pain down my arms and also it aggravates all the problems in my cervical spine

So it's usually a recipe for a really bad headache in the morning

But when the hip pain is bad, it's the only way I can sleep

9. If you're

hypermobile

have a connective tissue disorder, including EDS

and/or

have post-viral connective tissue problems

then you're probably higher risk for something like a torn hip labrum

which might also show up as low back/SI joint pain

#NEISvoid

Obviously not trying to diagnose anyone and I am not a doctor etc

Also again, I can't even promise there are a ton of treatments or that it's easy to get diagnosed

There are other things that can cause hip pain and similar symptoms

/Disclaimer

But it's probably a good idea to be aware that a torn hip labrum is a possibility and what that might look like

Because, again, there tends to be a long diagnostic delay with labral tears

Here's another resource about what a torn hip labrum looks like on an MRI

(although again, it often requires a special MRI with contrast injected into the joint to show up on imaging)

I know wading through videos is tiring, so here's what mine looks like

It's on the sagittal view of the MRI (this refers to the angle they take the images from)

The circle in this image is my femur, and again that weird little smudge inside the light blue box is the tear

I think the colors regarding what is what are different in MRIs depending on if there's contrast, and what weight magnets they use (T1, T2, etc)

I'm usually pretty good with reading MRIs once I know what I'm looking for, but tbh this just looks like a smudge to me lol