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Undiagnosed Hip Problem Causes Needless Suffering

Patient, a Physical Therapist, Does Own Detective Work to Get Accurate Diagnosis

(New York, N.Y. April 2003.) A difficult-to-diagnose hip problem is causing pain and limiting the activities of many people who go from doctor to doctor seeking relief.

The hip problem, called a labral tear, can be compared to a torn cartilage in the knee. Left untreated, a labral tear can cause the joint to deteriorate. Patients often develop arthritis and may eventually need a hip replacement, according to Dr. Geoffrey Westrich, an orthopedic surgeon at the Hospital for Special Surgery in Manhattan.

Peter Schultz, a 27-year-old physical therapist from Queens, had pain in his hip for two years before he finally got to the bottom of it. But he had to do his own detective work. He had seen two orthopedic surgeons who had no idea he had a labral tear and offered little help. But the pain got worse, especially when Peter engaged in athletic activities or even sat for long periods of time. He had limited range of motion and also felt a sharp pinching pain when he moved his hip a certain way.

Peter, who as a physical therapist has a good understanding of orthopedic injuries, their treatment and rehabilitation, finally decided to do his own research. He took to the internet to investigate hip arthroscopy -- an operation that entails the use of a tiny video camera and very small incisions. He collected articles from major medical journals about hip problems along the way. Peter found that although knee arthroscopy is run of the mill, relatively few doctors perform minimally invasive surgery on the hip. In his internet search, though, he came across Dr. Westrich.

After a thorough physical exam, Dr. Westrich ordered an MRI and found the cause of Peter's pain -- a labral tear. "I've seen patients who've had the problem for so long that what starts out as an occasional pain becomes almost constant torment. Even simple activities, such as getting out of a car, become extremely difficult," says Dr. Westrich,who specializes in hip and knee problems.

The labrum is a ring of cartilage that lines the rim of bones in the hip joint. Like a gasket, the labrum serves to cushion the joint. If it tears, often the result of an injury, it can cause pain, catching or locking in the joint, and limited motion for many patients. Peter's pain was in the front and back of his hip. Some patients also feel the discomfort in the inner hip area.

"This type of hip pain, along with catching or locking in the joint, are common symptoms of a labral tear, but many diagnostic imaging tests -- and physicians -- fail to pick up the problem" says Dr. Westrich. At the Hospital for Special Surgery, exceptionally high-resolution magnetic resonance imaging tests can pinpoint the exact location of the torn labrum.

Relieved to finally find out what was causing his pain, Peter decided to have surgery to repair the tear about two weeks ago. Since Dr. Westrich performed the procedure arthroscopically, Peter was able to leave the hospital the same day he had the operation. Minimally invasive surgery allows for a shorter hospital stay, faster recovery and less discomfort than the standard open operation.

Dr. Westrich says anyone experiencing hip pain should make sure it is properly diagnosed and treated. Labral tears often go undiagnosed for years and may lead to arthritis.

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