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4 years of hip/groin pain. Help!
I will try to make this short. I am a 37 year old man. I had pain in the front and back of my left hip during exercise that gradually came on 4 years ago. It kept getting worse to where I would get aching on both sides of the hip after sitting for more than an hour or so. Leaning forward made it even worse. Standing for more than 30 minutes or so would cause aching. Running/hiking for more than 15 minutes would hurt so I had to stop doing that. A general surgeon said he thought I had a small, inguinal hernia which he could repair and “see if that worked”. An MRI showed something that could have been small, bilateral fat filled hernias, but ultrasound showed nothing. I had an MRI of my hip joint that showed a small labral tear, so I had labrum surgery. That did not work. I had a second labrum surgery (releasing psoas tendon that time), also did not work. Now I still have pain and weaker hip flexion, though the ortho surgeon says my labrum looks fairly good.
I just went to another general surgeon a few weeks ago who palpated and said I had a small hernia on the left, and possibly the right too. I got a repeat MRI which the radiologist said was unremarkable, no hernia. No other significant findings. So, I don’t know if I really have a hernia or not. I’m not sure what to do now, I am in constant pain and it is greatly affecting my life in a negative way. Should I proceed with a hernia surgery and hope for the best? I also still have pain in the back of the hip, which is probably not related to the possible hernia. It might be bursitis/tendonosis, and is a separate issue. I’m also starting to feel an occasional twinge in the front of the right hip as well. Would that make sense I’m starting to get a right hip/hernia problem now if I really did have a small hernia? I”m getting a third opinion from another surgeon next week. I don’t know what to do, I can’t even walk a mile or even sit in a chair without pain. I’ve tried PT, acupuncture, chiropractor, labrum surgery, etc. to no avail. I used to be very athletic, ran a half marathon, played basketball, did boot camp workouts, etc. Now all I can pretty much do is yoga.
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18 Replies
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4 years of hip/groin pain. Help!
Thanks for the update, and best of luck.
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4 years of hip/groin pain. Help!
Hi guys,
I did end up doing the labrum surgery again about 2 months ago. Turns out the labrum had calcified somewhat after the last surgery, and I also had a bone spur forming on the edge of the acetabulum. The surgeon shave those down and then replaced that area of the labrum with a piece of my IT band. Fun stuff! I do have less pain now in the anterior portion of the hip now (though still have some), so it was probably more likely it was labrum and not a hernia. Unfortunately it hasn’t really done anything for my posterior pain, even with all the PT and massage I have been getting in the area. So I am somewhat better, but not back to normal. The surgeon isn’t quite sure why I still have pain in that area. Might try a cortisone shot right on the exact spot into the muscle/tendon on my next visit.
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4 years of hip/groin pain. Help!
Hi Wes,
Any updates? -
4 years of hip/groin pain. Help!
How did your labrum surgery go? Did it help with your pain? Any update on the possible hernia?
I don’t know if it is helpful, but there is a well-known physical therapist in Santa Monica named Holly Silvers who knows a lot about FAI, sports hernia, etc, she works with a variety of pro-sports teams and sees a lot of the injuries in athletes, could be helpful in ruling in or out some diagnosis or rehabbing afterwards http://smsmf.org/our-team/holly-silvers
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4 years of hip/groin pain. Help!
Thank you Dr. Earle and Dr. Towfigh for all your advice. I have decided to have another labrum surgery next week to see if I need it reconstructed this time, as I have seen 3 different general surgeons, all of whom can’t definitely say I even have a hernia to begin with (MRI and ultrasound don’t conclusively show one either). I also feel the pain is a little more towards the hip flexor than deep in the groin. I am hesitant to undergo surgery to put in mesh and risk making things worse if it is not even the problem to begin with. If this surgery does not work, I will circle back with Dr. Jacobsen and re-visit the hernia. I tried to get his opinion as well, but he is booked for two months.
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4 years of hip/groin pain. Help!
Try Dr Garth Jacobsen in San Diego. If he sees a hernia on laparoscopy, he will repair it.
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4 years of hip/groin pain. Help!
In San Diego, I would suggest Garth Jacobsen or Santiago Horgan at UCSD.
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4 years of hip/groin pain. Help!
Dr. Towfigh,
Thank you for your response. I have had two hip labrum repair surgeries (along with psoas tendon release) but no hernia surgeries. The surgery did not help the pain, but probably didnt’ make it worse either. Not much change. The pain has started to get worse this year though. Still have pain in the front, pretty close to where the psoas was attached, maybe slightly closer to the groin. Also have pain on the side/back, where the gluteus maximus tendon is. I have looked at the SI and lumbar spine, but nothing appears wrong there. I am kind of running out of options and ideas, which is why I am investigating the possibility of a hernia. I can’t decide if doing hernia surgery for a “maybe” , is worth the risk of making it worse. I asked this in another thread, but If you take down the peritoneum, do you have to place mesh at that point or can you stop at that time and do nothing? I was thinking maybe that was a possibility if no hernia is seen once the scope is in. Do you know of a good hernia surgeon in San Diego county by chance?
Thank you -
4 years of hip/groin pain. Help!
Wes,
Am I to understand you had hip and hernia operations with no improvement?
Did either make the pain worse?
Did they look at your sacroiliac joints to look for sacroiliitis? -
4 years of hip/groin pain. Help!
Getting a dynamic ultrasound study with valsava is pretty easy and it may be helpful, sometimes clinics also do them standing up with valsava, but I think the key thing is not just coughing but actually bearing down. That may be something worth pursuing.
Dr Chen and Dr Towfigh are both hernia experts in Los Angeles that see a lot of the challenging cases like ones you’ll find on this forum, it could be worth making an office visit with either (or both) of them.
If you have a core muscle or pelvic muscle injury that is being overlooked you could always venture across the country to Vincera Institute in Philadelphia, it’s quite a trek but they handle many pro athletes in the US.
Anyway, good luck and keep us posted.
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4 years of hip/groin pain. Help!
Hi Chaunce,
1. Neither my ultrasound or MRI were done with valsalva. The anterior pain can sometimes feel like it’s around the hip flexor, and then sometimes more towards the groin. If I end up pushing it too hard by walking a lot or a short hike, I get a dull aching pain deeper into the groin that can last a couple of days.
2. I did have lidocaine injected in my hip and ran around a bit. It seemed to reduce the pain somewhat, which is why I went ahead with the labrum surgery. But considering I have had two surgeries with no improvement, maybe the pain relief was wishful thinking?
3. I’ve had PRP in the hip joint, in the gluteal area (where I also have pain) and in the hip flexor. All with no effect. I even had stem cells put in the joint which I thought helped somewhat at first for a few months, but now the pain is the same again, so not sure if that actually did anything.
3. I live in San Diego and have seen top hip surgeons and hernia specialists in San Diego, Orange County, and LA. Unfortunately, still searching for a fix!I also have pain in the back of my hip/upper lateral thigh, which I realize is not hernia related. It’s possibly trochanteric bursitis, and/or gluteus maximus tendonosis. It’s not a burning, zapping nerve type pain, so it’s not sciatica. More of a dull, throbbing ache.
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4 years of hip/groin pain. Help!
Dr Goldstein,
This may be a silly question, but for the 80% better / 5% worse / 15% same numbers … Is that 5% worse risk basically the true chronic pain risk associated with any hernia repair? Is there anything that generally raises or lowers that risk chance?
Thank you
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4 years of hip/groin pain. Help!
wes878, can you elaborate on your symptoms? Can you pinpoint a specific pain location or is it generalized in the area?
I am merely a patient, but I do know two things: sports hernia is routinely misdiagnosed, and small inguinal hernias can go undiagnosed and are often overlooked in radiology as well. Groin issues in general can be very difficult to track down, so you want to work with someone well experienced as the wonderfully helpful doctors here have suggested.
Some thoughts, from a fellow patient …
– Was your groin ultrasound with valsava? That may be helpful for a hernia diagnosis
– Have you had nerve block injection or otherwise? Some clinics use nerve block as a diagnostic method (shoot into hip joint for checking hip pathology, etc), some clinics also use Platelet Rich Plasma (PRP) injections into soft tissue injuries with good result
– Where in the country are you located?
These resources are a bit in the thick of things with imaging studies for diagnostic purposes, but it may be helpful for both your own use and a doctor you may be working with …
http://sportsmedicineimaging.com/topics/sports-hernia/
http://sportsmedicineimaging.com/topics/pubic-instabilty/
Good luck, good health, and keep us updated on your progress and findings!
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4 years of hip/groin pain. Help!
I advise patients with exertional groin pain and no definite findings that a laparoscopic hernia repair offers about an 80% chance of improvement, a 5% chance of making things worse and a15% chance that there will be no change. I don’t know the data on hip surgery but I would recommend doing things one at a time to minimize risk and to know where the problem is if very something gets worse after surgery.
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4 years of hip/groin pain. Help!
Thanks for your response Dr. Towfigh. I saw another general surgeon yesterday. He looked at my recent MRI and said that he did not really see anything unusual. ( The MRI was not done with valsalva) On physical exam he said I could maybe have small hernias, but nothing obvious. He suggested that he could put some mesh in, even if I did not have an obvious hernia upon inflating my abdomen. He said it would cover both the inguinal area, and any possible sports hernias. He thought there was a 50/50 chance that this would give any improvement. I also have a hip surgeon that can do either a bursa removal, or a labrum reconstruction, in hopes that this could fix the issue. The surgeons could even both do their surgeries back to back, while I was under anesthesia. (They are friends) I am not sure which avenue to purse, as I don’t have any obvious hernia, nor an obvious labrum tear. Something is wrong though, as I can’t do any kind of physical activity without pain during or afterwards. I’ve had two labral repairs that have not worked, but not a labral reconstruction yet. I’m kind of leaning toward just doing everything at once in hope that something fixes the problem. Any advice? Is it a good idea to do a hernia surgey as a “maybe”? Thank you
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4 years of hip/groin pain. Help!
Thanks for your post.
Groin pain and hip pain overlap and can mimic each other with similar symptoms. Symptoms of pain with prolonged sitting, prolonged standing, bending, and any activity-related pain can be due to inguinal hernias.
It seems the MRI did diagnose fat-containing hernias and so it’s odd that subsequent studies are “normal.” These can be the cause of your pain. The story, exam, and radiologic findings need to correlate. I wonder if re-review of the films would show otherwise.
In any case, the best option is
1. have your MRI re-reviewed. I can do that as an online consultation (go to my website http://www.beverlyhillsherniacenter.com or email me).
2. if the imaging supports your symptoms, then I agree with Dr. Earle that laparoscopy is the best and least invasive option to explore your groin. If there is no hernia there, then little harm is done.Hope this is helpful.
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4 years of hip/groin pain. Help!
Thank you for the feedback Dr. Earle. I have been evaluated for a sports hernia, but nothing has been found. My pain is closer to the hips than in the middle of the pubic bone, so does not seem to be that. No weakness doing a sit up or anything either. The anterior pain is right in the hip flexor/groin area. If anyone wants to chime in on this, please feel free!
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4 years of hip/groin pain. Help!
Given what you have tried so far, a laparoscopic bilateral hernia repair is an option. I have seen small hernias cause pain. More common in women, but I have seen it in men. Could also be a core muscle injury, and there are PT exercises on YouTube you could try to see if this helps. That may be a good next step. Search for sports hernia exercises. Obviously, a more complete evaluation is better than an online forum, but this is a start. Hope this helps!
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