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Female triathlete with groin pain following 2 hip labrum repairs & FAI
Hi Dr. Towfigh and others,
I am a female (age 29) with potential sports hernia/athletic pubalgia issues seeking some guidance and expertise. I am an endurance triathlete who recently underwent two hip labrum repairs and FAI (left hip in Sept 2017 and right hip in Nov 2017). My recovery was going well and as planned until February 2018 when I began experiencing left pubic bone pain and lateral/outer hip pain. Shorty thereafter, the pain turned from muscular/skeletal pain (which was painful yet tolerable) to include nerve pain. At this point, everything seemed to spiral. I now regularly experience “flare ups” with pain starting in my left labia/pubic area, blossoming to my inner and upper thigh, up to my mid abdominals, around my belly button, and outer/lateral hip (all left side). Sometimes it comes with back pain too. The pain feels like it’s radiating, at times with sporadic electric “shocks”, and with some numbness (especially just below my illiac crest). It is unlike any muscular/skeletal pain that I’’ve ever felt before and I can barely tolerate it. I also have regular muscle spasms with it in my thigh, groin, abdominal area. It knocks me off my feet and takes 48 hours+ for me to recover from, until the cycle starts again. It normally comes on after a more “strenuous” day (such as when I walk a mile (which is now considered a long distance for me) or when I bike for 10 minutes just to keep my joints moving or when I do leg press with almost no weight a PT just to keep some muscles moving). I’ve been almost completely sedentary for 5+ months. Since February, I have been unable to partake in all physical activities and require assistance for routine activities such as lifting pots and pans too cook, carrying a light suitcase, etc. After months of trying to understand it, I think some of it is nerve pain.
In terms of test and diagnosis – I have seen several orthopedic hip specialists and surgeons as well as general surgeons, a rheumatoid specialist (who confirmed no rheumatoid issues), and pain management specialists. I have had two pelvic MRIs (one that included a few images of my upper abdomen), a left hip MRI, a lower lumbar MRI, and a CT scan (with my left and right hips read). I have also had multiple nerve blocks into my hip joint, psoas, genitofemoral nerve and ilioinguinal nerve. All have provided some relief but not full.
My MRIs show possibility of a very small re-tear of my left labrum or perhaps just abnormalities from the original surgery – it’s unclear and I have received differing opinions from multiple hip specialists. Otherwise, my joint seems normal and in good shape. I have been diagnosed by a general surgeon with a likely hidden inguinal hernia. I have received mixed diagnosis on athletic pubalgia/sports hernia and/or perhaps mild chronic detachment of the rectus abdominus-adductor plate at the lateral edges.
I lived and was very active with labrum tears for years and so I am relatively confident my pain is not coming from a possible small retear. I do however have some swelling, numbness, and burning/tingling feeling (with certain movements) in my lateral/front hip and upper/outer thigh though which is perplexing. Touching my left pubic bone is also tender. I still have some outer hip muscular/tissue pain as well which I didn’t think was consistent with an inguinial hernia but not certain. And then of course the nerve pain starts in my pubic area and quickly radiates as described above. I am really struggling to figure this out and fearful of going into surgery again without some clarity.
I welcome any thoughts and feedback on this as it’s been incredibly debilitating. I promise to pay it forward!
Much appreciated!
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2 Replies
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I’m sorry you’re going through this. Based on your history and descriptions, I would strongly recommend reaching out to an expert in athletic pubalgia and groin/pelvic sports injuries.
Vincera Institute in Philadelphia is considered one of the best groin/pelvic/abdominal/core injury clinics in the USA if not the world and they handle many pro and amateur athlete cases.
– Dr William Meyers at the Vincera Institute in Philadelphia PA
– Dr Alexander Poor at Vincera Institute in Philadelphia PA
Other well known resources are:
– Dr William Brown in Fremont CA
– Dr Ulrike Muschaweck in Munich Germany / London UK
There’s a thread in the main forum about sports hernias with additional resources, surgeon names, etc.
Good luck and keep us updated on your case!
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quote emckenna:I am an endurance triathlete who recently underwent two hip labrum repairs and FAI (left hip in Sept 2017 and right hip in Nov 2017). I had great recovery for both until February 2018 when I began experiencing left pubic bone pain and lateral/outer hip pain. Shorty thereafter, the pain turned from muscular/skeletal pain (which was painful yet tolerable) to include nerve pain. At this point, everything seemed to spiral.
Since February, I have been unable to partake in all physical activities and require assistance for routine activities such as lift pots and pans too cook, carrying a light suitcase, etc. After months of trying to understand it, I think it is nerve pain.
In terms of test and diagnosis – I have seen several orthopedic hip specialists and surgeons as well as general surgeons, a rheumatoid specialist (who confirmed no rheumatoid issues), and pain management specialists. I have had two pelvic MRIs (one that included a few images of my upper abdomen), a left hip MRI, a lower lumbar MRI, and a CT scan (with my left and right hips read). I have also had multiple nerve blocks into my hip joint, psoas, genitofemoral nerve and ilioinguinal nerve. All have provided some relief but not full.
My MRIs show possibility of a very small re-tear of my left labrum or perhaps just abnormalities from the original surgery –
I have been diagnosed by a general surgeon with a likely hidden inguinal hernia. I have received mixed diagnosis on athletic pubalgia/sports hernia and/or perhaps mild chronic detachment of the rectus abdominus-adductor plate at the lateral edges.
I lived and was very active with labrum tears for years and so I am relatively confident my pain is not coming from a possible small retear. I do however have some swelling, numbness, and burning/tingling feeling (with certain movements) in my lateral/front hip and upper/outer thigh though which is perplexing
Hello emckenna. I don’t have any direct advice but I did have some questions while reading your post, that others might have also. I broke your post in to pieces to try to make it more clear.
Your last surgery was about 6 months ago? You “recovered” then were okay for about 2 – 3 months. Then started having pain which has lasted about 2 – 3 months. So, it’s been a relatively short time since surgery.
How long did you wait before going back to full effort activities? Your “recovery” time. Did you feel like you were completely healed up or were you training around the healing process?
Did the pain in February come on “overnight” or did it slowly build as you ramped up activity level? Are you taking full rest and recovery breaks or are you testing things as soon as you can? Maybe you need to take more rest and start from a lower base. I know that athletes hate to lose their fitness and will often try to shorten recovery times.
Did you talk to the surgeon who did the original surgeries?
I’m not a doctor but I think that swelling is caused by some sort of physical damage. I’m not sure that nerve irritation alone will cause swelling. So, the swelling seems to show that some sort of physical damage is occurring. Even if nerve irritation alone will cause swelling, it seems like the physical manifestation of the pain is a good area to focus on.
Good luck. I’m trying to work back to higher fitness myself, and figuring out what is happening in the surgery area is very difficult.
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