Diagnosis FAI w/labral tear

My symptoms began about 10 months ago and I've had everything from a CT scan to an ultrasound to a regular pelvic MRI. All came back completely normal. It wasn't until I met with Dr. Fitch at Vanderbilt here in Nashville (where I live) about 4 months ago that he mentioned that a labral tear may be a cause of my pain (bone grindingly brutal centered in the hip, right at the bikini line, low back pain, buttock pain, thigh pain/swelling). So we started some rehab and specific core strengthening exercises because he thought it was more likely a severe muscle tear (and possible sports hernia). That made things better for about 3 weeks, and then dramatically worse. Worse to the point that I couldn't even stand up long enough to make dinner let alone run or exercise in any fashion. At that point, I got back with him and he ordered an MRI - Arthrogram (contrast dye). He did offer to have the test before rehab, but after discussing with him the procedure of the test, I decided to wait. Anyway, the arthrogram was bad. They numb your upper thigh right below the bikini line and then stick this gigantic needle into the joint space to inject the dye.

1. Ask for an Arthrogram. Outside of arthroscopic surgery, it's the most accurate diagnostic test for this condition. Some docs say CT scans are also necessary, but from the research I've done (a lot) they don't seem to show much of a diagnosis, but may help the surgeon in reshaping the femoral head or the acetabulum.
2. When you have the arthrogram, ask politely for some sedation unless you have a high pain tolerance; actually ask for it anyway because you'll have to lie perfectly still for about 30-45 minutes until the radiologist gets the images he/she requires. Also, ask for a lortab afterwords, I was very sore for 2-3 days.
3. Don't wait! Get the best doctor you can find and get a consultation scheduled as soon as possible. Dr. Fitch at Vanderbilt referred me to Dr. Thomas Byrd at Nashville Sports Medicine and Orthopedic Clinic (NSMOC) - he is also one of the best in the country outside of the doctors mentioned above and a gentleman in Boulder, CO. Anyway, his schedule was full until January, that's why I recommend getting a specialist's appointment asap. They usually have waiting lists for cancellations so be assertive and get on that (I did that with Dr. Byrd and fortunately got an appt for Tuesday the 17th).

I've not had surgery yet, but I can tell you that Dr. Fitch was very clear that hip/groin pain is very very difficult to diagnose, and most people with FAI and/or labral tears go for years without a concrete diagnosis. Mine was acute enough to generate severe pain which put me into the doctor immediately.

If you want more information a lady named Vanessa started a blog detailing her journey through surgery at http://www.understandingfai.com. I've e-mailed her a few times as Dr. Byrd operated on her and she had nothing but great things to say about him and his staff. Read her blog, that's what made me feel comfortable with the surgery (I mean, come on man, they're reshaping bone here, it's not good!) and recovery/rehab process.

My name is Sam Ferrise and I'm a 27 year old male who used to be (about 10 months ago) a casual runner of around 30 miles per week. I used to run around 80-90 per week during high school and my first year of college for cross country training.

By the way, some posts above mentioned the cause of FAI. To this day the exact cause is unknown, but some doctors have found a correlation (not causation) with heavy training before the skeletal system has been fully developed. Primarily they think one may be genetically predisposed to it and heavy training may cause the bones to shape funny (in my case I have Cam Impingement - significant according to the radiologist and essentially my femoral head is oval shaped, not round; others may have the same type of impingement, but there may be a small bump on the bone which is most likely congenital and not caused by training).

Sorry for writing a book, but if I can help one person not spend the thousands of dollars I have and see the 7 different doctors in 3 different cities until I ended up with Dr. Fitch at Vanderbilt, it's worth it.

Also, if your pain is bad and it limits you, insist the doctor give you something for it. I was not assertive enough in the beginning and had excruciating pain that would bring me to my knees for the first 7 months of this ordeal. Don't go to a GP or an urgent care facility, get in to a specialist and be very clear how bad the pain is, what it feels like and what it limits your activity to. At the end of the day, only you know what's right for you and your body, not the doctor. They can be wrong so if you don't think you are receiving adequate care, find the best of the best and get an appointment.

Erin (intake coordinator) from Dr. Byrd's office has been so nice to me even though I've probably been rude to her due to my frustration level about waiting for so many months before seeing the surgeon, let alone scheduling surgery.

Please feel free to e-mail me if you want - my appointment with Dr. Byrd is on Tuesday the 17th and I can ask him who may be best for you to see given your locale.

Sam Ferrise
sam@ferrise.net