Suggest treatment for pain and swelling in the thigh

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Posted on Mon, 13 Feb 2017 in Bones, Muscles and Joints
Question: I am a 60 year old female that had a bad fall at work. I slipped (food on the concrete) and fell on my lower buttock, felt pelvis hit hard and heard a loud thump. Immediately I endured inflammation and swelling around my whole thigh and hip area, front and back. I could not move it at all--took to emergency by ambulance--and x-rays revealed no fractures. Weeks went on and they (Workman's comp doctors) realized that nothing they were doing were making me better (lots of pain) (PT, Heat wraps, Celebrex, Muscle relaxants, Crutches) finally ordered an MRI--here are the results. And my question is? What should come next?

"The conjoined fibers of the left hamstrings are detached from the left ischial tuberosity. This involves the lateral head of the hamstring. There is a fluid-filled gap between the tendons and the bone measuring approximately 1.6 cm with surrounding T2 hyperintense stranding, consistend with inflammation and edema. The medial head of the hamstring is still attached to the ischial tuberosity. There isno evidence of a hematoma formation. There is no evidene of an avulsion fracture of the ischial tuberosity or bone marrow edema otherwise... Impression 1) Hamstring tear involving the lateral head. The lateral head is completely detached from the ischial tuberosity with a fluid filled gap and surround soft tissue edema and inflammation. The medial head remains attached and unremarkable. There is no evidence of an avulsion fracture or bone marrow edema involving the ischial tuberosity. 2) the remainder of the exam is otherwise unremarkable as outlined above.
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Answered by Dr. Ahmed Aly Hassan 1 hour later
Brief Answer:
rehabilitation and physiotherapy with leg elevation and relaxation is very effective followed by endoscopic surgical repair in your case is the best choice .
Detailed Answer:

Hi i am Dr Ahmed Aly
thanks for using healthcaremagic site ,
I had gone through your question and understand your concerns ..

For my patients i would recommend endoscopic rather than surgical repair , but after at least 1 month post rehabilitation from injury to allow edema and inflammation to subsides completely according to the grading plan i think you are a grade 3 case.
grading outlines may help : Grade 1
Sensation of cramp or tightness and a slight feeling of pain when the muscles are stretched or contracted.[citation needed]
Grade 2
With a grade two hamstring strain there is immediate pain which is more severe than the pain of a grade one injury. It is confirmed by pain on stretch, swelling and contraction of the muscle.
Grade 3
Bruising due to strained hamstring, horizontal lines show where bandage was.

A grade three hamstring strain is a severe injury. There is an immediate burning or stabbing pain and the individual is unable to walk without pain. The muscle is completely torn and there may be a large lump of muscle tissue above a depression where the tear is.
After a few days with grade two and three injuries a large bruise may appear below the injury site caused by the bleeding within the tissues.
Treatment
Recommended treatment for this injury consists of the RICE protocol — rest, ice, compression and elevation. RICE is used to reduce bleeding and damage within the muscle tissue. Lower grade strains can easily become worse if the hamstring is not rested properly. Complete ruptures require surgical repair and rehabilitation.
Initial treatment of the injury, regardless of the severity of the strain, is the same. Within the first five days, the hamstring is rested in an elevated position with an ice pack applied for twenty minutes every two hours. A compression bandage is applied to limit bleeding and swelling in the tissues. After five days of rest, active rehabilitation begins
endoscopic surgeries leave minor skin marks and have proven good results nowadays .

Please click THANK YOU and consider a 5 star rating with some positive feedback if the information was helpful. Hope the above information helps you,
Any further clarifications feel free to ask.
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Ahmed Aly Hassan 1 hour later
Thank you so much. This clears up some confusion. My only question now is why would the doctors not recognize the initial problem." There is an immediate burning or stabbing pain and the individual is unable to walk without pain. The muscle is completely torn and there may be a large lump of muscle tissue above a depression where the tear is." These were my exact symptoms on December 7, 2016; I have been in a great deal of pain ever since. Why wait so long to do an MRI to see what is happening. I can't dwell on that--and only look forward.

My next questions are: Literature states that the surgery should happen almost immediately following the injury. (1) Is the time lapse going to make the surgery more difficult, and (2) Do all Orthopedic Surgeons do endoscopic in lieu of full surgery? (3) Do you recommend any Ortho Surgeons in the Orange County, CA, USA area that are reputable and will take Workman's Compensation? (I know this is a far fetched question...just in case you might know and can share that information. I'm not too convinced that the Doctor's my employer had me go to are the best.
doctor
Answered by Dr. Ahmed Aly Hassan 19 minutes later
Brief Answer:
MRI scans will be more accurate showing each tissue structure site after inflammation subsides and provides proper evaluation of the management plans for such a case .

Detailed Answer:
Hi i am Dr Ahmed Aly
thanks for using healthcaremagic site ,
I had gone through your question and understand your concerns ..

For my patients i recommend :( answers to your query )

( 1 ) That only happens mainly with open fractures or stiff joint dislocations or when there is bone injury that requires open reduction and fixation . So , No it will make the operation easier in my opinion.
( 2 ) Not all orthopedics are experts with endoscopic interventions especially in the ischeal hip bone which is a sub specialty within orthopedics .
( 3 )In my opinion you may choose the academic orthopedics within your nearest orthopedic university where you can find an orthopedic specialized within hip joints as academic doctors have seen a higher variety of cases within endoscopic interventions and pre to post operative complications and preparations .I think they are more experienced than others .

Please click THANK YOU and consider a 5 star rating with some positive feedback if the information was helpful. Hope the above information helps you,
Any further clarifications feel free to ask.
Above answer was peer-reviewed by : Dr. Nagamani Ng
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Answered by
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Dr. Ahmed Aly Hassan

Orthopaedic Surgeon

Practicing since :2002

Answered : 441 Questions

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