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Suggest treatment for severe pain due to twisted left leg and hip

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Posted on Tue, 24 Mar 2015
Question: Hi, my left leg and hip was violently twisted resulting in sever pain. I could not stand unless leg was extended horizontally and used inside of foot to place weight on. In that position, the side of my hip made a big, V-like hole into my hip. Upon standing, there was a deep dent/space on the normally curved part of hip...I could insert my hand (making a deeper V) and place entire hand over the thigh bone (greater trochanter). I texted pics to friend who was xray tech and she said hip looked partially dislocated & symptoms match. When I layed down with feet together, the greater trochanter was protruding outward right below where the dent/hole was in curve part. After a snap, crackle, pop and unnatural tugging/pulling feeling with slight painful pinch my leg straightened and I could stand. The dent was almost closed up but there was a slight V dent and on either side the muscles were puffy. I still went to ER to get checked - xray showed my hip fine. But they had no explaination for what made hip muscles/tendons part. Another dr ordered MRI to check for labrum tear. That Dr said I didn't have a hip that could dislocate but he couldn't explain why my hip muscles parted like the red sea. MRI showed there was small cyst suggesting tear but whoever read MRI said outer hip unremarkable. ??? I could hardly walk and was in severe pain and visually and physically you could see something was wrong with outer tissues. My chiro looked at MRI and said the whole hip on fire and severe tendonitis in all surrounding tissues. My chiro told me go see another ortho because your hip has trauma. Every Dr is not hearing me that I still haven't been examined or evaluated. They think because one DR ordered MRI that I must have been. That Dr never followed up with me nor does he take my insurance so I can't afford to see him privately. It has been a long 10 months since injury... sever pain, crutches and couldn't walk...then severe pain & hobbling....etc etc... and now I can walk with slight pain. Over use causes pain. I still can't lay on left side. Sitting and driving painful causing a burning sensation across hip in area the dent was made. And I can't cross my leg or even bend joint or bring knee to chest without pain (eg: bending to put on shoes, sitting, etc). My symptoms match partial dislocation and tendon/muscle ruptures/tears. Help! Last DR NEVER examined me! Took one look at me and said I was attractive, slender and appear in good physical shape so obviously I must be able to work out! What? Just because I look good in yoga pants doesn't mean I exercise and my flabby butt and thighs would disagree! He thought I'm a hypochondriac because MRI shows tiny tear and that doesn't cause pain. Exactly, it's not my labrum. Nobody will address the deformity, dent, bulges and pain in outer hip. So if it wasn't dislocated, then what happened to muscles and tendons in hip and why didn't the visual damage show on MRI? And Radiologist only instructed to check for labral tear so he/she may have overlooked outer hip fast forwarding to views of labrum. HELP. My hip hurts and not better yet. Also, I was born with congenital subluxation of left hip. Hip socket formed but I have permanent impingement in that the dr's told me 1 or more of my ligaments didn't grow and are short. Hence, my whole life I am not allowed to do sports, bike ride, run, or breaststroke kick and no lengthy walking or sitting because aggravates hip. Hip "seizes/locks" from those short ligaments cramping or getting inflamed from excessive use. I also have malicious malalignment syndrome and knock knee's, high patella, and loose knee caps and tracking problems.
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Answered by Dr. Praveen Tayal (2 hours later)
Brief Answer:
Needs a direct examination.

Detailed Answer:
Hello,
Thanks for posting your query.
From your symptoms and the images attached it seems to be a partial dislocation of the hip. But this should have shown on an MRI scan. The swelling and pain could be due to inflammation that can improve with rest and pain killers.
This needs a direct clinical examination to detect the range of movement. Physiotherapy exercises and hot compress can help in improvement since it is a long standing pain. A second opinion from another orthopedician and a repeat MRI scan will help.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Praveen Tayal (2 days later)
Thank you. However, finding an ortho to listen to me and consider the possibility that the MRI was not read correctly and a huge oversight on the outer hip tissues was made, has been impossible.

The ER, all xray tech's, nurses, physician assistants, Physical therapists, chiropractors, and even the people registering me at every dr appointment and now you, all agree that my hip was partially dislocated and my muscles/tendons incurred injury too (sprains, strains, tears and/or ruptures).

The Dr who ordered MRI only instructed to look for labrum tear and it was MRI without contrast. MRI confirmed possibility of tear because cyst at labrum and outer tissues normal. Does an MRI without contrast also show soft tissues on outside of hip and any tears, ruptures or severe inflammation (tendonitis)? If so, then obvioiusly whoever read my MRI made a serious oversight because it's obvious from pictures and physical exam I incurred damage to outer hip. I can't upload MRI for your review, and assuming it was misread, then if I were to get that MRI correctly reread and analyzed for second opinion it would definitely show damages in outer hip? And if that MRI would have shown damage and it was misread, then how much damage have continued to incurr from lack of treatment? Dr told me take advil and my hip be fine in few weeks (because he thought just that tiny tear on labrum).

Or was the wrong test ordered and my outer hip needed MRI w contrast to view damage to soft tissues? If so, then that explains why Dr's think I just have tiny tear to labrum and think I'm being a hypochondriac!

It's been 10 months since hip injury and the outer hip damage has never been addressed! I've erred on side of caution but I had to live life. I delayed knee physical therapy but proceeded in spite of hip pain. Hip injury made physical therapy difficult to do because most the exercises involve hip strengthening. As a result, knee therapy took months to do instead of few weeks. Total waste of time because still can't do exercises without hip getting severely inflammed and then have to suspend any activity until pain subsides. I'm just in vicious cycle --do a little and then have to stop because hip inflammed and then regress a little and start over when hip better. My knee's still need more strengthening but until hip can handle it's slow progress.

Is there way to send you my MRI? I'm just so worried that this misdiagnosis has incurred more damage to my hip! dislocations cause damage and my muscles and tendons were injured.....I never had proper treatment so I don't know if I should of had hip brace and used crutches for period of time, or did I need surgical repair or medications or injections in hip and therapies to help it heal.

Thank you for your time (and listening). I'm tired of being in pain and knowing something not right in hip
doctor
Answered by Dr. Praveen Tayal (4 hours later)
Brief Answer:
Repeat MRI scan with contrast is needed.

Detailed Answer:
Hello.
Thanks for writing again.
MRI scan without a contrast can also detect the tear or inflammation or tendonitis. A review of MRI films from another radiologist can be helpful. Even if some injury was there, there is not likely to be a complete tear. All the partial tears are likely to heal in few weeks if proper rest is provided.
It is best to get a fresh MRI scan done with contrast to find out the present situation of the hip. Do mention about your detailed history to your radiologist too.
Till then using a hip brace and rest can help. Only a complete tear needs a surgical repair which is less likely in your case.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.
Above answer was peer-reviewed by : Dr. Raju A.T
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Dr. Praveen Tayal

Orthopaedic Surgeon

Practicing since :1994

Answered : 12140 Questions

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Suggest treatment for severe pain due to twisted left leg and hip

Brief Answer: Needs a direct examination. Detailed Answer: Hello, Thanks for posting your query. From your symptoms and the images attached it seems to be a partial dislocation of the hip. But this should have shown on an MRI scan. The swelling and pain could be due to inflammation that can improve with rest and pain killers. This needs a direct clinical examination to detect the range of movement. Physiotherapy exercises and hot compress can help in improvement since it is a long standing pain. A second opinion from another orthopedician and a repeat MRI scan will help. I hope this answers your query. In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out. Wishing you good health. Regards. Dr. Praveen Tayal. For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal