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Hips Don't Lie; Neither Do Radiologists


On this blog, we frequently write about what it’s like to work for — or experience life at — Penn Medicine. What we don’t get the chance to write about very often is what it’s like to see the University of Pennsylvania Health System from the other side: as a patient, just trying to figure out what’s wrong and get better. Fortunately (well, not ‘fortunately,’ per se, but you get the idea), I’ve now got one such story to relate. It’s ongoing, so this is the first of what I’m hoping will only be two parts.

Prologue (or: Five Years of Bad Decisions)

It’s winter, five years ago. I’m doing some weightlifting, putting in time at the squat rack when I notice a sharp but relatively mild pain on the outside of my left hip. I don’t think much of it, since squats engage your hips quite a bit and I’m pushing myself. The pain goes away by the end of the night.

It then returns and recedes repeatedly over the next four-and-a-half years. Sometimes there are months between recurrences. Sometimes it sticks around for a few days, sometimes it’s gone within seconds. I make a mental note of it each time, but it’s consistently mild and brief enough for me to not bother getting it checked out.

Six months ago, I’m running on a treadmill when I notice the pain is back again. It’s mild, like before, but this time it doesn’t go away. In fact, it sticks around for the better part of a week, despite my taking it easy. It starts bothering me outside of exercise, too. Sitting too long? Hip starts to hurt. Standing too long? Hip starts to hurt.

It “catches” a few times, which is a bizarre and difficult-to-describe sort of feeling. Imagine cracking your knuckles. You know how there’s that one moment mid-crack where you feel a ton of tension or stiffness in the joint and know it’s a millisecond away from popping? Now imagine that on a much larger scale, except in your hip. And when it finally releases, you aren’t left with a satisfyingly loose knuckle, you’re left with a mild tingling in and around the entire hip joint — as well as the unease of knowing something down there, to use a technical term, just ain’t right.

Two months ago, I make an appointment to see an orthopaedic physician here at Penn Medicine. (An aside: It's a Penn Medicine convention to spell it 'orthopaedic,' not 'orthopedic.' This, I believe, is in reverence to the health system's founding, 250 years ago in Ye Olden Times O' Wizards and Shopkeeps. It's also how they spell it in Europe — but alas, I repeat myself.) They schedule me for mid-December — which is a few days earlier than the initial appointment date, actually, because the specialist they originally scheduled me for can’t take me on as a patient.

“You’re twenty-nine,” I’m told as they’re finding me another physician, “that’s too young.”

I’m inclined to agree.

First Appointment (or: But that’s a Problem for Old Guys)

Waiting five years to get hip pain checked out is a big enough error on my part, but it’s made particularly bad by my history with orthopaedics. Before landing here at Penn Medicine, I wrote news and covered conferences within the orthopaedic field. I was able to coherently explain to my fiancé what was likely (but hopefully not) going on — the femoral head was doing all sorts of terrible things to the acetabular labrum, which is the cartilage rim that protects the socket from the ball (and vice versa) in the ball-and-socket joint that is the hip — but unwilling to do anything about it.

“Maybe it’ll go away,” Past Rob kept thinking to himself.

Past Rob was kind of a moron, Present Rob thinks to himself while waiting to be brought in for a simple hip X-ray at Penn Medicine University City.

It’s uneventful, with two exceptions: One, I find out that I look pretty good in the nifty wraparound gowns they give patients going in for imaging. Two, when I’m on my back under the X-ray machine and I’m asked to bring my left knee up slightly while turning my leg outward, I’m rewarded with a catching sensation and a jolt of pain to the entire hip. I let out an “oh-ho-HO,” which to my ears lands somewhere on the spectrum between ‘a noise of pain and surprise’ and ‘the noise my dad makes when he’s proven me wrong about something.’

“Maybe don’t move so quickly,” I’m told by the radiologist. Noted.

After the X-ray, I reluctantly exit the fashionable but weather-and-perhaps-work-inappropriate gown and make my way to an examination room, where I’m to sit and wait until my physician’s available to see me.

Something I learned while writing orthopaedic news (and had reaffirmed by my experience getting a broken ankle taken care of two years ago): Orthopaedic physicians and surgeons waste absolutely no time. Mine swoops into the room, white coat billowing behind him, introduces himself and shakes my hand before sitting down and getting right to business.

“So, what’s going on with your hip?” he says.

“You tell me,” I say with a chuckle, proud of myself before realizing he’s probably heard that exact joke a few thousand times. I promptly clam it.

“Five years of pain, huh?” he continues. “You’re too young for that.”

I’m inclined to agree.

I’m told that nothing on the X-ray really stands out as being problematic. No obvious bone spurs, no trouble areas in the bone structure itself. The imaging report — which I look up on MyPennMedicine a day or two after the appointment — refers to the hip as “grossly unremarkable,” which is one of those things you love to hear about your body in a doctor’s office but absolutely nowhere else.

Since the X-ray doesn’t reveal anything of note, I’m told that the next step is to get a contrast MRI of the hip. The MRI can inspect soft tissue, which means it’ll be able to pick up on abrasions or tears within the acetabular labrum — which, I’m informed, is what the physician thinks the problem might be.

The English language is versatile, but I don’t know if a word exists within it to express the feeling of being right precisely when you didn’t want to be.

Next month: I explain what it’s like to undergo an arthrogram and contrast MRI (spoiler: It’s super, super weird), and learn what the next steps might be.

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