Thursday, January 12, 2012

Good News, Bad News: The Detail on the Latest Setback

So, the good news is I do not have another stress fracture. The bad news is I have osteoarthritis in my left hip. I'd rather have the fracture. Fractures heal. Arthritis lives on. Here is the official write-up and conclusion:


CLINICAL INFORMATION: The patient is a 50-year-old male with left hip pain. Evaluate for stress injury.

TECHNICAL INFORMATION: Large field-of-view coronal T1 and STIR images were obtained. Thin section coronal and sagittal proton density and T2-weighted spin echo sequences were obtained through the left hip followed by axial proton density and fat saturation T2-weighted images. Comparison is made to the prior examination dated 03/16/2011.

INTERPRETATION: STIR imaging of the pelvis shows no evidence for marrow edema or cortical injury. There is no evidence for residual signal change involving the left superior or inferior pubic rami to suggest ongoing stress or traumatic injury. No evidence for injury to the sacroiliac joints or symphysis pubis can be seen. The left and right proximal femora appear normal. There is no evidence for femoral stress injury or avascular necrosis.

Degeneration and blunting of the central and anterior aspects of the left superior acetabular labrum can be seen with chondral thinning and irregularity along the superior and anterosuperior articular surfaces of the left hip. Mild subcortical cystic changes involving the anterosuperior aspect of the left acetabulum is present, and the findings are in keeping with mild osteoarthritic changes. No evidence for intraarticular loose body is seen.

No abnormal fluid collections about the hips and pelvis can be seen. There is no evidence for iliopsoas or trochanteric bursitis. No acute intrapelvic abnormalities are seen.

No definite musculotendinous abnormalities about the hips and pelvis are present. There is no evidence for myotendinous strain or intramuscular mass. The common hamstrings origins appear intact. No injuries to the distal gluteus medius or gluteus minimus tendons can be seen.


1. Mild osteoarthritic changes of the left hip can be seen with chondral thinning and irregularity along the articular surfaces and mild subcortical cystic changes. Degeneration and blunting of the central and anterior aspects of the left superior acetabular labrum can be seen.

2. No acute bony abnormalities about the hips and pelvis can be seen. The previously noted areas of stress or traumatic injury have resolved.

3. No musculotendinous abnormalities are present.

4. No abnormal fluid collections are seen.

Not sure I totally trust the diagnosis. I have little trust in our our fine medical community given some past personal episodes. What if there is a stress fracture not in the pelvic region but in the femur and the MRI did not cover that area? What if there is some necrosis from the past stress fracture (March 2011) and the femur/hip/pelvis are getting a reduced blood flow, in essence killing the bone?

Look at it this way. I can take any runner that has been pounding the pavement for 35+ years and they are going to show some mild osteoarthritis in the leg joints. It goes with the territory. So does this equate to the leg pain I've been having?

I have other issues going on with the left leg as well. The middle toe on my left foot goes numb off-and-on during the day. The inside of my upper calf area (between shin and muscle) is painful to the touch. The lower quad is also painful to the touch. It feels as if someone has just been pounding the quad area with a hammer. So, is there an underlying circulation issue and there may be some time of deep vein thrombosis? Time will tell. For now, I have to go on what is being told to me.

I have continued to swim. This week I have been walking to test if the leg can start to engage in a slow ramp up of running and biking. No 90-120 minutes spins on the bike. No 9-milers on the run. Simple 30-minute stuff. If the pains come back with a vengeance, then I go back in and press for further testing. Otherwise, I continue to slowly ramp up and hopefully will be toeing the start line in the upcoming 2012 season. Let's take a deeper dive into osteoarthritis.

Osteoarthritis (OA) is the most common joint disorder, which is due to aging and wear and tear on a joint. In other words, my decades of running may have caught up to me. Osteoarthritis is a normal result of aging. It is also caused by 'wear and tear' on a joint. Cartilage is the firm, rubbery tissue that cushions your bones at the joints, and allows bones to glide over one another. If the cartilage breaks down and wears away, the bones rub together. This causes pain, swelling, and stiffness. Bony spurs or extra bone may form around the joint. The ligaments and muscles around the joint become weaker and stiffer.

Often, the cause of OA is unknown. It is mainly related to aging. The symptoms of OA usually appear in middle age. Almost everyone has some symptoms by age 70. However, these symptoms may be minor. Other factors can also lead to OA:

• OA tends to run in families.
• Being overweight increases the risk of OA in the hip, knee, ankle, and foot joints because extra weight causes more wear and tear.
• Fractures or other joint injuries can lead to OA later in life. This includes injuries to the cartilage and ligaments in your joints.
• Jobs that involve kneeling or squatting for more than an hour a day put you at the highest risk. Jobs that involve lifting, climbing stairs, or walking also put you at risk.
• Playing sports that involve direct impact on the joint (such as football), twisting (such as basketball or soccer), or throwing also increase the risk of arthritis.

Medical conditions that can lead to OA include:

• Bleeding disorders that cause bleeding in the joint, such as hemophilia
• Disorders that block the blood supply near a joint and lead to avascular necrosis
• Other types of arthritis, such as chronic gout, pseudogout, or rheumatoid arthritis

Pain and stiffness in the joints are the most common symptoms. The pain is often worse after exercise and when you put weight or pressure on the joint. If you have osteoarthritis, your joints probably become stiffer and harder to move over time. You may notice a rubbing, grating, or crackling sound when you move the joint.

OA cannot be cured. It will most likely get worse over time. At best, OA symptoms can be controlled.


Anonymous said...

Major bummer! Ironically, I've been having some discomfort in my left hip, suspecting OA. It's less surprising at 62 than at 50.

Maybe you should get a second opinion to help answer your many questions. You might see Ralph Bovard, MD, in St. Paul ( He's trained in Sports Medicine and is quite an athlete himself. He's originally from Mason City.

Nice article in the Star Trib. Quite an honor to be featured with The Boy.

Steve Schurtz
Mason City

Christopher Hawes said...

Great, detailed post about your injurty. Too bad it is about your injury. Hope you get things worked out.