Iliopsoas Tendinitis

What a way to learn anatomy!

The iliac spine is not part of the spine.  It’s where the thigh and pelvis are held together by tendons (I think).  (see sketch here).  Without an injury, it’s pretty unusual for a person to have tendonitis there at the front of the hip.  It’s even more unusual for a person to have bilateral tendonitis.

And, for the record, it’s extremely scary when that person is a child who’s had Raynauds for four years and has a family history of autoimmune disease.  We all know where this is going, right?  I’m so afraid for my daughter.

Once again, this child was vomiting due to the severity of her hip pain.  400 mg ibuprofen did nothing for her, so after two hours I gave her a second 400 mg dose.  The difference is that this time I didn’t ask if it’s bad enough to make a doctor’s appointment.  I just made the phone call.  And she was highly miffed when I “drug” her to the doctor.

• He noted that she’d been in before with a similar complaint. 
• He did a careful examination and asked lots of questions.
• He offered a steroid injection, but didn’t push knowing that my daughter hates needles.

If it’s me, I’ll let this particular doctor give me a cortisone shot any day.  With my kid, it’s a different story.  It’s tricky finding the right balance of “I’m the mom, you’ll do what I say,” and “You’re an adolescent capable of making some of your own decisions.”

When the doctor also said that he’d be ordering lab work, my daughter looked frightened.  “You mean I either have to get a shot or have my blood drawn?!”  No escape from the needles this time.  I’m so glad to have a good relationship with our family physician.  He told her that she needed the blood work done whether or not she got the shot.

He also said that iliopsoas tendonitis is pretty unusual and he’d like to refer her to an orthopod to figure out what’s going on.  While he did some charting, I had a chance to talk with her.

Still not wanting to push, I let her know, “An orthopedist is going to want to give a steroid injection.  The difference is that our PCP is very good and his shots don’t hurt, plus he uses kenalog which doesn’t make a person sick like depo-medrol does.  If it was me, I’d get the shot now knowing that I’d probably feel better the next day.”  But it was her choice.

I’m happy to report that the injection was very effective and she’s not so afraid of shots now.  Unfortunately, I suspect this was a snowball appointment and we’re about to race downhill accumulating referrals, diagnoses, PT, and medication for my daughter.

This really really sucks.

Rotator Cuff Tears

Found an interesting bit at MedPage Today.

There are several effective approaches for treating a rotator cuff tear, but none stands above the rest, a systematic review showed.  A literature review revealed that both operative and nonoperative approaches work for improving function and relieving pain, Jennifer Seida, MPH, of the Alberta Research Center for Health Evidence at the University of Alberta in Edmonton, and colleagues reported online July 5 in the Annals of Internal Medicine.

But evidence comparing different techniques was limited and weak, “which precludes firm conclusions for a single approach or the optimal overall management of this condition,” the researchers wrote.

Complication rates across studies were low.

“Because of the low event rates, the benefit of receiving treatment for rotator cuff tears seems to outweigh the risk for associated harms,” Seida and her colleagues concluded from their review, which was prepared for the Agency for Healthcare Research and Quality.

Really?  Getting treatment for a tear is a good idea?  They spent money to figure this out?

Without treatment:  can’t get things out of the cupboard, can’t use a computer’s mouse, can’t wash own hair, can’t dress without assistance, can’t reach overhead, difficult to lift things, can’t play guitar (or violin or piano), can’t help put up hay…

With treatment:  function restored (at least enough to do most routine activities)

It’s really not as obvious as some of the studies Dr. Grumpy reads.  There are risks associated with treatment (even though the article doesn’t say what those risks are).  It’s like taking medicine:  you only want to do it if the potential benefits outweigh the risks.  What they wanted to know is which treatment is best (comparative effectiveness at work?).  The answer is that we just don’t know.  It’s worth reading the entire article:  No Clear Favorite for Rotator Cuff Repair 

With any luck, some poor student in need of a study topic will follow-up and figure out which treatment is most effective.  Not just PT versus surgery, either.  If the answer is PT, I want to know which PT exercises would be best.

I tore my rotator cuff last July.  That’s right – a full year ago.  First I did exercises at home that had previously been prescribed for tendonitis.  They didn’t work.  Eventually I spent hours travelling for treatment only to pay a physical therapist to tell me to do the exact same thing I was already doing.

Since all that work/time/money didn’t help, I wasn’t too optimistic when I was sent back for yet another round of PT.  This time, though, I’ve been given different exercises.  This time it’s working.  I don’t have full use, but enough to do most things.  So why didn’t we start with these exercises instead of spending two months (and blowing my insurance company’s PT allotment) on something that was useless.  It would have been really nice to start with the exercises that work.

I guess that’s the point of the study.  Treatment helps, but it would be nice to know which treatments would be best for a specific tear.