X-Ray Vision: Diagnosing A-Rod's Pain

New York Daily News—March 8, 2009

By Dr. Josh Dines and Dr. Rock Positano

Professional baseball players subject their bodies to extreme forces. For example, the hip joint may experience forces up to five times its body weight during activities such as running, jumping, and twisting. Alex Rodriguez is finding this out firsthand. After years of running and swinging a bat, it sounds like he has developed some early arthritis and damaged his hip labrum.

The majority of injuries to the hip joint are typically muscular strains, or inflammation of the tendons and ligaments around the joint. These types of injuries generally improve with appropriate treatments such as rest, ice, massage, muscle stimulation, ultrasound and a variety of manual therapy techniques.

If hip pain does not resolve after an appropriate period of these types of treatments, the athlete and trainer/doctor should consider injuries to the inside of the joint involving cartilage structures such as articular cartilage and the labrum. From reports in the news, it sounds like this is exactly what A-Rod has.

Injuries to the labrum are among the most common source of hip pain in athletes. The labrum is a relatively small tissue similar in structure to the meniscus in the knee and the labrum in the shoulder. It surrounds the outer perimeter of the hip socket, known as the acetabulum, and forms a seal around the joint, which helps to preserve joint mechanics. When the labrum tears, the torn fragment can get pinched between the ball of the hip joint (the femoral head) and the socket (the acetabulum). The diagnosis of a labral tear remains largely clinical and is similar to those patients who present with a meniscus tear in the knee.

The athlete almost always describes pain in the groin particularly with twisting maneuvers. Often there will be a sense of catching or locking within the joint as the torn tissue gets caught in the joint. Sometimes their presentation is more subtle, with symptoms of dull, activity-induced, positional pain that fails to improve with rest. Frequently, the athlete will misinterpret the pain as a chronic groin strain or injury.

If these “groin pulls” don’t respond effectively to more traditional treatments such as rest, ice treatments, manual therapies, muscle stimulation and ultrasound, then a labral tear within the joint may be present and further evaluation should be performed. The definitive diagnosis can be made by MRI.

Treatment of a torn labrum depends on the symptoms. Sometimes, physical therapy, modifying activities, and medication to reduce the pain and inflammation can do the trick. For people with severe symptoms, arthroscopic surgery may be the only way to get relief. According to Dr. Bryan Kelly, a hip and sports medicine specialist at Hospital for Special Surgery and a team physician for the football Giants: “Hip arthroscopy is a minimally invasive outpatient procedure that allows the doctor to look inside the hip joint with a small camera and fix small tears in structures including the joint capsule, the labrum, and the joint surface.”

Hip arthroscopy has been very effective for the treatment of numerous athletic injuries including labral tears, the removal of bone spurs that cause a condition called “impingement,” injuries to the cartilage surfaces and the removal of loose bodies. Recovery after surgery can take up to three months.

Drs. Positano and Dines practice sports medicine at the Joe DiMaggio Sports Medicine Center at Hospital for Special Surgery.

Read the full story at nydailynews.com.

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