Hip Labral Q&A: An Angry Psoas or Ovarian Cyst?

Hip Labral Q&A: An Angry Psoas or Ovarian Cyst?

Q: Still trying to get to the right diagnosis…What does the pain from a torn labrum feel like?

A: Pain from a torn labrum can feel like everything (pelvic, hip, or back related) or nothing at all. What this means is, some labral tears are asymptomatic, while some can cause anything from back pain, SIJ pain, outer hip pain, groin pain, pelvic pain, or sexual dysfunction.

Sarah*:

I’m at the 4-week mark today and this hip feels great! However, my other hip (10 months PO) has psoas pain. It flared up three days ago. Pain is from groin up to ribs. I’ve never had psoas issues before. Anyone have tips on how to calm it? My NSAID isn’t helping. Ice is giving some relief.


Ginger:

That is a million dollar question Sarah, and it begins with realizing the many variables that can contribute to a psoas flare.

First, was there a specific onset – something that happened, that could have contributed to the flare up? Second, what you describe is part of the superficial and deep front line of the fascial planes. Third, it could be muscular, fascial, neuromuscular (meaning posterior or trunk muscular patterns are firing improperly, inhibited, weak, or shut off), skeletal (thoracic spine can be to blame quite a bit), or reproductive in origin. Because you had no previous psoas pain and this is just a flare up – I am assuming it is not scar tissue at this point. But all those variables would have to be sorted through in a hands-on evaluation. Hope this helps!

Sarah: This helps a lot–thanks! I suspect the trigger was something I did in PT. I do the work on both hips. My next PT appointment is tomorrow, so you have given me points to bring up with her. Bless you, Ginger!

Ginger: Fantastic! Glad that helps. Keep us posted on the progress. I am sure everyone will want to know which variable was to blame. I know I do!

Sarah: At PT this morning, my entire psoas is tender to touch. We looked through my exercises and nothing new would explain the onset. It did occur to me that I may have an ovarian cyst that is pressing on the psoas. I made an OBGYN appt to check on Monday.

Ginger: Good follow-up Sarah, gyn issues should be ruled out before moving on to other possibilities.

Sarah: The verdict is in: I have an ovarian cyst. But what is causing the pain is excess fluid floating and pressing on my psoas and pelvis.

Ginger: Thank you so much for following up and letting me know the results. This is information can be VERY helpful for other women suffering from hip/pelvic pain – Differential diagnosis is everything!

Sarah: Absolutely! I was relieved when I saw the ultrasound pictures because I want to keep advancing in PT!

Other concerns that must be considered in orthopaedic and reproductive differential diagnosis include:

• Tumors (malignant and benign)
• Hernia (inguinal, femoral, or sport)
• Slipped capital femoral epiphysis
• Legg-Calve-Perthes disease
• Fracture/stress fx (patellar-pubic percussion test SN 95%, SP 96% in 3 different studies)
• Osteitis pubis/Avascular necrosis of femoral head
• Septic arthritis
• Reproductive, urological issues – ovarian cysts, endometriosis, pelvic pain

*Name changed to protect privacy

Past Posts in the Series:

• Hip Labrum Q&A: How Long Does Recovery After Surgery Take?
  
• Hip Labraum Q&A: How Long Should I Wait To Have Surgery? 

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