Let’s take an in-depth look at hip injuries, specifically discussing the Celtics’ Isaiah Thomas
The Celtics’ superstar Isaiah Thomas originally suffered a right hip injury on March 15 of this season and ended up costing him 2 games back then. For the most part, Thomas has played fantastic in his breakout season (at least offensively), playing in 76 games, averaging 33.8 minutes, 28.9 points, and 5.9 assists per game while shooting 46.3% from the field and 37.9% from 3-point range.
By far his best season in the NBA, Thomas led the Boston Celtics to a first place seed in the Eastern Conference, with a record of 53-29, 2 games ahead of the LeBron-lead Cleveland Cavaliers.
Unfortunately Thomas reinjured his right hip during game 6 of the Eastern Conference Semifinals at Washington on May 12. The Celtics Chief Medical Officer, Dr. Brian McKeon, admits that Thomas was working diligently since his injury first occurred. Dr. McKeon stated that Thomas was dealing with increased hip swelling during the first two games of the Eastern Conference Finals in Boston.
In order to help preserve their star, Dr. McKeon and the Celtics staff decided to air on the side of caution and not allow Thomas to continue to play injured, and he was not allowed to travel with the team to Cleveland.
Thomas underwent an MRI on Saturday May 20, and was officially diagnosed with a right femoroacetabular impingement as well as a labral tear. This is actually quite a significant injury, and although Thomas is seeking multiple medical opinions now to help decide what the best course of action will be.
First off, let’s briefly discuss the hip joint; this can get a bit confusing so bear with me. The hip joint is vital to our everyday lives; as it allows us to walk, jump and run. The joint serves to bear the majority of the body’s weight as it transitions from our lower to our upper body and vice-versa.
The hip and shoulder joints are very similar in that they both are ball-and-socket joints that are responsible for a large range of motion. The hip joint is formed between the hip bone (os coxa), and the femur (thighbone). There is a cup-shaped structure within the os coax known as the acetabulum that helps to form the ‘socket’ of the hip joint.
The top (head) of the femur (thighbone) is rounded, and this head helps to form the ball of the joint.
Ensuring that the ball and socket slide smoothly amongst one another, there is hyaline cartilage that provides a smooth surface for the acetabulum and the head of the femur to glide against one another.
This strong fibrocartilage surrounding the acetabulum, called the labrum, helps act as a shock absorber of sorts. The labrum’s job is to form a tight seal around the socket, thereby providing stability to the joint.
Further helping to prevent the hip from dislocating, there are multiple ligaments and strong muscles to help keep the ball-and-socket in place. Isaiah Thomas was diagnosed with a labrum tear as a result of a condition known as Femoroacetabular Impingement, or FAI for short.
What exactly is Femoroacetabular Impingement (FAI)? This hip condition is actually a deformity in the hip joint itself, whereby extra bone spurs grow along one (or both) of the two bones that form the hip joint.
These extra bone growths give the bone an irregular shape, which in turn cause issues when trying to slide up against each other. After thousands and thousands of hip movements over time, these extra bone grows lead to friction, causing joint damage.
This friction then leads to pain, limiting the joint’s mobility and the activity that would go along with it.
While the exact origin of FAI is unclear, the running theory is that certain people are born with an issue between the ball and socket of their hip joint.
Well why doesn’t everyone with this deformity develop pain and require subsequent surgery? The answer to this likely lies in the amount of activity and stress the person puts on this joint. Athletes and highly active people with this joint deformity have the potential to increase their risk of developing FAI.
While people who do not stress their hip joint as much (as athletes) may be able to get away with this issue until much later in life, when osteoarthritis likely joins these bone spurs leading to pain and difficulty ambulating.
While I won’t get into the details of FAI in terms of the different types, I will insert a photo that was edited by Dr. Selene Parekh, demonstrating the two different types of hip impingements commonly seen in FAI.
The Celtics team staff have likely been working with Thomas on this for the past couple months since the initial diagnosis. The first few steps of treatment typically include anti-inflammatories, physical therapy and sometimes a corticosteroid injection.
Unfortunately since Thomas is not only dealing with FAI, but also a tear of his labrum, I believe that he will need to undergo surgery to completely resolve the issue.
I fully expect Thomas to undergo arthroscopic surgery addressing his FAI and labrum tear over the next couple of weeks. Right now Dr. McKeon and the rest of the Celtics medical staff are likely reviewing the MRI results and discussing the potential options with Thomas. Thomas will likely seek a second opinion or two from some of the top orthopedic hip surgeons in the country, and after Thomas and his team have come to a conclusion where they will decide which surgeon they want to go with.
What does Thomas’ basketball future look like after being diagnosed with FAI and a labrum tear? The good news is that surgery can successfully reduce the symptoms caused by the impingement, as well as help to prevent future damage to the joint. The Fantasy Doctors’ Dr. Selene Parekh believes that Thomas will likely require a timeline to return to play of about 6 to 8 months, depending on the type of surgery and how his rehab progresses.
Thomas is an integral part of the Boston Celtics’ future. I fully expect him to be back on the court in Celtics green before the start of 2018.
This was written for the @TheFantasyDRS by Dr. Jesse Morse. I am a Family Medicine trained physician, and I will be beginning a Sports Medicine Fellowship in the next couple of months. If you have any questions or comments, you can contact me directly at @DrJesseMorse.