Impingement

Femoroacetabular Impingement Syndrome (FAI)

  • Mechanical hip pain caused by morphological abnormalities of the acetabulum and/or femur
  • These can be a cam or pincer deformity or combined
  • This may progress to include a labral tear or cartilaginous changes

Media

Range of motion (ROM) simulations of the hip joint. The pose of the femur is adjustable. When imping

Range of motion (ROM) simulations of the hip joint. The pose of the femur is adjustable. When impingement is detected, the femur is colored red.

 

Subjective Examination:

  • Insidious onset of a deep aching pain in the groin
  • Patients often use their hand to point to their pain with the thumb over the greater trochanter and index finger over the anterior hip – this is termed the ‘C-sign’
  • Pain is generally worse after activity and with movements involving flexion and twisting
  • If they can continue activity through their pain this suggests FAI, if not then there is potential for a labral tear.

Objective Examination:

  • Flexion and internal rotation are usually restricted and reproduce pain
  • The flexion, adduction, internal rotation (FADDIR) test for posterior capsule
  • Flexion, abduction, external rotation (FADER) tests for anterior capsule

Treatment:
  • Consensus seems to be 4-6 months of conservative measures, therefore refer to Physiotherapy
  • Aim at reducing the levels of aggravating activities
  • Graded strengthening of the hip and pelvic stabilisers
  • The Physiotherapist can refer for MR arthrogram +/- arthroscopy should this be required
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