Hip Impingement

Pathophysiology

Femoroacetabular Impingement Syndrome (FAI) is caused by abnormalities of the femur (ball) or acetabulum (socket). There are two types depending on which area is affected: Cam (Femoral head is not round) and Pincer (socket has increased coverage of the ball) or both may be present which is then termed a mixed deformity. More common in sports where the hip is flexed and internally rotated e.g. hockey, tennis, football and horse riding.

Symptoms

• Gradual onset of a deep aching in the groin

• Pain gradually worsens after activity

• Pain with end of range movements into flexion and internal rotation

Management

• Activity modification

• Ice or heat

• Pain relief

• Physiotherapy including a graded strengthening programme

Investigations

• X-ray should show any bony deformity of the Femur or Acetabulum

• MRI can be useful if symptoms are not improving with conservative measures beyond 3-6 months