What is Femoroacetabular Impingement? Femoroacetabular Impingement (FAI) is a hip condition which describes a mechanicalmismatch between the hip "ball" and the "socket". There are three described types of femoroacetabular impingement:
Cam Type FAI 'Cam' type femoroacetabular impingement describes a 'bump' on the surface of the femoralhead (ball) which jams on the rim of the (acetabulum) socket. This typically affects youngathletic men.
Pincer Type FAI 'Pincer' type femoroacetabular impingement describes an increased coverage by theacetabulum over the anterior femoral head. This typically affects middle aged women and isless common.
Mixed Type FAI Often there can be a combination of both cam and pincer types, which is termed
What Causes Femoroacetabular Impingement? It is believed that many normal people have 'bumps' or slightly over-deep sockets andcould potentially develop femoroacetabular impingement-this is just the way we are builtand develop. The result of these deformities is increased friction between the acetabular socket andfemoral head, which may result in pain and decreased range of motion. However, the hip has to also be provoked in some way to cause damage. This explains thetendency for athletes, sporting professionals and active people to be more susceptible tothis form of injury.
Symptoms of Femoroacetabular Impingement? ● FAI often presents as hip and groin pain with restricted range of hip motion. ● Symptom onset can be acute, following injury, or insidious after prolonged exertion. ● Pain is often provoked with prolonged sitting, walking, crossing the legs as well asduring and after sport and exercise. ● There will typically be a restriction in hip flexion and internal rotation range ofmotion. ● Pain is primarily felt deep in the groin at the front of the hip, more rarely it can be onthe side of the hip or the buttock.
How is Femoroacetabular Impingement Diagnosed? Physical examination involves a series of hip tests. Diagnosis is 90% positive withreproduction of symptoms on the impingement test-flexion adduction and internal rotationof the hip.
When testing hip range of motion there may be restriction in hip flexion and internalrotation. Provocation of pain by flexion abduction and external rotation (FABER test) mayprovoke pain but is generally non-specific.
Radiology Tests for FAI Radiology investigations for femoroacetabular impingement can be undertaken to confirm thediagnosis with AP X-rays of the pelvis and lateral X-rays of the hips being the first lineof investigation.
Femoroacetabular Impingement Treatment An initial trial of non-operative treatment is advocated for most patients, as the pain isrelatively self-limiting. Physiotherapy can assist FAI by using a variety of techniques to: ● mobilise the hip joint that stretch any tight structures eg joint capsule or muscles ● improve soft tissue flexibility and length ● strengthen the deep, intermediate and superficial hip muscles ● progress hip muscle, proprioception, joint position sense and functional control todynamically control your hip Use of painkillers and anti-inflammatories may temporarily help the pain reduce the localanti-inflammatory reaction.
Hip Surgery for Femoroacetabular Impingement? If your symptoms continue to remain unchanged on return to sport, then referral to anorthopaedic surgeon is recommended. Surgical treatment for FAI is performed either by arthroscopic debridement or can beperformed by open surgical debridement. While
the techniques are quite different, theoperations both aim to address the mechanical and pathological changes around theneck/acetabulum junction. Post-FAI Hip Surgery Rehabilitation A supervised hip rehabilitation program with your physiotherapist is an essential part ofyour post-surgical FAI recovery. Recovery from hip arthroscopy typically takes 3-4 months, while open hip debridement istypically 12 months. Hip arthroscopy has been the preferred method in recent years and hasreported excellent results with 80% of patients asymptomatic by 3-4 months and up to 95%having improved symptoms by one year. For more advice about femoroacetabular impingement, please ask your physiotherapist ordoctor.
Hip Impingement Symptoms You can have hip impingement for years and not know it, because it is often not painful inits early stages. When hip impingement causes symptoms, it may be referred to as hip impingement syndrome.The main symptoms are stiffness in the groin or front of the thigh and/or a loss of yourhip's full range of motion. At first, you may only feel pain when you move the hip near its limits. As the conditionprogresses, however, you may feel pain with more subtle activities, such as sitting for along time or walking up a hill. Pain that occurs at night or when walking on flat groundsuggests that the cartilage cushioning the ball and socket has begun to break down andwear away, a condition known as osteoarthritis.
Hip Impingement Causes There are two main causes of hip impingement: A deformity of the ball at the top of the femur (called cam impingement). If the head isnot shaped normally, the abnormal part of the head can jam in the socket when the hip isbent. This may occur during activities such as riding a bicycle or tying your shoes.
A deformity of the socket (pincer impingement). If the front rim of the socket (called theacetabulum) sticks out too far, the area of the thigh bone (femur) just below the ball,called the neck of the femur, may bump into the rim of the socket during normal hipflexion movement. In some cases, there is a problem with both the ball and the socket. Other problems thatcan cause hip impingement include conditions such as: ● Legg-Calve-Perthes disease, a disease in which the ball part of the hip joint doesn't getenough blood, which causes the bone to die. ● Slipped capital femoral epiphysis, a separation of the ball from the thigh bone at theupper growing end (growth plate) of the bone in adolescents. It is more common in childrenwho are obese. ● Coxa vara, an unusual condition in which the thigh bone and ball do not grow at the samepace in children. This discrepancy leads to deformity of the hip joint.
Hip Impingement Tests and Diagnosis If you have symptoms of hip impingement, your doctor can diagnose the problem based onyour description of your symptoms, a physical exam, and the findings of imaging tests.These tests may include one or more of the following: ● X-ray, a test that produces images of internal structures on film. X-rays can showirregularities in the shape of the ball or top of the thigh bone or excess bone around therim of the socket. ● Magnetic resonance imaging (MRI), a procedure that uses large magnets, radio waves, and acomputer to produce detailed pictures of tissues inside the body. An MRI can show frayingor tears of the cartilage, including that which runs along rim of the socket (labrum). ● CT scan, a technique that combines special X-ray equipment with sophisticated computers toproduce multiple images or pictures of the inside of the body. These images can beexamined on a computer, printed, or transferred to a CD. A CT or MRI scan can help adoctor decide whether you need surgery.
Hip Impingement Treatments Treatment for hip impingement should begin with: ● Resting the affected hip ● Modifying your activities to avoid moving the joint in a way that causes pain ● Exercising as recommended by your doctor or physical therapist to strengthen the musclesthat support the hip ● Taking anti-inflammatory and pain medications If these treatments do not relieve pain, your doctor may recommend hip impingementsurgery. The type of surgery needed will depend on the problem causing hip impingement and how muchcartilage damage has occurred. If the affected hip does not have too much cartilage damage, the surgeon may use tools toreshape the ball and/or the outside edge of the socket that is catching on the thigh bone.In a technique called microfracture, the surgeon may also cut away the frayed cartilagethat is causing pain or drill holes into patches of bone where cartilage has worn away inorder to stimulate cartilage growth. Microfracture is being used less frequently. Often, surgery for hip impingement can be performed arthroscopically. This techniqueinvolves inserting a lighted scope and thin tools through small incisions over your hipinstead of making a large incision. Arthroscopy is usually an outpatient surgery. Thismeans you can go home the same day. The earlier you have surgery, the greater your chances of a complete recovery. But even ifcartilage has been damaged, surgery may still reduce pain and improve range of motion. If cartilage damage is severe, however, hip replacement may be the only treatment thatwill relieve pain and improve function. However, there are promising treatments, including one in which parts of your own bloodare injected into joints to stimulate cartilage growth.
What Kind of Physical Therapist Do I Need? All physical therapists are prepared through education and experience to treat patientswho have hip impingement. You may want to consider: ● A physical therapist who is experienced in treating people with musculoskeletal problems.Some physical therapists have a practice with a sports or orthopaedic focus. ● A physical therapist who is a board-certified clinical specialist or who completed aresidency or fellowship in sports or orthopaedic physical therapy. This therapist hasadvanced knowledge, experience, and skills that may apply to your condition. You can find physical therapists who have these and other credentials by using Find a PT,the online tool built by the American Physical Therapy Association to help you search forphysical therapists with specific clinical expertise in your geographic area. General tips when you're looking for a physical therapist (or any other health careprovider):. ● Get recommendations from family and friends or from other health care providers. ● When you contact a physical therapy clinic for an appointment, ask about the physicaltherapists' experience in helping people with hip impingement. ● During your first visit with the physical therapist, be prepared to describe your symptomsin as much detail as possible, and say what makes your symptoms worse.
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