Femoracetabular Impingement
Femoroacetabular impingement (FAI) is a condition where there is abnormal contact between the hip joint bones, specifically the femoral head and the acetabulum of the pelvis. There are three types of FAI: cam impingement which refers to impingement caused by the head of the femur, pincer impingement which refers to impingement caused by the acetabulum, or a mixed impingement which is a combination of both. This improper contact can lead to damage of the hip joint, causing pain and restricted movement. FAI can develop due to several factors including congenital abnormalities in the shape of the hip joint, repetitive movements or activities that put stress on the hip joint, or previous injuries.
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1. Hip pain, often felt in the groin area, but can also be around the outside of the hip.2. Stiffness in the hip.
3. Limited range of motion in the hip joint.
4. Pain during certain activities, especially during those that involve hip flexion, such as sitting for long periods, squatting, or turning/twisting movements.
Treatments
Nonoperative treatment is the preferred first line of treatment as it helps to identify the patients whereby the area of damage to the joint may heal compared to those who remain symptomatic. Conservative treatment is often more appropriate in mild FAI. The main areas of focus for rehabilitation are the avoid aggravating activity for a set period, maintaining or building muscle strength, and using anti-inflammatory drugs when needed [1]. Maintaining range of motion through manual therapies such as massage and mobilisations which target capsular restrictions are also recommended during treatment [2]. Physiotherapy will focus on building core stability, proprioception, and dynamic stability of the hip through strengthening of the hip flexors, external rotators, abductors, and adductors [3].Therapeutic musculoskeletal injections are also used for FAI. Ultrasound guided corticosteroid injections have been shown to significantly reduce pain within the hip, however this may only provide minimal improvement and in more severe cases whereby there are large morphological changes within the hip joint then surgical intervention is preferred [4].
References
1. Brady, C., & Dutta, A. (2016). Medial epicondylitis and medial elbow pain syndrome: Current treatment strategies. J Musculoskelet Disord Treat, 2(2), 1-5.2. Bennell, K. L., O’Donnell, J. M., Takla, A., Spiers, L. N., Hunter, D. J., Staples, M., & Hinman, R. S. (2014). Efficacy of a physiotherapy rehabilitation program for individuals undergoing arthroscopic management of femoroacetabular impingement–the FAIR trial: a randomised controlled trial protocol. BMC musculoskeletal disorders, 15, 1-11.
3. Trigg, S. D., Schroeder, J. D., & Hulsopple, C. (2020). Femoroacetabular impingement syndrome. Current sports medicine reports, 19(9), 360-366.
4. Krych, A. J., Griffith, T. B., Hudgens, J. L., Kuzma, S. A., Sierra, R. J., & Levy, B. A. (2014). Limited therapeutic benefits of intra-articular cortisone injection for patients with femoro-acetabular impingement and labral tear. Knee surgery, sports traumatology, arthroscopy, 22, 750-755.