Hip Impingement… Often Difficult To Diagnose and Misunderstood

Hip impingement or FAI (femoroacetabular impingement) is a result of overuse or wear-and-tear to the hip joint.  The pain can be acute or chronic depending on the severity of the injury.  More importantly, there are 3 different types of FAI (pincer, cam, or combined; pincer involves additional bone extending over the acetabulum/hip socket creating a “pinch”; cam involves the femoral head not rotating smoothly within the socket and and as a result, it creates a “bump” here-see photos below).  Understanding which type you may have will give insight into how you can change the activities you engage in to avoid worsening.  The pain can worsen with time (even if you haven’t reported pain or felt pain there, which can be deep).

Pincer & Cam Impingement

(Left) Pincer impingement. (Right) Cam impingement.
*Photo Courtesy of AAOS
It often presents with several different symptoms that can include, but are not limited to: pain in the groin or deep hip with pain ranging from tight, achy, and sore to sharp and stabbing.
A proper physical exam by a hip specialist or healthcare professional with experience in evaluating hips is important to making the initial diagnosis.  A complete and thorough history usually indicates a great deal of activity performing different activities (ex. hiking, swimming, biking, weight lifting, running done over a chronic period).  Moreover, if conservative treatment methods don’t improve the condition, then an MRI should be considered to evaluate the possible damage.  The problem with receiving an MRI is that one may not arrive at a diagnosis even with an MRI.  MRI with contrast, or arthrograms, are the best evaluation for possible FAI, but it is a combination of conservative treatment, imaging, and rehab to strengthen his hip.
So, as you can see, FAI is not simple, nor easy to diagnose and/or treat. Identifying the complicating factors and avoiding them, can ensure proper healing and a greater success in recovery to get you back to doing soon what you enjoy/love most.
Stay tuned to next month’s blog!


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