Femoroacetabular impingement (FAI) syndrome is a movement disorder of the hip, resulting in symptomatic contact between the thigh bone and hip bone. The common term for this syndrome is ‘hip impingement’. It is associated with specific symptoms, clinical findings, and imaging findings.
Diagnosis
The diagnosis of FAI syndrome is made by combining the results of imaging findings, with the symptoms and clinical findings present on assessment. For a diagnosis of FAI syndrome to be made there must be positive symptoms and clinical signs associated with findings on imaging.
Symptoms
The main symptom of FAI syndrome is pain in the hip or groin that is associated with hip movement or position. It is also possible to feel pain in the back, buttock, or thigh. Individual’s may also report sensations of clicking, catching, locking, or stiffness in the hip.
Clinical Findings
Clinical findings are the outcomes of the tests performed during your physical assessment with a physiotherapist. There are a variety of tests that can be performed to assist in the diagnosis of FAI syndrome, and help rule out other potential causes. Common tests performed are hip impingement tests, hip range of motion, functional testing of walking and single leg control, and muscle testing. FAI syndrome is associated with positive hip impingement, reduced hip range of motion, and muscle imbalances and tenderness around the hip itself.
Imaging Findings
Initially an x-ray can assist in diagnosis by determining if the individual has a CAM or Pincer morphology. A CAM morphology relates to a flattening or extra bone on the head of the thigh bone. A Pincer morphology relates to extra bone on the hip joint itself. Both morphologies have the potential to cause hip impingement and the symptoms associated with FAI syndrome.
CT and MRI scans may also be useful in determining how much, if any, damage has been done to the cartilage of the hip. This may help explain the severity of the symptoms and assist in prognosis.
It is possible to have a CAM or Pincer morphology on imaging without any symptoms. However, if there are no symptoms or clinical findings associated with the imaging findings it is not considered FAI syndrome.
Management
Education
Education on load management and activity/lifestyle modification is particularly important. Simple strategies to avoid positions or postures of aggravation, such as avoiding low seats, may assist in settling the pain. Each individual may have different aggravating activities so your physiotherapist will be able to help identify these and then put in place strategies to help manage them.
Exercise Rehabilitation
Exercise aims to reduce an individual’s symptoms by improving hip stability, control, and movement. Exercises should be targeted at the muscle deficits and imbalances found during the physical assessment. These may include strengthening, stretching, or proper activation of muscles around the hip, pelvis, and lower back. Exercises should be guided by the individual’s symptoms to ensure they are not causing impingement.
Soft Tissue Therapy
Often muscle spasm and tightness are present during FAI syndrome as a result of muscle imbalances and pain. It is important to correct these issues around the hip, pelvis, and lower back to optimise hip movement and control. Massage, trigger point release, and dry needling are effective interventions to resolve spasm and tightness.
Anti-inflammatories
Oral anti-inflammatories or cortisone may be considered if there is a large amount of inflammation contributing to the pain. The aim will be to reduce the inflammation to allow the individual to move and exercise more to try and address some of the muscle imbalances and control. This will need to be discussed with and facilitated by a doctor.
Surgery
Often surgery is considered after conservative therapy as it is more aggressive, invasive, and there is no high-quality evidence showing superior outcomes for surgery. The aim of surgery is to correct hip morphology and repair any damage to allow for impingement free movement. Physiotherapy will be important for rehabilitation post-surgery.
Prognosis
Individual’s treated for FAI syndrome frequently see improvements in symptoms and a return to full activity, including sports. Those that go untreated often see a gradual increase in symptoms and decline in function. The long-term outlook for individual’s is currently unknown, however CAM morphology appears to be associated with the formation of hip osteoarthritis.
See A Physiotherapist
If you or someone you know is experiencing symptoms like the ones described today your first step should be to book in to see a physiotherapist. Left untreated symptoms can gradually progress over time. So, if you want expert and personalised care book in to see one of our physiotherapists at Peak Physio in Newcastle today.