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Cheatography

Femoroacetabular Impingement (FAI) Cheat Sheet (DRAFT) by

Presentation, Management etc

This is a draft cheat sheet. It is a work in progress and is not finished yet.

FAI

- Mismatch between head of the femur and acetab
- Common cause of labral injury due to repetitive abutment during terminal ROM
- Causes Chondr­olabral separa­tion, acetabular chondral delami­nation and labral detachment

Classi­fic­ation

Cam: Femoral head becomes non-sp­her­ical, decreased joint space. Can be caused by congenital variations of the femoral neck or disorders of the femoral neck (SCFE, Legg-C­alv­es-­Perth, post traumatic deformity) - More common in young men (20-30 years old)

Pincer: Cartilage overde­vel­opment on acetab­ulu­m/rim, usually on anteri­or-­sup­erior aspect. Usually in hyperm­obile patients, more common in women in their 3rd decade

Combined: Both - most common

Presen­tation

- Usually young and physically active
- Symptoms usually unilat­eral, but can be bilateral
- Insidious onset of dull/achy anterior hip/groin pain
- Radiates towards GT/lateral thigh
- Aggravated by prolonged periods of sitting, stair climbing, stressful activity (hip flexio­n/r­ota­tion)
- Limited Hip ROM can have clicki­ng/­popping
- Abnormal hip movement while walkin­g/s­qua­tting
- Hip flexor tightness
- +ve Quadrant test, +ve roll test, +ve FAIR, +ve FABRE
- Pain caused by pincer type is provoked by hip ext + Ext rot

Imaging

- X-ray showing combined FAI
- Usually needed as clinical evaluation is inadequate
- US for labral tear/ other structures of the hip
- MRI only if surgical interv­ention / elimin­ating non-FAI hip pain

DDx

- Labral Tear
- OA
- Lx radicu­lopathy
- GTPS
- Psoas muscle strain
- Adductor tendin­opathy
- Ischio­femoral imping­ement
- AIIS and Subspine Imping­ement
- Iliopsoas impingment
- GT - Pelvic imping­ement
- Hip dysplasia
- Osteon­ecrosis
- Stress f#
- Snapping iliopsoas
- Inguin­al/­femoral hernia
- Tumour
- Infection
- Neoplasm
- SCFE
- LCPD
- Inflam­matory arthro­pathy
- AVN

Management

- Avoid aggrav­ating activities (usually squats)
- Avoid hip flexio­n/i­nternal rot
- SMT of Lx and SI
- Gentle, passive hip mobili­sat­ion­/di­str­action
- Avoid stretc­hin­g/PROM exercises
- Core and Glut med streng­thening
- Posterior Pelvic tilt exercises
- NSAID use
- Surgery interv­ention is considered if no improv­ement with conser­vative care