Cheatography
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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 |
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