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Femoroacetabular impingement


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Femoroacetabular impingement

  2. 2. Femoroacetabular impingement (FAI) • An impingement of the chondro-labral structures between the femur and acetabulum. Whilst the diagnosis of femoroacetabular impingement has only recently gained attention, it is more common in the athletic population. particularly athletes who participate in sports which require them to frequently move into a position of internal rotation and flexion. • This makes it an important diagnosis for the sports physiotherapist to be aware of FAI management and the best practice.
  3. 3. TYPES OF FAI
  4. 4. • Cam impingement occurs when the patient has an aspherical femoral head and there is an abnormal head/neck junction with an increased radius at the waist. At extremes of ROM this will result in femoral abutment causing sheer stress on the articular cartilage and a subsequent labral tear or detachment.
  5. 5. Computed tomography 3-dimensional reconstructed images of right and left hips, demonstrating small protuberances of the femoral head-neck junction (arrows) that can be seen in cam-type femoroacetabular impingement (right greater than left).
  6. 6. • Pincer impingement occurs when the patient has excessive acetabular coverage (or “over coverage”). This over coverage will cause femoral abutment against the chondrolabral tissues at extremes of ROM.
  7. 7. • MIXED: The majority of cases are a mixed presentation of both
  9. 9. PHYSIOTHERAPY MANAGEMENT The aims of physiotherapy are initially antiinflammatory in nature. This includes • rest from aggravating activities • electrophysical modalities. • Pelvic/Gluteal Strengthening • Core Stability(global muscle ) Strengthening • Gentle!!! Stretching • Mulligan (lateral hip distraction) techniques are useful (anecdotally)
  10. 10. The real take home messages from this PRESENTATION is that: • FAI should be considered as a cause of groin pain, particularly in an athletic population • Early and correct clinical diagnosis is essential (remember to rule out competing hypotheses) • Radiography should progress from initial X-ray to MR arthrography to fully assess pathology • The athlete should be educated on the usual clinical pathway of FAI (low response to conservative management) • The athlete should undertake a short term conservative trial • Surgical interventions should be considered early, given conservative treatment failure, as development of OA will decrease probability of successful outcome • Arthroscopic decompression will allow the majority of professional athletes to return to play.
  11. 11. REFERENCES • • • • • • • • • Bedi A, Chen N, Robertson W, Kelly BT. The management of labral tears and femoroacetabular impingement of the hip in the young, active patient. Arthroscopy. 2008;24(10):1135-1145. Byrd JWT, Jones KS. Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients. Am J Sports Med 2004;32(7):1668–74. Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H. Clinical Presentation of Patients with Symptomatic Anterior Hip Impingement. Clin Orthop Relat Res. 2009 March; 467(3): 638–644. Czerny C, Hofmann S, Neuhold A, et al. Lesions of the acetabular labrum: accuracy of MR imaging and MR arthrography in detection and staging. Radiology 1996;200:225–30. Keeney JA, Peelle MW, Jackson J, et al. Magnetic resonance arthrography versus arthroscopy in the evaluation of articular hip pathology. Clin Orthop 2004;429:163–9. Keogh MJ, Batts ME. A Review of Femoroacetabular Impingement in Athletes. Sports Med 2008; 38 (10): 863-878 Phillipon M, Schenker M, Briggs K, Kuppersmith D. Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression. Knee Surg Sports Traumatol Arthrosc (2007) 15:908–914 Ng VY, Arora N, Best TM, Pan X and Ellis. TJ Efficacy of Surgery for Femoroacetabular Impingement : A Systematic Review Am J Sports Med 2010 38: 2337 Manaster BJ, Zakel S. Imaging of Femoral Acetabular Impingement Syndrome. Clin Sports Med 25 (2006) 635–657
  12. 12. REFERENCES • • • • • • Burnett RS. Della Rocca GJ. Prather H. Curry M. Maloney WJ. Clohisy JC. Clinical presentation of patients with tears of the acetabular labrum. Journal of Bone & Joint Surgery - American Volume. 88(7):1448-57, 2006 Jul. Ganz R. Parvizi J. Beck M. Leunig M. Notzli H. Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clinical Orthopaedics & Related Research. (417):112-20, 2003 Dec. Wenger DE. Kendell KR. Miner MR. Trousdale RT. Acetabular labral tears rarely occur in the absence of bony abnormalities. Clinical Orthopaedics & Related Research. (426):145-50, 2004 Sep. Trousdale RT. Acetabular osteotomy: indications and results. Clinical Orthopaedics & Related Research. (429):182-7, 2004 Dec. Garbuz DS. Masri BA. Haddad F. Duncan CP. Clinical and radiographic assessment of the young adult with symptomatic hip dysplasia. Clinical Orthopaedics & Related Research. (418):18-22, 2004 Jan. Sanchez-Sotelo J, Trousdale RT, Berry DJ, Cabanela ME. Surgical Treatment of DDH in Adults: I NonArthroplasty Options and II Arthroplasty Options JAAOS 2002; 10(5): 321-344.