What is Femoral Acetabular Impingement (FAI) and how do I treat it?
FAI is short for “Femoro-Acetabular Impingement” and is a painful condition effecting the hip joint. It is caused by an abnormal bony collision between the neck of the femur and the edge of the hip joint. It often causes tearing of a cartilage structure in the joint called the acetabular labrum. FAI is thought to be a significant risk factor for developing arthritis of the hip joint.
PREVALENCE
Studies of people without hip pain have shown radiographic evidence of FAI in up to 19% of the population. Depending upon how the disease is studied prevalence values vary widely.
ANATOMY/PHYSIOLOGY
There are three types of FAI
1) Cam Type - a bony prominence at the head/neck junction of the femur causes the bony collision
2) Pincer type - an abnormally deep hip socket casues the acetabulum to contact the normal femoral neck during hip flexion
3) Mixed - the most common type of FAI this includes both a cam lesion and a pincer deformity creating impingement.
SYMPTOMS
Adam with a model (staff member) pointing to area’s of his/her hip; moving hip into flexion and internal rotation
Most patients with FAI symptoms describe anterior groin pain and sometimes pain that wraps around the entire hip joint or refers down the front of the thigh. Symptoms tend to be worse after activities that include hip flexion especially when coupled with internal rotation.
DIAGNOSIS
FAI can be diagnosed with a good clinical examination and can be supported by imaging.
On clinical exam, the patient typically describes the pain pattern described earlier.
They have a positive “impingement sign” which is a reproduction of the patient’s typical pain by flexing and internally rotating the hip.
They often show decreased mobility of the hip especially internal rotation and flexion.
The diagnosis can be confirmed with special x-rays aimed at discovering a cam or pincer deformity and/or an MRI that is performed to specifically look for markers of the condition.
PHYSIOTHERAPY TREATMENT
Many patients can manage their FAI and resolve their symptoms with Physiotherapy and modification of a few contributing activities.
Physiotherapy should focus on strength and motor control of the lower extremity and pelvis. Specifically, the patient should learn exercises that prevent valgus alignment of the leg when standing or squatting. To do this the therapist must first discover what is contributing to the poor lower extremity mechanics and skillfully prescribe exercises that will target the cause.
Commonly patients are found to have weak hip abductors and poor control of their pelvis in single leg stance.
Muscle length and endurance should also be evaluated.
It is important to improve movement quality using exercise but we also must eliminate some the impingement by modifying activities that include hip flexion including sitting positions, the patients exercise routine, work postures, sleep and driving positions.
SURGICAL TREATMENT
Some patients have large enough cam or pincer deformities that they still have symptoms even when their strength and control is great. For these patients the range of motion available at the joint is just not enough for them to be able to perform their regular activities without pain.
For these patients hip arthroscopy can help to eliminate symptoms. Typically, this involves a reshaping of the cam and/or pincer deformity as well as a repair or removal of the acetabular labral tear.
These surgeries are done to decrease symptoms. We do not yet know how arthroscopy effects the long-term prognosis for the patient.
Rehabilitation form a hip arthroscopy is considerable and usually takes form 5-10 months depending upon the severity of the problem.
At Cornerstone Physiotherapy in Toronto, North York and Burlington we effectively assess and treat FAI regularly. Contact us and see if we can help you!
24 июн 2020
