FAI - exam 2 Flashcards
what is femoral acetabular impingement (FAI)?
abnormal hip joint morphology or bony shape and arrangement
If FAI is symptomatic, what two structures are contacting?
proximal femur and acetabulum
who is more likely to get FAI?
males
higher with vigorous or end range activities (dance)
what are risk factors of FAI?
genetics and gender
- higher risk for sibling
susceptible populations and activities such as:
- vigorous loading in athletics
- use of excessive motion
- peds hip conditions
what are abnormal hip/pelvis kinematics that could be risk factors for FAI?
ant pelvic tilt
limited post tilt, may limit coupled hip ER
excessive hip adduction
limited hip IR (more likely due to bony abutment than capsular tightness)
although the cause of FAI is largely unknown, what are more often thought to be causes of FAI?
abnormal hip mechanics
vigorous athletic loading
combo of both above
what are less often causes of FAI?
slipped capital femoral epiphysis*
legg-calve-perthes’ disease*
femoral neck fx or malunion
- peds hip conditions
3 congenital types of FAI
1. Cam:
- _____ spherical femoral head
- head contacts _________ __________ (___ o’clock position)
- more common in _____
- less
- anterosuperior acetabulum or 12 o’clock
- males
is a cam FAI more present in general population without pain or athletes without pain? why?
athletes without P!
if you don’t go into end range positions a lot you may not get symptoms
overtime, what can a cam type FAI cause?
labrum tear
damage articular cartilage on femur head
3 congenital types of FAI
2. Pincer:
- deeper _______ or _______ ________
- neck primarily contacts _______ but may also contact ______. explain
- most common in _____
- acetabulum or anterior osteophyte
- anterior; posterior. impact on one side can cause rebound on the back side.
- middle aged athletic females
what is the 3rd and most common type of FAI?
mixed
what structures are involved with or without age related joint changes/labral tears?
articular cartilage damage (83%)
labral damage aka fibrocartilage (93%)
what is the labrum primarily made up of? can FAI cause gradual damage to the labrum?
type I collagen (resists tension)
yes, up to 75%
an active patient comes in complaining of mechanical groin pain with activity and without an alternative radiological dx. what should you consider has happened?
labral tears
20% of athletes w groin P!
55% prevalence in those with hip and groin P!
what is happening to cause FAI?
what other condition does this sound like?**
mechanical impingement leading to degenerative cascade of events
Shoulder impingement
Symptoms of FAI:
–worsened with:
–_________P! (100% specificity)
gradual onset of hip P! into ant. hip/groin (deep pinch)
–repetitive and/or prolonged hip flexion (squatting, stairs, and sitting) (bony CPP)
–groin P! (lateral hip P! possible)
A pt. with FAI will likely report clicking and/or locking ant. hip? T or F
False; minimal to no support
Signs of FAI:
-Observation
-Functional test
impaired LE control
impaired balance and LE control
Quad dominant squatting pattern
Signs of FAI:
-A/PROM
Primarily P! and loss of motion w/flex to 90º, IR <20º @ 90º of hip flexion and/or H add.
Possible limitation w/abd & dysplasia if >20º difference of hip flx and/or H Add.
Hip maltracking may be present - hip deviates into and while moving into flexion at 90º-100º flexion
<85º total rot. @ 90º flx is LARGEST predictor of groin P!
Signs of FAI:
resisted test/MMT:
CM:
Stress Tests:
decreased activation of G.Med and Max and ERs
—weak ER and Abd in chronic conditions
possibly consistent block
possibly (+) w/ compression; (-) with distx
Signs of FAI:
AM:
Special test:
Palpation:
possible hypomobile
FIR, FADDIR, FABER likey (+); possible (+) femoral torsion
TTP over ant. hip jt.@ 12oclock region
PT Rx: FAI
POLICED
-load management including cross training
-foot orthotics to limit hip add/IR
Pt. Education:
–limit hip flexion >90º
–verbal cues for LE control
JM for cartilage integrity & possibly mobility
MET:
–Primarily for cartilage integrity, mm. function, and possibly mobility (local mm./anti-gravity)
–empathize LE control
FAI prognosis:
66% return to play thru PT in athletes w/laberal tears (no sx)
ARJC poor prognosis (older pt.)
MD Rx:
Ultrasound/Fluoroscopic guided injections
Sx: open or arthroscopy for FAI
-iliopsoas release and/or labral address
—NO evidence to suggest sx is better than PT
Age-Related Jt. Change, what is happening?
lose GAGs; decreased hydration
articular cartilage is thinning. joint space narrow
doesn’t absorb shock well
Prevalence:
Most common cause of _________ P!
Up to 25% of ______
hip P!
adults
What are the structures involved with AJRC?
synovial membrane, joint capsule, articular cartilage, joint space, synovial fluid
Symptoms of ARJC:
like FAI plus BUT more of labrum, articular cartilage not primary structure
AM stiffness < 30 min
Less tolerant to WBing activities and sitting w/possibly limping (articular cartilage more shock absorbent)
C-sign of P! groin, lateral hip, and buttock; may even refer to knee
*maybe nociplastic
Trendelenburg gait the hip drops to ____________affected hip and pt. leans to ____________ side of the affected hip
contralateral; ipsilateral
Signs of AJRC:
planes?
capsular pattern?
CM -
Resisted/MMT-
Compression; Distx-
AM-
like FAI plus
≥3 planes of motion restricted (high specificity)
Inconclusive capsular pattern of restriction at the hip
CM - consistent block
Resisted/MMT: P! and possible weakness w/ABD (high specificity)
Compression- possibly (+); Distx possibly reliving (-)
AM- hypomobility
Specials Tests of AJRC?
OA CPR ≥ 3 present
-P! w/ squatting
-P! w/ hip flx
-P! w/ hip ext
-P! IR < 25º
-(+) Scour and FABER
OA Combined Results
-Hip P!
-IR < 15º
-IR P!
-AM stiffness < 60 min
->50 yrs. or age
Impaired functional performance testing
-6 min walk test
-Timed up and Go Test
Impaired balance test like Berg Balance Scale
PT Rx: ARJC
_________P!/inflammation: (3)
___________mod support: (4)
POLICED
Modalities for P!/Inflammation
–no more than 2 wks.
–only short-term P! influence
–assistive device to minimize/avoid limping
PT. education -mod support
–limit hip flexion >90º
–avoid low seats and sit on a wedge
–no knee to chest stretches
–Wt. management (10-20 lbs)
Left hip P! which UE would you use a cane? Why?
Right; increase base of support—> weak hip abductors on left so cane go in R.
PT Rx: ARJC
JM for:
MET primarily for:
cartilage integrity and mobility
–better than usual care out to 1 yr.
MET: mobility, cartilage integrity, and mm. function
**include trunk and hip anti-gravity mm. groups
**balance training as WBing is tolerated
**1-5x/wk for 6-12wks.
–effective for improving P! and function
–better than usual care out of 1 yr.
–mod support
–aerobic component beneficial
