Pelvis and Hip 2 Flashcards
what is femoral acetabular impingement
abnormal hip morphology or bony shape/arrangement
symptomatic contact between proximal femur and acetabulum
best functional questionairres for FAI
hip outcome score (HOS)
Copenhagen Hip and Groin Outcome Score (HAGOS)
Int’l Hip Outcome Tool (iHOT 33)
prevalence of FAI
Males > Females
higher with vigorous/end range activities like dance
risk factors for FAI
genetics and gender
abnormal bone morphology
higher risk for siblings if one has it
susceptible populations and activities for FAI
vigorous loading in athletics
use of excessive motion
pediatric hip conditions
what specific abnormal hip/pelvis kinematics are risk factors for FAI
lamen terms = occurs when femur and pelvis get closer together than they should
anterior pelvic tilt
limited post tilt that may also limit the coupled hip ER
excessive hip ADD
limited hip IR but this is more likely due to bony abutment than capsular tightness
more common etiology for FAI
abnormal hip mechanics
vigorous loading in athletics
combo of the above
less common etiology for FAI
slipped capital femoral epiphysis
femoral neck fx and or malunion
leg calve perthes disease - avascular necrosis
what is a cam type FAI and it’s prevalence
less spherical femoral head
head contacts the anterosuperior acetabulum or 12 oclock position
more common in males
37% presence in general population without pain
55% presence in athletes without pain
what is pincer type FAI
deeper acetabulum or anterior osteophyte
neck primarily contacts anterior but may also contact posterior labrum (countercoup phenomenon)
most common in middle aged athletic females
most common congenital type of FAI
mixed (pincer and cam)
structures involved with FAI
can be with or without ARJC/labral tears
83% with articular cartilage damage
93% with labral damage (primarily type I collagen); up to 75% insidious or gradual
when should labral tears be considered
in active individuals with mechanical groin pain without alternative dx
20% if althetes with groin pain
up to 55% prevalenc ein those with hip AND groin pain
pathomechanics of FAI
mechanical impingement leading to degenerative cascade of events
symptoms of FAI
gradual onset hip pain into anterior hip/groin (deep pinch)
worse with repetitive and or prolonged hip flexion (squatting, stairs, and prolonged sitting); bony closed packed position
groin pain
lateral hip pain possible
is clicking/popping a reliable symptom to diagnose FAI
minimal to no support of clicking or locking
observation of those with FAI
impaired LE control
functional tests with FAI
impaired balance and LE control
quad dominant squatting pattern
A/PROM for FAI
primarily pain and loss of motion with flex to 90, IR less than 20 at 90 hip flex, and/or horizontal add
possible limit with ABD and dysplasia of greater than 20 degree difference between sides
hip maltracking may be present where hip deviates into hip abduction while moving into flexion at 90-100 degrees of flexion
what is the largest predictor of groin pain
less than 85 degrees of total RT at 90 degrees felxion is the largest predictor (i.e. predicts FAI)
resisted/MMT findings for FAI
decreased activation of G med and max and ERs
weak ER and ABD in chronic conditions
combined motions finding for FAI
possibly consistent
stress tests for FAI
compression = possible + (mainly because of articular cartilage but some labrum too)
distraction = possibly relieving
accessory motion and special tests for FAI
AM = hypo mobile
Special tests:
-FIR, FADDIR, FABER likely +
-possible + femoral torsion
palpation findings for FAI
TTP over anterior hip joint at 12 oclock region
differential dx of FAI
no specifics from CPG summary
consider ARJC and IPI
PT Rx for femoral acetabular impingement
POLICED
load management including cross training
foot orthotics to limit hip ADD/IR
pt edu for FAI
limit hip flexion >90 (i.e. with seats, stretches, etc)
verbal cues for LE control
MT and MET for FAI
JM for cartilage integrity and possible mobility
MET for cartilage integrity, muscle function, and possible mobility
emphasize LE control (repetitively remind to maintain quality of movement pattern)
prognosis for FAI
66% return to play thru PT in athletes with labral tears (no sx)
presence if ARJC is a poor prognosis
MD Rx for FAI
ultrasound/fluoroscopic guided injections
sx- open or arthroscopy
what may occur during a arthroscopy for FAI and what is the effectiveness of sx
iliopsoas release and/or labral address
no evidence to suggest sx is better than PT
characteristics and statistics regarding arthroscopy for FAI
requries high skill
labral reconstruction for athletes
75-93& success rate
complication rate = 5.5%
