Pelvis and Hip 2

Question 1

what is femoral acetabular impingement

Answer 1

abnormal hip morphology or bony shape/arrangement

symptomatic contact between proximal femur and acetabulum

Question 2

best functional questionairres for FAI

Answer 2

hip outcome score (HOS)

Copenhagen Hip and Groin Outcome Score (HAGOS)

Int’l Hip Outcome Tool (iHOT 33)

Question 3

prevalence of FAI

Answer 3

Males > Females

higher with vigorous/end range activities like dance

Question 4

risk factors for FAI

Answer 4

genetics and gender

abnormal bone morphology

higher risk for siblings if one has it

Question 5

susceptible populations and activities for FAI

Answer 5

vigorous loading in athletics

use of excessive motion

pediatric hip conditions

Question 6

what specific abnormal hip/pelvis kinematics are risk factors for FAI

Answer 6

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

Question 7

more common etiology for FAI

Answer 7

abnormal hip mechanics

vigorous loading in athletics

combo of the above

Question 8

less common etiology for FAI

Answer 8

slipped capital femoral epiphysis

femoral neck fx and or malunion

leg calve perthes disease - avascular necrosis

Question 9

what is a cam type FAI and it’s prevalence

Answer 9

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

Question 10

what is pincer type FAI

Answer 10

deeper acetabulum or anterior osteophyte

neck primarily contacts anterior but may also contact posterior labrum (countercoup phenomenon)

most common in middle aged athletic females

Question 11

most common congenital type of FAI

Answer 11

mixed (pincer and cam)

Question 12

structures involved with FAI

Answer 12

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

Question 13

when should labral tears be considered

Answer 13

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

Question 14

pathomechanics of FAI

Answer 14

mechanical impingement leading to degenerative cascade of events

Question 15

symptoms of FAI

Answer 15

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

Question 16

is clicking/popping a reliable symptom to diagnose FAI

Answer 16

minimal to no support of clicking or locking

Question 17

observation of those with FAI

Answer 17

impaired LE control

Question 18

functional tests with FAI

Answer 18

impaired balance and LE control

quad dominant squatting pattern

Question 19

A/PROM for FAI

Answer 19

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

Question 20

what is the largest predictor of groin pain

Answer 20

less than 85 degrees of total RT at 90 degrees felxion is the largest predictor (i.e. predicts FAI)

Question 21

resisted/MMT findings for FAI

Answer 21

decreased activation of G med and max and ERs

weak ER and ABD in chronic conditions

Question 22

combined motions finding for FAI

Answer 22

possibly consistent

Question 23

stress tests for FAI

Answer 23

compression = possible + (mainly because of articular cartilage but some labrum too)

distraction = possibly relieving

Question 24

accessory motion and special tests for FAI

Answer 24

AM = hypo mobile

Special tests:
-FIR, FADDIR, FABER likely +
-possible + femoral torsion

Question 25

palpation findings for FAI

Answer 25

TTP over anterior hip joint at 12 oclock region

Question 26

differential dx of FAI

Answer 26

no specifics from CPG summary

consider ARJC and IPI

Question 27

PT Rx for femoral acetabular impingement

Answer 27

POLICED

load management including cross training

foot orthotics to limit hip ADD/IR

Question 28

pt edu for FAI

Answer 28

limit hip flexion >90 (i.e. with seats, stretches, etc)

verbal cues for LE control

Question 29

MT and MET for FAI

Answer 29

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)

Question 30

prognosis for FAI

Answer 30

66% return to play thru PT in athletes with labral tears (no sx)

presence if ARJC is a poor prognosis

Question 31

MD Rx for FAI

Answer 31

ultrasound/fluoroscopic guided injections

sx- open or arthroscopy

Question 32

what may occur during a arthroscopy for FAI and what is the effectiveness of sx

Answer 32

iliopsoas release and/or labral address

no evidence to suggest sx is better than PT

Question 33

characteristics and statistics regarding arthroscopy for FAI

Answer 33

requries high skill

labral reconstruction for athletes

75-93& success rate

complication rate = 5.5%