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SPRING MSK II - Exam 2 > Pelvis and Hip - FAI > Flashcards

Pelvis and Hip - FAI Flashcards

1
Q

What is a femoral actabular impingement?

A

Abnormal hip joint morphology or bony shape and arangement
- symptomatic contact between proximal femur and acetabulum

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2
Q

What are some functional questionnaires for femoral acetabular impingement syndrome?

A
  • HOS ( hip outcome score) ADL and Sport Related Activities
  • HAGOS (Copenhagen Hip and Groin Outcome Score)
  • iHOT 33 (International Hip Outcome Tool)
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3
Q

What gender is femoral acetabular impingement syndrome more common in?

A

Biological males more than females

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4
Q

What makes the prevalence of femoral acetabular impingement syndrome higher?

A
  • vigorous or end range activities such as dance
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5
Q

Can you be born with femoral acetabular impingement syndrome?

A

YES

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6
Q

Can femoral acetabular impingement syndrome be present without symptoms?

A

YES

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7
Q

What are risk factors for femoral acetabular impingement syndrome?

A
  • Genetics and biological sex
  • Susceptible populations and activities
  • Abnormal hip/pelvic kinematics
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8
Q

What about genetics and biological sex increase the risk for femoral acetabular impingement syndrome?

A
  • abnormal bony morphology
  • higher risk for siblings
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9
Q

What susceptible populations and activities increase the risk of femoral acetabular impingement syndrome?

A
  • vigorous loading in athletics
  • use of excessive motion
  • pediatric hip conditions (i.e. Legg-Calve Syndrome)
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10
Q

What are some abnormal hip/pelvic kinematics that can be risk factors for femoral acetabular impingement syndrome?

A
  • anterior pelvic tilt position
  • limited posterior tilt that may also limit the coupled hip ER
  • Excessive hip adduction
  • Limited hip IR but this is more likely due to bony abutment than capsular tightness
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11
Q

What is the etiology of femoral acetabular impingement syndrome?

A

Largely unknown

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12
Q

What is the etiology of femoral acetabular impingement syndrome MORE often?

A
  • abnormal hip mechanics
  • vigorous athletic loading
  • combo of both above
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13
Q

What is the etiology of femoral acetabular impingement syndrome LESS often?

A
  • slipped capital femoral epiphysis
  • femoral neck fx and/or malunion
  • Legg-Calve-Perthes’ Disease - avascular necrosis
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14
Q

What are the 3 congenital type of FAIS?

A
  • CAM
  • Pincer
  • Combination of the two
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15
Q

What is a CAM impingement caused by?

A
  • less spherical femoral head
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16
Q

Where does the head contact the acetabulum with a CAM impingement?

A
  • Head contact anterosuperior acetabulum or 12 o’clock position
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17
Q

What gender is a CAM impingement more common in?

A

Biological Males

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18
Q

What can we find with radiology of a CAM impingement?

A
  • 37% presence in general population without pain
  • 55% presence in athletes without pain
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19
Q

What causes a pincer impingement?

A

deeper acetabulum or anterior osteophyte

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20
Q

Where does the neck contact the acetabulum with a Pincer impingement?

A
  • neck primarily contacts anterosuperior but may also contact posterior labrum (countercoup phenomenon)
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21
Q

What population is a Pincer impingement most common in?

A
  • Middle aged athletic and biological females
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22
Q

What structures are involved with femoral acetabular impingement syndrome?

A
  • articular cartilage
  • Labral

** WITH or WITHOUT age-related joint changes/labral tears

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23
Q

What makes up the labrum?

A

type I collagen

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24
Q

Is femoral acetabular impingement syndrome gradual or traumatic?

A

Most often insidious or gradual

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25
Q

What can happen along with femoral acetabular impingement syndrome?

A

Labral tears

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26
Q

When should we consider a labral tear with femoral acetabular impingement syndrome?

A
  • in active individuals with mechanical groin pain without alternative radiological diagnosis
27
Q

What percentage of athletes have labral tears with groin pain?

A
  • 20%
28
Q

What percentage of people with hip AND groin pain have labral tears?

A

55%

29
Q

What are the pathomechaics of femoral acetabular impingement syndrome?

A
  • mechanical impingement leading to degenerative cascade of events
30
Q

What are symptoms of femoral acetabular impingement syndrome?

A
  • gradual onset of hip pain into the anterior hip/groin (deep pinch)
  • worsened with repetitive and/or prolonged hip flexion (squatting, stairs and prolonged sitting / bony CPP)
  • groin pain
  • lateral hip pain possible
31
Q

What is the sens and spec for groin pain for femoral acetabular impingement syndrome?

A

100% sens 4% spec

32
Q

What is there minimal or no support of for symptoms of femoral acetabular impingement syndrome?

A
  • clicking or locking
33
Q

What are signs of femoral acetabular impingement syndrome we will see in observation?

A
  • impaired LE control
34
Q

What are functional tests for femoral acetabular impingement syndrome?

A
  • impaired balance and LE control
  • Quad dominant squatting pattern
35
Q

What will/can we find with A/PROM with femoral acetabular impingement syndrome?

A
  • primarily pain and loss of motion with flexion to ~90˚, IR <20˚@ 90 degrees of hip flexion and/or hip adduction
36
Q

What can be limited between sides with femoral acetabular impingement syndrome?

A
  • abduction and dysplasia if > 20˚ difference between sides
37
Q

What can be present where hip deviates into abduction while moving into flexion at ~100˚ of flexion?

A

Hip maltracking

38
Q

What is the LARGEST predictor of groin pain?

A
  • <85˚ total rotation at 90˚ flexion
39
Q

Is there an association between limited ROM and type of impingement?

A

NO

40
Q

What will we find in our resisted/MMT with femoral acetabular impingement syndrome?

A
  • Decreased activation of G. Med and Max and ERs
  • Weak ER and ABD in chronic conditions
41
Q

What will we find with combined motions with femoral acetabular impingement syndrome?

A
  • possibly consistent block
42
Q

What will we find with stress tests with femoral acetabular impingement syndrome?

A
  • compression possibly positive
  • distraction possibly relieving
43
Q

What will we find with accessory motion with FAIS?

A

-possibly hypomobile

44
Q

What special tests are there for femoral acetabular impingement syndrome?

A
  • FIR, FADDIR, FABER likely positive
  • ligamentum teres test possibly positive
  • possible positive femoral torsion
45
Q

What will we find with palpation with FAIS?

A
  • TTP over anterior hip joint at 12 o’clock region
46
Q

What are some differential diagnoses for FAIS?

A
  • no specifics from CPG summary
  • Consider age-related joint changes, hypermobility and IPI as discussed later
47
Q

What is the PT rx for FAIS?

A
  • POLICED
  • Load management including cross training
  • Orthotics
  • Pt education
48
Q

What orthotics can help FAIS?

A
  • foot: limits hip add/IR
  • hip: conflicting evidence and NO recommendation
49
Q

What can we do as far as patient education with femoral acetabular impingement syndrome?

A
  • limit hip flexion less than 90˚
  • verbal cues for LE control
50
Q

What should be the recommended instruction for sitting with FAIS?

A
  • sit with hips higher than knees
51
Q

What are some impingement seated positions with FAIS?

A
  • sit for prolonged periods
  • sit with crossed legs
  • sit with forward lean trunk
52
Q

What are JM for with femoral acetabular impingement syndrome?

A

cartilage integrity and possibly mobility

53
Q

What is MET for with femoral acetabular impingement syndrome?

A
  • primarily for cartilage integrity, muscle function, and possibly mobility
  • hip and core strengthening over 10-12 weeks provided the MOST effective treatment
  • emphasize LE control
54
Q

What provides significant clinical improvement but no better than advice and a HEP?

A
  • Combo of JM and MET
55
Q

What is the prognosis of femoral acetabular impingement syndrome?

A
  • little more than 50% report satisfactory outcome with PT
56
Q

What percentage of athletes return to play through PT with labral tears?

A

66%

57
Q

What is related to a poor prognosis with femoral acetabular impingement syndrome?

A

the presence of age-related joint changes

58
Q

What do we know about oral medications for femoral acetabular impingement syndrome?

A

no quality studies

59
Q

What do we know about injections for femoral acetabular impingement syndrome?

A
  • viscosupplementation injection - pain more than benefits at 2 weeks and in some cases up to 12 months
  • corticosteriods = pain more than functional benefits at 2 weeks, benefits last up to 12 weeks
  • orthobiologic = regenerative, no quality studies
60
Q

What is the surgery for femoral acetabular impingement syndrome?

A

Open or arthroscopy

61
Q

What does an open or arthroscopy for FAIS do?

A
  • bony and labral modifications
62
Q

Is there evidence to suggest surgery is better than PT?

A

NO

63
Q

What should we know about an arthroscopy for femoral acetabular impingement syndrome?

A
  • requires high skill
  • labral reconstruction for athletes
  • 75-93% success rate
  • complication rate .5-5%

SPRING MSK II - Exam 2 (6 decks)

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