1. Femoral Acetabular Impingement

2. Normal Anatomy Acetabulofemoral joint synovial joint
Articulation between the acetabulum and femoral head
Fibrocartilage called the labrum rings around the acetabulum
Deepens acetabulum improving stability
Hip is a very stable joint
During hip flexion the femoral rolls superiorly and the femoral neck moves closer to the acetabulum

3. Pathology
Osseous abnormality that can lead to labral or acetabular cartilage damage
Femur coming into contact with the acetabulum

4. Mechanism of Injury Insidious Traumatic Osseous morphology abnormality
Abnormal bone growth following fracture

5. Classification Cam Impingement Pincer Impingement Combined Impingement
Most common isolated FAI
Typically seen in young adult men 20 – 30
Loss of normal anterolateral femoral head-neck contour
Non spherical portion of the femoral head produces a shear force at the chondrolabral junction as it enters the acetabulum during hip flexion
Repetitive shearing results in chondrolabral separation, acetabular chondral delamination from subchondral bone and labral detachment
Pincer Impingement
Typically seen in women 30 – 40
Acetabular over coverage
Causes compression of the labrum against the femoral neck in hip flexion and internal rotation
Leads to labral degeneration
Combined Impingement
Most common form of FAI
Components of both cam and pincer morphology

6. Associated Pathology
Osteoarthritis
Labral Tear

7. Subjective Examination
Inguinal pain
“C-Sign” – cup their hand around the anterior hip region
May refer to greater trochanter or buttocks
Insidious onset of symptoms
Anterior pinching sensation in flexion, adduction, internal rotation
May report sharp pain with clicking and giving way
Worse with flexion, adduction and internal rotation activities
Worse with rotation and pivoting athletic positions
Pain with prolonged sitting, standing and walking

8. Objective Examination
Restricted flexion and/or internal rotation
Grinding or popping sensation in the hip on testing

9. Special Tests Flexion Adduction Internal Rotation Test (FADIR)
Flexion Internal Rotation Test
Thomas Test
Flexion Abduction External Rotation Test (FABER)

10. Further Investigation
X-ray CT
MRI

11. Management
Conservative management usually attempted first for 8-10 weeks
Should symptoms not change surgery is required to correct anatomical/bony abnormalities

12. Conservative Reduce pain and inflammation
NSAID’s
Ice
Massage
Rest from aggravating activities for positions
Restore Normal Range of Movement
Lumbar spine, Hip
Joint mobilisation
Joint manipulation
Stretches N.B stretches should not replicate clients symptoms

13. Conservative Reduce pain and inflammation
NSAID’s
Ice
Massage
Rest from aggravating activities for positions
Restore Normal Range of Movement
Lumbar spine, Hip (Posterior capsule)
Joint mobilisation
Joint manipulation
Stretches N.B stretches should not replicate clients symptoms

14. Conservative Restore Normal Muscle Activation
Hip Flexors
Hip Extensors and Abductors
Deep Hip Rotators
Restore Dynamic Stability
Proprioceptive Training
Sport Specific Training

15. Plan B
Surgery
Different types of surgery depending on arthroscopic findings and surgeon preference
Acetabular rim resection
Labral debridement
Labral repair
Femoroplasty

16. References
Anderson, C. N., G. M. Riley, G. E. Gold and M. R. Safran (2013). "Hip- femoral acetabular impingement." Clin Sports Med 32(3):
Cheatham, S. W., K. R. Enseki and M. J. Kolber (2016). "The clinical presentation of individuals with femoral acetabular impingement and labral tears: A narrative review of the evidence." J Bodyw Mov Ther 20(2):
Hendry, D., E. England, K. Kenter and R. D. Wissman (2013). "Femoral acetabular impingement." Semin Roentgenol 48(2):
Reiman, M. P., R. C. Mather and C. E. Cook (2015). "Physical examination tests for hip dysfunction and injury." British Journal of Sports Medicine 49(6):
Tijssen, M., R. E. van Cingel, E. de Visser, P. Holmich and M. W. Nijhuis-van der Sanden (2016). "Hip joint pathology: relationship between patient history, physical tests, and arthroscopy findings in clinical practice." Scand J Med Sci Sports.