Diseases

Femoro-Acetabular Impingement – Causes, Symptoms & Treatment

Femoro-Acetabular Impingement

Femoro -acetabular impingement is a painful narrowing of the hip joint space. Young athletes are particularly affected by the syndrome.

What is Femoro-Acetabular Impingement?

Doctors also refer to femoro-acetabular impingement ( FAI ) as hip impingement . What is meant by this is the presence of a constriction between the hip socket and the femoral head. Due to the constriction, the bones collide during strong flexions.

This in turn creates the risk that structures close to the joint, such as cartilage or joint lips, are pinched or damaged. This results in severe pain in the groin area . A distinction is made between two forms of femoroacetabular impingement. These are the pincer impingement hip (pincer-FAI) and the cam impingement hip (cam-FAI).

In a pincer impingement hip , the femoral neck has a normal configuration while the acetabulum is deformed and resembles a pincer. In this way, the femoral head is literally “held in the pliers”. Because the head of the joint is therefore covered more, this easily leads to the socket roof and the hip joint head hitting each other. Pincer hip impingement is most common in women between the ages of 30 and 40.

We talk about a cam impingement hip when the natural waisting of the hip joint head, which provides more freedom of movement, is no longer available due to a growth. A bony bulge narrows the joint space, which promotes the painful rubbing of the socket roof and the head of the femoral neck. This happens especially in young men who are active in sports. Soccer players in particular suffer from this FAI form.

causes

Femoro-acetabular impingement usually occurs due to a bony deformity of the acetabulum (hip socket roof). The pelvic bone (os ileum) forms a joint socket that resembles a bowl. Together with the femoral hip joint head, it forms the hip joint.

If bone spurs form on the bony parts of the hip joint, this often leads to mechanical narrowing. Young people who are active in sports often suffer from femoro-acetabular impingement because they often subject the hip joint to increased physical stress. However, the exact cause of numerous cam impingement and pincer impingement cases could not be clarified.

However, the bony structural changes can usually be detected in the majority of patients. A conceivable explanation for the development of femoro-acetabular impingement is growth disorders in adolescence, which lead to defective closure of the growth plates.

Symptoms, Ailments & Signs

In many cases, the symptoms caused by femoroacetabular impingement are only insidious. They sometimes show up as sporadic pain in the hip joint . The pain radiates into the thigh. The symptoms are further aggravated by stress.

Many patients also have problems driving a car when they are in a sitting position and climbing stairs. Rotating the bent leg inwards often results in pain as well, which often causes those affected to adopt a relieving posture by rotating the painful leg outwards.

In some cases, patients also experience dull hip pain during intercourse or restricted hip movement when flexed. If the affected person stands or walks for a long time, this can also cause pain. Coxarthrosis sets in in most patients in the late stage of femoroacetabular impingement . Premature hip wear is also possible in younger people.

Diagnose

If there is a suspicion of femoro-acetabular impingement, the affected person should contact an orthopedist . He first looks at the medical history and wants to know which sports the patient does, what movement restrictions occur and whether the pain was caused by an injury. After taking the medical history, the doctor performs a physical exam.

To test hip mobility, the patient has to put his leg in different positions. If the orthopedist presses the leg against the edge of the hip socket, this usually leads to pain. Another important examination is the taking of X-rays . The images enable precise detection of structural changes in the bone.

Using magnetic resonance imaging (MRT), it is also possible to precisely depict the soft tissues surrounding the hip. About 70 to 80 percent of femoroacetabular impingement takes a positive course. After about 6 to 12 weeks, you can usually do light sporting activities again. However, around 15 to 20 percent of all patients suffer from residual symptoms.

complications

Femorocetabular impingement occurs primarily in young people who are physically active. In most cases, the diagnosis is delayed because the symptoms are ambiguous and increase and become more frequent over time. Most of the time, however, there is sporadic pain in the hip joint, which can also occur in the form of rest pain without strain.

If the affected person puts additional strain on the respective areas, the pain increases even further and can thus severely affect the patient’s life, so that many postures of the body lead to pain. This includes, for example, climbing stairs or sitting down while driving, which is why the affected person suffers from severe mobility restrictions. Many people also suffer from psychological problems if the restrictions on movement appear at a young age.

The pain can be treated with painkillers without any further complications. However, patients should avoid long-term use of painkillers. Exercises and therapies also help against the symptoms and can fight the disease. However, many patients also suffer from residual symptoms and minor pain after the treatment. It is often no longer possible to carry out sporting activities.

When should you go to the doctor?

Since this disease does not usually heal itself and the symptoms continue to increase in most cases, a doctor should always be consulted. In this way, further complications or even permanent movement restrictions can be avoided.

A doctor should be consulted if the person affected suddenly and without any particular reason experiences severe pain in the hip joint. This pain can occur in the form of rest pain or stress pain and have a very negative effect on the quality of life and everyday life of the person concerned.

The pain can occur especially when sitting. Furthermore, the doctor should also be consulted if there are restrictions in movement. This wears down the hip faster, which can lead to further complications. The disease is usually diagnosed and treated by an orthopedist .

Some of those affected are dependent on surgical interventions, although most of the symptoms can be reduced with the help of exercises and therapies. Sporting activities should be restricted when the disease occurs. As a rule, this does not reduce the life expectancy of the person affected.

Treatment & Therapy

Surgery is usually required to correct the cause of femoro-acetabular impingement. In the early stages, conservative methods are primarily used to relieve the pain. For this purpose, the patient is given painkillers such as ibuprofen or acetylsalicylic acid .

Electrotherapy , baths, applying fango packs and carrying out specific physiotherapy exercises are also considered to be helpful . As part of an operative therapy, a hip arthroscopy (hip joint reflection) is usually carried out.

With this procedure, the structural changes in the bone can be eliminated. If it is possible to correct the mechanical narrowing through the operation, this leads to an improvement in the pain in most cases. Hip arthroscopy is particularly recommended for young patients because it reduces the risk of joint stiffness.

Outlook & Forecast

In a large number of patients, femoroacetabular impingement shows a favorable disease course and a good prognosis. Most patients can be discharged from treatment cured within three months. Nevertheless, a restructuring of the usual physical activities is often necessary.

The disease mainly occurs in people who are very active in sports. To prevent the symptoms from returning, the activities or the exercise of individual movement sequences should be changed and optimized. This can result in discontinuation of the practice of the usual sports.

A little more than twenty percent of those affected complain of long-term consequences, despite considerable efforts to recover. The symptoms do not completely regress with them. You get a less favorable prognosis. There is a risk of a chronic course of the disease. In addition, the restrictions on everyday processes are significantly increased for them.

Pain at rest and the necessary life changes can create complications in these patients. There is a risk of psychological problems that can trigger secondary diseases. This worsens the overall prognosis for the patient.

In exceptional cases, the patient receives a poor prognosis. If it becomes apparent during the treatment that a stiffening of the joint is necessary, healing can no longer take place. This step takes place when the symptoms continue to spread or increase despite adequate treatment.

prevention

In order to prevent symptoms caused by femoro-acetabular impingement, it is advisable to exercise moderately. While exercise is not the cause, it often causes the associated pain.

aftercare

In most cases, there are no aftercare measures available to those affected by this disease. The person concerned is primarily dependent on a quick and, above all, early diagnosis and subsequent treatment, so that further complications or worsening of the symptoms can be avoided. The focus of this disease is therefore early detection and further treatment.

The earlier it is recognized by a doctor, the better the further course is, since self-healing cannot occur. The treatment of this disease is primarily through the use of medication. The person concerned should definitely pay attention to the correct dosage and continue to take it regularly.

However, long-term use of painkillers should be avoided. Furthermore, physiotherapy measures often have a positive effect on the course of the disease. The person concerned can also carry out many exercises from such a therapy at home and thus increase the movement of the muscles again. The life expectancy of those affected is usually not reduced by this disease.

You can do that yourself

Despite reluctance, the patient should always pay attention to the needs of his body and react accordingly. If pain occurs, sporting activities or vigorous physical activity should be reduced and stopped immediately. It is important to protect the body in order not to trigger any further complications.

In many cases it is helpful if help is sought to stabilize the psyche . Cognitive methods for realigning existing attitudes and relaxation techniques have proven their worth . Methods such as yoga , autogenic training or meditation can reduce stress and create an inner balance.

Discussions with therapists , mentors or relatives often help to get new impetus for dealing with the disease. In forums or self-help groups, experiences are exchanged and tips are given for overcoming the challenges of everyday life. The patient should maintain a positive attitude.

Although the activities you love can no longer be carried out, new possibilities arise that also contribute to a strengthening of well-being. Adequate protective clothing must be worn when exercising. Knee and elbow pads and bandages stabilize the body and have a positive impact on health. If swelling occurs, the affected person should immediately cool the region with gel pads. Cooling ointments such as aloe vera gel are also helpful .

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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.