A 24-year-old recreational soccer player is referred to physical therapy by a general practitioner with a diagnosis of "hip pain." The patient reports that she has had left hip pain which has been progressively increasing over the past 4 years. She reports the primary location of pain has been in the front of the hip with an occasional "piercing sensation deep inside." She cannot recall a specific injury to the joint, although her pain worsened approximately 2 months ago during a soccer game when her hip went into extreme flexion. She now has pain especially when lifting her leg to get out of bed or out of a car. In addition to an intensification of her hip pain, she now notices a "catching" sensation as she moves her hip around. She has been unable to play soccer for 2 months and there has been no improvement in her symptoms. When asked to point to the location of the pain, she makes a "C" with her thumb and fingers and grabs her hip, digging her fingers into her anterior hip. Based on the patient's history, the physical therapist suspects femoroacetabular impingement with an acetabular labral tear.
What examination signs may be associated with this suspected diagnosis?
What are the most appropriate examination tests?
What is her rehabilitation prognosis?
What are possible complications that may limit the effectiveness of physical therapy?
ACETABULAR LABRUM: Fibrocartilaginous ring around the rim of the acetabulum that can become damaged during femoroacetabular impingement; often the source of pain in symptomatic patients with femoroacetabular impingement1,2
CAM IMPINGEMENT: Femoroacetabular impingement caused by a cam or egg-shaped deformity of the femoral head
COMBINATION IMPINGEMENT: Femoroacetabular impingement caused by a combination of cam and pincer impingements
FEMOROACETABULAR IMPINGEMENT (FAI): Condition in which the femoral head and/or neck makes excessive contact with the acetabulum
PINCER IMPINGEMENT: Femoroacetabular impingement caused by a retroverted acetabulum that creates excessive anterior coverage of the femoral head
Describe femoroacetabular impingement and identify potential risk factors associated with this diagnosis.
Describe the clinical examination for the patient with suspected FAI, including special tests and their associated diagnostic accuracy.
Prescribe appropriate joint range of motion and/or strengthening exercises for a patient with FAI.
Provide appropriate medical referral for the patient with suspected FAI.
PT considerations during management of the individual with a suspected diagnosis of femoroacetabular impingement:
- General physical therapy plan of care/goals: Decrease pain; increase lower quadrant strength; increase hip range of motion as tolerated; prevent or minimize loss of aerobic fitness capacity
- Physical therapy interventions: Patient education regarding functional anatomy and injury pathomechanics; modalities and manual therapy to decrease pain; resistance exercises to increase muscular endurance capacity of the ...
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