FAI - exam 2

Question 1

what is femoral acetabular impingement (FAI)?

Answer 1

abnormal hip joint morphology or bony shape and arrangement

Question 2

If FAI is symptomatic, what two structures are contacting?

Answer 2

proximal femur and acetabulum

Question 3

who is more likely to get FAI?

Answer 3

males
higher with vigorous or end range activities (dance)

Question 4

what are risk factors of FAI?

Answer 4

genetics and gender
- higher risk for sibling

susceptible populations and activities such as:
- vigorous loading in athletics
- use of excessive motion
- peds hip conditions

Question 5

what are abnormal hip/pelvis kinematics that could be risk factors for FAI?

Answer 5

ant pelvic tilt
limited post tilt, may limit coupled hip ER
excessive hip adduction
limited hip IR (more likely due to bony abutment than capsular tightness)

Question 6

although the cause of FAI is largely unknown, what are more often thought to be causes of FAI?

Answer 6

abnormal hip mechanics
vigorous athletic loading
combo of both above

Question 7

what are less often causes of FAI?

Answer 7

slipped capital femoral epiphysis*
legg-calve-perthes’ disease*
femoral neck fx or malunion

• peds hip conditions

Question 8

3 congenital types of FAI
1. Cam:
- _____ spherical femoral head
- head contacts _________ __________ (___ o’clock position)
- more common in _____

Answer 8

• less
• anterosuperior acetabulum or 12 o’clock
• males

Question 9

is a cam FAI more present in general population without pain or athletes without pain? why?

Answer 9

athletes without P!
if you don’t go into end range positions a lot you may not get symptoms

Question 10

overtime, what can a cam type FAI cause?

Answer 10

labrum tear
damage articular cartilage on femur head

Question 11

3 congenital types of FAI
2. Pincer:
- deeper _______ or _______ ________
- neck primarily contacts _______ but may also contact ______. explain
- most common in _____

Answer 11

• acetabulum or anterior osteophyte
• anterior; posterior. impact on one side can cause rebound on the back side.
• middle aged athletic females

Question 12

what is the 3rd and most common type of FAI?

Answer 12

mixed

Question 13

what structures are involved with or without age related joint changes/labral tears?

Answer 13

articular cartilage damage (83%)
labral damage aka fibrocartilage (93%)

Question 14

what is the labrum primarily made up of? can FAI cause gradual damage to the labrum?

Answer 14

type I collagen (resists tension)
yes, up to 75%

Question 15

an active patient comes in complaining of mechanical groin pain with activity and without an alternative radiological dx. what should you consider has happened?

Answer 15

labral tears

20% of athletes w groin P!
55% prevalence in those with hip and groin P!

Question 16

what is happening to cause FAI?
what other condition does this sound like?**

Answer 16

mechanical impingement leading to degenerative cascade of events
Shoulder impingement

Question 17

Symptoms of FAI:
–worsened with:
–_________P! (100% specificity)

Answer 17

gradual onset of hip P! into ant. hip/groin (deep pinch)

–repetitive and/or prolonged hip flexion (squatting, stairs, and sitting) (bony CPP)

–groin P! (lateral hip P! possible)

Question 18

A pt. with FAI will likely report clicking and/or locking ant. hip? T or F

Answer 18

False; minimal to no support

Question 19

Signs of FAI:
-Observation
-Functional test

Answer 19

impaired LE control

impaired balance and LE control
Quad dominant squatting pattern

Question 20

Signs of FAI:
-A/PROM

Answer 20

Primarily P! and loss of motion w/flex to 90º, IR <20º @ 90º of hip flexion and/or H add.

Possible limitation w/abd & dysplasia if >20º difference of hip flx and/or H Add.

Hip maltracking may be present - hip deviates into and while moving into flexion at 90º-100º flexion

<85º total rot. @ 90º flx is LARGEST predictor of groin P!

Question 21

Signs of FAI:
resisted test/MMT:
CM:
Stress Tests:

Answer 21

decreased activation of G.Med and Max and ERs
—weak ER and Abd in chronic conditions

possibly consistent block

possibly (+) w/ compression; (-) with distx

Question 22

Signs of FAI:
AM:
Special test:
Palpation:

Answer 22

possible hypomobile
FIR, FADDIR, FABER likey (+); possible (+) femoral torsion
TTP over ant. hip jt.@ 12oclock region

Question 23

PT Rx: FAI

Answer 23

POLICED
-load management including cross training
-foot orthotics to limit hip add/IR

Pt. Education:
–limit hip flexion >90º
–verbal cues for LE control

JM for cartilage integrity & possibly mobility

MET:
–Primarily for cartilage integrity, mm. function, and possibly mobility (local mm./anti-gravity)
–empathize LE control

Question 24

FAI prognosis:

Answer 24

66% return to play thru PT in athletes w/laberal tears (no sx)

ARJC poor prognosis (older pt.)

Question 25

MD Rx:

Answer 25

Ultrasound/Fluoroscopic guided injections Sx: open or arthroscopy for FAI -iliopsoas release and/or labral address ---NO evidence to suggest sx is better than PT

Question 26

Age-Related Jt. Change, what is happening?

Answer 26

lose GAGs; decreased hydration articular cartilage is thinning. joint space narrow doesn't absorb shock well

Question 27

Prevalence: Most common cause of _________ P! Up to 25% of ______

Answer 27

hip P! adults

Question 28

What are the structures involved with AJRC?

Answer 28

synovial membrane, joint capsule, articular cartilage, joint space, synovial fluid

Question 29

Symptoms of ARJC:

Answer 29

like FAI plus BUT more of labrum, articular cartilage not primary structure AM stiffness < 30 min Less tolerant to WBing activities and sitting w/possibly limping (articular cartilage more shock absorbent) C-sign of P! groin, lateral hip, and buttock; may even refer to knee *maybe nociplastic

Question 30

Trendelenburg gait the hip drops to ____________affected hip and pt. leans to ____________ side of the affected hip

Answer 30

contralateral; ipsilateral

Question 31

Signs of AJRC: planes? capsular pattern? CM - Resisted/MMT- Compression; Distx- AM-

Answer 31

like FAI plus ≥3 planes of motion restricted (high specificity) Inconclusive capsular pattern of restriction at the hip CM - consistent block Resisted/MMT: P! and possible weakness w/ABD (high specificity) Compression- possibly (+); Distx possibly reliving (-) AM- hypomobility

Question 32

Specials Tests of AJRC?

Answer 32

OA CPR ≥ 3 present -P! w/ squatting -P! w/ hip flx -P! w/ hip ext -P! IR < 25º -(+) Scour and FABER OA Combined Results -Hip P! -IR < 15º -IR P! -AM stiffness < 60 min ->50 yrs. or age Impaired functional performance testing -6 min walk test -Timed up and Go Test Impaired balance test like Berg Balance Scale

Question 33

PT Rx: ARJC _________P!/inflammation: (3) ___________mod support: (4)

Answer 33

POLICED Modalities for P!/Inflammation --no more than 2 wks. --only short-term P! influence --assistive device to minimize/avoid limping PT. education -mod support --limit hip flexion >90º --avoid low seats and sit on a wedge --no knee to chest stretches --Wt. management (10-20 lbs)

Question 34

Left hip P! which UE would you use a cane? Why?

Answer 34

Right; increase base of support---> weak hip abductors on left so cane go in R.

Question 35

PT Rx: ARJC JM for: MET primarily for:

Answer 35

cartilage integrity and mobility --better than usual care out to 1 yr. MET: mobility, cartilage integrity, and mm. function **include trunk and hip anti-gravity mm. groups **balance training as WBing is tolerated **1-5x/wk for 6-12wks. --effective for improving P! and function --better than usual care out of 1 yr. --mod support --aerobic component beneficial