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

Pelvis and Hip - FAI Flashcards

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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
What can happen along with femoral acetabular impingement syndrome?
Labral tears
26
When should we consider a labral tear with femoral acetabular impingement syndrome?
- in active individuals with mechanical groin pain without alternative radiological diagnosis
27
What percentage of athletes have labral tears with groin pain?
- 20%
28
What percentage of people with hip AND groin pain have labral tears?
55%
29
What are the pathomechaics of femoral acetabular impingement syndrome?
- mechanical impingement leading to degenerative cascade of events
30
What are symptoms of femoral acetabular impingement syndrome?
- 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
What is the sens and spec for groin pain for femoral acetabular impingement syndrome?
100% sens 4% spec
32
What is there minimal or no support of for symptoms of femoral acetabular impingement syndrome?
- clicking or locking
33
What are signs of femoral acetabular impingement syndrome we will see in observation?
- impaired LE control
34
What are functional tests for femoral acetabular impingement syndrome?
- impaired balance and LE control - Quad dominant squatting pattern
35
What will/can we find with A/PROM with femoral acetabular impingement syndrome?
- primarily pain and loss of motion with flexion to ~90˚, IR <20˚@ 90 degrees of hip flexion and/or hip adduction
36
What can be limited between sides with femoral acetabular impingement syndrome?
- abduction and dysplasia if > 20˚ difference between sides
37
What can be present where hip deviates into abduction while moving into flexion at ~100˚ of flexion?
Hip maltracking
38
What is the LARGEST predictor of groin pain?
- <85˚ total rotation at 90˚ flexion
39
Is there an association between limited ROM and type of impingement?
NO
40
What will we find in our resisted/MMT with femoral acetabular impingement syndrome?
- Decreased activation of G. Med and Max and ERs - Weak ER and ABD in chronic conditions
41
What will we find with combined motions with femoral acetabular impingement syndrome?
- possibly consistent block
42
What will we find with stress tests with femoral acetabular impingement syndrome?
- compression possibly positive - distraction possibly relieving
43
What will we find with accessory motion with FAIS?
-possibly hypomobile
44
What special tests are there for femoral acetabular impingement syndrome?
- FIR, FADDIR, FABER likely positive - ligamentum teres test possibly positive - possible positive femoral torsion
45
What will we find with palpation with FAIS?
- TTP over anterior hip joint at 12 o'clock region
46
What are some differential diagnoses for FAIS?
- no specifics from CPG summary - Consider age-related joint changes, hypermobility and IPI as discussed later
47
What is the PT rx for FAIS?
- POLICED - Load management including cross training - Orthotics - Pt education
48
What orthotics can help FAIS?
- foot: limits hip add/IR - hip: conflicting evidence and NO recommendation
49
What can we do as far as patient education with femoral acetabular impingement syndrome?
- limit hip flexion less than 90˚ - verbal cues for LE control
50
What should be the recommended instruction for sitting with FAIS?
- sit with hips higher than knees
51
What are some impingement seated positions with FAIS?
- sit for prolonged periods - sit with crossed legs - sit with forward lean trunk
52
What are JM for with femoral acetabular impingement syndrome?
cartilage integrity and possibly mobility
53
What is MET for with femoral acetabular impingement syndrome?
- 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
What provides significant clinical improvement but no better than advice and a HEP?
- Combo of JM and MET
55
What is the prognosis of femoral acetabular impingement syndrome?
- little more than 50% report satisfactory outcome with PT
56
What percentage of athletes return to play through PT with labral tears?
66%
57
What is related to a poor prognosis with femoral acetabular impingement syndrome?
the presence of age-related joint changes
58
What do we know about oral medications for femoral acetabular impingement syndrome?
no quality studies
59
What do we know about injections for femoral acetabular impingement syndrome?
- 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
What is the surgery for femoral acetabular impingement syndrome?
Open or arthroscopy
61
What does an open or arthroscopy for FAIS do?
- bony and labral modifications
62
Is there evidence to suggest surgery is better than PT?
NO
63
What should we know about an arthroscopy for femoral acetabular impingement syndrome?
- 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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