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Chiropractic Journal of Australia : CJA September 2012
92 Chiropractic Journal of Australia Volume 42 Number 3 September 2012 options of FAI, as well as to discuss the role chiropractors have in the management of this syndrome. DISCUSSION Clinical Presentation FAI typically presents in physically active adults aged 20 to 50 years (average age: 33-35 years).3,15 Males account for two-thirds of cases.15,16 The Cam-type impingement is most common in men between the ages of 20-30; whereas the pincer- type is more common in middle-aged women.9 However, most clinical manifestations occur with a combination of both the Cam-type and pincer-type impingement.3 Patients are often involved in athletic activities, with participation in sports reported in 70% of cases in a prospective study, with 30% of patients being elite athletes.17 Athletic activities that involve extreme ranges of motion, especially repetitive hip hyperfexion, hyperextension, internal and external rotation (Australian rules football, ballet, martial arts, soccer, netball, gymnastics, rowing) typically cause an increase in intensity or duration of symptoms.3,7,10,15,18,19 Initially, FAI symptoms are often insidious and may include intermittent groin pain, lateral trochanteric pain, or both.11,14,15,19 Although groin pain appears to be the most common site of presentation, pain may be referred to the low back, gluteal region or knee (as with other hip disorders).6 As the acetabular labrum and articular cartilage degenerate, symptoms gradually worsen and are exacerbated by continued athletic activity, prolonged sitting, and prolonged walking.7,14 Due to the gradual onset, and intermittent symptoms, patients often wait several months or years before seeking advice from a health care provider.3 Patients may report a dull ache or a sharp pain in the anterior groin; episodes of catching, locking or giving way (these fndings are pathognomonic for labral pathology)12 with pain for a few minutes to a few hours; or a feeling of discomfort or apprehension especially with prolonged sitting, particularly when the seat is low.3,7 These symptoms most commonly occur with movements that involve some degree of hip fexion or de-fexion (i.e. standing after prolonged sitting).3 However, without a focused physical examination and the appropriate diagnostic tests, FAI is often misdiagnosed and mismanaged as groin strain, early osteoarthritis, inguinal hernia or a low back disorder.14,19 FEMOROACETABULAR IMPINGMENT JAROSZ Figure 1: FAI. (Top): Normal hip confguration with suffcient joint clearance allows unrestricted range of motion. (Center): Excessive acetabular coverage (pincer-type impingement), leads to early linear contact between the femoral head–neck junction and acetabular rim, resulting in labrum degeneration and signifcant cartilage damage. The posteroinferior portion of the joint can be damaged (i.e. contre- coup lesion) due to subtle subluxations. (Bottom): With abnormal morphology of the proximal femur (Cam-type impingement), the aspherical portion of the femoral head–neck junction is jammed into the acetabulum (Reprinted with permission from the American Journal of Roentgenology) Figure 2: Anterior hip impingement test. With the patient in a supine position, the hip is internally rotated and adducted, as it is passively fexed to 90°. A reproduction of the patient’s symptoms is considered a positive sign.
CJA June 2012
CJA December 2012