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Chiropractic Journal of Australia : CJA September 2012
94 Chiropractic Journal of Australia Volume 42 Number 3 September 2012 patients with hip pain.22 The os acetabulum results from a reactive ossifcation of the acetabular labrum due to repetitive FAI (Figure 6).7,14 Advanced cases of FAI will demonstrate the typical signs of DJD (loss of joint space, subchondral sclerosis, subchondral cysts, osteophyte formation). The presence of advanced degenerative changes precludes a diagnosis of FAI.19 Magnetic resonance imaging (MRI) arthrography (injection of contrast into the joint) is considered the most specifc and sensitive imaging study in the diagnostic work- up for patients with FAI.23 A triad of anomalies has been described in the MRI of patients with FAI: abnormal femoral head-neck morphology (Figure 7), anterosuperior acetabular cartilage and anterosuperior labral pathology.12 The two main secondary lesions of anterosuperior chondropathy and labral pathology may be suspected on MRI, however they can only be confrmed on MRI-arthrography.3 FAI Diagnosis Many patients with symptomatic FAI experience delays in diagnosis, Incorrect diagnosis, and ineffective treatment recommendations.15 Clohisy et al15 reported the mean time from symptom onset to defnitive FAI diagnosis was 3.1 years. Additionally, patients were evaluated by an average 4.2 healthcare providers prior to diagnosis and inaccurate diagnoses were common.15 FEMOROACETABULAR IMPINGMENT JAROSZ Figure 6: Os acetabulum and Cam-type FAI. AP Pelvic radiograph of a 42-year-old male patient with bilateral Cam-type FAI (arrows) and os acetabulum (arrowheads). Additionally, there is a lumbarisation of the S1 vertebral body. Figure 5A: Femoral head-neck junction abnormality and alpha angle. Axial view radiograph of a 32-year-old male with a normal hip, normal offset (OS) and normal alpha angle (α <50°). Figure 5B: Axial view radiograph of a 26-year-old man with a Cam lesion, decreased femoral head-neck offset (OS’) and increased alpha angle (α >55°). (Reprinted with permission from the American Journal of Roentgenology) Figure 7: MRI-arthrography in FAI. Right hip oblique sagittal MRI- arthrography of a 22-year-old male patient with a Cam-type FAI (arrow).
CJA June 2012
CJA December 2012