Hip Impingement and Anatomy

By Kathryn Trumble, PT, DPT, ATC/L

What is Hip Impingement?

Hip impingement or femoroacetabular impingement (FAI) is a problem that affects the hip. With this condition, one of the bones that form the hip is irregularly shaped. This causes rubbing or pinching of the hip and, over time, results in pain and degenerative changes in the joint.

Hip Anatomy

The hip joint has two bones, the pelvis and the femur (thigh bone). This joint is a ball-and-socket joint, similar to the shoulder. The top of the femur is rounded and sits in a cup or socket (acetabulum) on the side of the pelvis. Each part of the joint is covered by articular cartilage, which helps reduce the friction of the bones as they move on each other. The hip also consists of another type of cartilage called the labrum, which is a ring of tissue that helps to improve the congruency of the joint.

Causes of Hip Impingement

A structural problem causes hip impingement in the hip. Below are the typical causes of hip impingement:

Cam Impingement

Not having a round ball (femoral head). This can cause excessive bone growth that forms on the end of the femur, which rubs/grinds the cartilage of the acetabulum.

Pincer Impingement

Excessive bone growth on the rim of the acetabulum can cause pinching or grinding of the labrum or articular cartilage of the femoral head.

Cam & Pincer Impingement

A combination of both impingements, where excessive bone growth is found on the ball and the socket of the hip.

Signs and Symptoms of Hip Impingement

Patients with hip impingement typically complain of sharp or dull pain in the front of the hip. They will usually have:

• Decreased range of motion of the hip – stiffness.
• Pain when going into hip flexion (bringing your thigh to your chest).
• Difficulty/pain with:
  • Squatting.
  • Standing from a seated position.
  • Pivoting.
  • Tying putting on/taking off shoes/socks.
• Popping in the front of the hip.

 

Hip Impingement Diagnostic Testing

Manual Testing

• A physician will manipulate the hip joint into different positions attempting to reproduce symptoms felt in the hip.

Imaging

• X-rays – will show excessive bone growth on the ball or the socket of the hip.
• MRI/CT scan – will show any irritation or irregularities of the articular cartilage or labrum of the hip.

Treatment of Hip Impingement

Treatment methods can vary. In most cases, the conservative treatments are performed first.

Treatments may include:

• Activity Modification – limit the activities that cause the impingement of the hip.
• Medication – anti-inflammatories to reduce the inflammation caused by the pinching.
• Physical Therapy – exercise-based treatment that involves stretching throughout the hip and strengthening around the hip to improve the mechanics of the hip.

• Injections
  • Steroid Injections – These will reduce inflammation and reduce pain in the hip.
  • Stem-Cell/Platelet Rich Plasma (PRP) – An injection of cells from your own to aid in improving any of the cartilage tears.
• Surgery – Typically arthroscopic (with small incisions). This surgery can reduce any excessive bone growth around the hip and clean up tears in the cartilage to reduce pain/symptoms.

Related Articles: hip preservation and reconstruction vs hip replacement,  Home Exercises for the Hip, & Direct Access to PT

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By: Kathryn Trumble, PT, DPT, ATC/L