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Clinical Diagnosis of FAI: An Evidence-Based Approach to History and Physical Examination of the Hip

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Diagnosis and Management of Femoroacetabular Impingement

Abstract

Assessing the young adult hip can be challenging. It is not simply about finding a “square peg in a round hole” [1]; patients exhibit a spectrum of disorders. The first hurdle is characterising these symptoms to differentiate major structural abnormalities in the hip from extra-articular soft tissue problems. As many patients presenting with hip pain often have an active lifestyle, they may have concomitant pathologies, which may be coincidental findings or compensatory disorders. Ultimately the goal is to ascertain an aetiology or structural abnormality and select an appropriate treatment option.

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References

  1. Reider B. Round hole, square peg. Am J Sports Med. 2014;42(4):789–92.

    Article  PubMed  Google Scholar 

  2. Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Fem- oroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–20.

    PubMed  Google Scholar 

  3. Imam S, Khanduja V. Current concepts in the diagnosis and management of femoroacetabular impingement. Int Orthop. 2011;35(10):1427–35.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Khanduja V, Villar RN. Arthroscopic surgery of the hip current concepts and recent advances. J Bone Joint Surg Br. 2006;88(12):1557–66.

    Article  CAS  PubMed  Google Scholar 

  5. Rubin DA. Femoroacetabular impingement: fact, fiction, or fantasy? [Review]. AJR Am J Roentgenol. 2013;201(3):526–34.

    Google Scholar 

  6. Gosvig KK, Jacobsen S, Sonne-Holm S, Gebuhr P. The prevalence of cam-type deformity of the hip joint: a survey of 4151 subjects of the Copenhagen Osteoarthritis Study. Acta Radiol. 2008;49:436–41.

    Article  CAS  PubMed  Google Scholar 

  7. Hack K, Di Primio G, Rakhra K, Beaule PE. Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers. J Bone Joint Surg Am. 2010;92(14):2436–44.

    Article  PubMed  Google Scholar 

  8. Kang AC, Gooding AJ, Coates MH, Goh TD, Armour P, Rietveld J. Computed tomography assessment of hip joints in asymptomatic individuals in relation to femoroacetabular impingement. Am J Sports Med. 2010;38(6):1160–5.

    Article  PubMed  Google Scholar 

  9. Clohisy JC, Keeney JA, Schoenecker PL. Preliminary assessment and treatment guidelines for hip disorders in young adults. Clin Orthop Relat Res. 2005;441:168–79.

    Article  PubMed  Google Scholar 

  10. Carsen S, Moroz PJ, Rakhra K, Ward LM, Dunlap H, Hay JA, Willis RB, Beaule PE. The Otto Aufranc Award. On the etiology of the cam deformity: a cross-sectional pediatric MRI study. Clin Orthop Relat Res. 2014;472(2):430–6.

    Article  PubMed  Google Scholar 

  11. Agricola R, Heijboer MP, Ginai AZ, Roels P, Zadpoor AA, Verhaar JA, Weinans H, Waarsing JH. A cam deformity is gradually acquired during skeletal maturation in adolescent and young male soccer players: a prospective study with minimum 2-year follow-up. Am J Sports Med. 2014;42(4):798–806.

    Article  PubMed  Google Scholar 

  12. Yamamura M, Miki H, Nakamura N, Murai M, Yoshikawa H, Sugano N. Open-configuration MRI study of femoro-acetabular impingement. J Orthop Res. 2007;25:1582–8.

    Article  PubMed  Google Scholar 

  13. Takeyama A, Naito M, Shiramizu K, Kiyama T. Prevalence of femoroacetabular impingement in Asian patients with osteoarthritis of the hip. Int Orthop. 2009;33:1229–32.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Lahner M, Jahnke NL, Zirke S, Teske W, Vetter G, von Schulze Pellengahr C, Daniilidis K, Hagen M, von Engelhardt LV. The deviation of the mechanical leg axis correlates with an increased hip alpha angle and could be a predictor of femoroacetabular impingement. Int Orthop. 2014;38(1):19–25.

    Article  PubMed  Google Scholar 

  15. Nawabi DH, Bedi A, Tibor LM, Magennis E, Kelly BT. The demographic characteristics of high-level and recreational athletes undergoing hip arthroscopy for femoroacetabular impingement: a sports-specific analysis. [Review]. Arthroscopy. 2014;30(3):398–405.

    Article  PubMed  Google Scholar 

  16. Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H. Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orthop Relat Res. 2009;467:638–44.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Philippon MJ, Maxwell RB, Johnston TL, Schenker M, Briggs KK. Clinical presentation of femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc. 2007;15:1041–7.

    Article  PubMed  Google Scholar 

  18. Bedi A, Dolan M, Leunig M, Kelly BT. Static and dynamic mechanical causes of hip pain. Arthroscopy. 2011;27:235–51.

    Article  PubMed  Google Scholar 

  19. Byrd JWT. Physical examination. In: Byrd JWT, editor. Operative hip arthroscopy. 2nd ed. New York: Springer; 2005. p. 36–50.

    Chapter  Google Scholar 

  20. Byrd JWT. Evaluation of the hip: history and physical examination. North Am J Sports Phys Ther. 2007;2:231–40.

    Google Scholar 

  21. Byrd JW. Femoroacetabular impingement in athletes: current concepts. Am J Sports Med. 2014;42(3):737–51.

    Article  PubMed  Google Scholar 

  22. Thomas GE, Palmer AJ, Andrade AJ, Pollard TC, Fary C, Singh PJ, O'Donnell J, Glyn-Jones S. Diagnosis and management of femoroacetabular impingement. Br J Gen Pract. 2013;63(612):e513–5.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Byrd JWT. Evaluation and management of the snapping iliopsoas tendon. Instr Course Lect. 2006;55:347–55.

    PubMed  Google Scholar 

  24. Yen YM, Kocher MS. Clinical and radiographic diagnosis of femoroacetabular impingement. J Pediatr Orthop. 2013;33 Suppl 1:S112–20.

    Article  PubMed  Google Scholar 

  25. Byrd JWT, Jones KS. Hip arthroscopy in athletes. Clin Sports Med. 2001;20(4):749–62.

    Article  CAS  PubMed  Google Scholar 

  26. Sansone M, Ahlden M, Jonasson P, Thomee R, Falk A, Sward L, Karlsson J. Can hip impingement be mistaken for tendon pain in the groin? A long-term follow-up of tenotomy for groin pain in athletes. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):786–92.

    Article  PubMed  Google Scholar 

  27. Alhaneedi GA, Abdullah AS, Ghouri SI, Abuodeh Y, Al Dosari MM. Avulsion fracture of anterior inferior iliac spine complicated by hypertrophic malunion causing femoroacetabular impingement: case report. Int J Surg Case Rep. 2015;11:117–20.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Jayasekera N, Aprato A, Villar RN. Fat pad entrapment at the hip: a new diagnosis. PLoS One. 2014;9(2):e83503 [Electronic Resource].

    Article  PubMed  PubMed Central  Google Scholar 

  29. Snow SW, Keret D, Scarangella S, Bowen JR. Anterior impingement of the femoral head: a late phenomenon of Legg- Calvé-Perthes’ disease. J Pediatr Orthop. 1993;13(3):286–9.

    Article  CAS  PubMed  Google Scholar 

  30. Pollard TCB, Villar RN, Norton MR, Fern ED, Williams MR, Murray DW, Carr AJ. Genetic influences in the aetiology of femoroacetabular impingement: a sibling study. J Bone Joint Surg Br. 2010;92(2):209–16.

    Article  CAS  PubMed  Google Scholar 

  31. Fraitzl CR, Käfer W, Nelitz M, Reichel H. Radiological evidence of femoroacetabular impingement in mild slipped capital femoral epiphysis: a mean follow-up of 14.4 years after pinning in situ. J Bone Joint Surg Br. 2007;89:1592–6.

    Article  CAS  PubMed  Google Scholar 

  32. Murgier J, Reina N, Cavaignac E, Espie A, Bayle-Iniguez X, Chiron P. The frequency of sequelae of slipped upper femoral epiphysis in cam-type femoroacetabular impingement. Bone Joint J. 2014;96-B(6):724–9.

    Article  CAS  PubMed  Google Scholar 

  33. Albers CE, Steppacher SD, Haefeli PC, Werlen S, Hanke MS, Siebenrock KA, Tannast M. Twelve percent of hips with a primary cam deformity exhibit a slip-like morphology resembling sequelae of slipped capital femoral epiphysis. Clin Orthop Relat Res. 2015;473(4):1212–23.

    Article  PubMed  Google Scholar 

  34. Yuan BJ, Bartelt RB, Levy BA, Bond JR, Trousdale RT, Sierra RJ. Decreased range of motion is associated with structural hip deformity in asymptomatic adolescent athletes. Am J Sports Med. 2013;41(7):1519–25.

    Article  PubMed  Google Scholar 

  35. Zaltz I, Kelly BT, Hetsroni I, Bedi A. The crossover sign overestimates acetabular retroversion. Clin Orthop Relat Res. 2013;471(8):2463–70.

    Article  PubMed  Google Scholar 

  36. Fukushima K, Uchiyama K, Takahira N, Moriya M, Yamamoto T, Itoman M, Takaso M. Prevalence of radiographic findings of femoroacetabular impingement in the Japanese population. J Orthop Surg. 2014;9:25.

    Article  Google Scholar 

  37. Byrd JWT, Jones KS. Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients. Am J Sports Med. 2004;32:1668–74.

    Article  PubMed  Google Scholar 

  38. Ilizaliturri VM, et al. Endoscopic iliotibial band release for external snapping hip syndrome. Arthroscopy. 2006;22(5):505–10.

    Article  PubMed  Google Scholar 

  39. Ayeni O, Chu R, Hetaimish B, Nur L, Simunovic N, Farrokhyar F, Bedi A, Bhandari M. A painful squat test provides limited diagnostic utility in CAM-type femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):806–11.

    Article  PubMed  Google Scholar 

  40. Van Houcke J, Pattyn C, Vanden Bossche L, Redant C, Maes JW, Audenaert EA. The pelvifemoral rhythm in cam-type femoroacetabular impingement. Clin Biomech. 2014;29(1):63–7.

    Article  Google Scholar 

  41. Beighton P, Horan FT. Surgical aspects of the Ehlers‐Danlos syndrome a survey of 100 cases. Br J Surg. 1969;56(4):255–9.

    Article  CAS  PubMed  Google Scholar 

  42. Martin HD, Kelly BT, Leunig M, Philippon MJ, Clohisy JC, Martin RL, Sekiya JK, Pietrobon R, Mohtadi NG, Sampson TG, Safran MR. The pattern and technique in the clinical evaluation of the adult hip: the common physical examination tests of hip specialists. Arthroscopy. 2010;26(2):161–72.

    Article  PubMed  Google Scholar 

  43. Tijssen M, van Cingel R, Willemsen L, de Visser E. Diagnostics of femoroacetabular impingement and labral pathology of the hip: a systematic review of the accuracy and validity of physical tests. Arthroscopy. 2012;28(6):860–71.

    Article  PubMed  Google Scholar 

  44. Reiman MP, Goode AP, Cook CE, Hölmich P, Thorborg K. Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis. Br J Sports Med. 2015;49:811.

    Article  CAS  PubMed  Google Scholar 

  45. Reiman MP, Goode AP, Hegedus EJ, Cook CE, Wright AA. Diagnostic accuracy of clinical tests of the hip: a systematic review with meta-analysis. Br J Sports Med. 2013;47(14):893–902.

    Article  PubMed  Google Scholar 

  46. Ratzlaff C, Simatovic J, Wong H, Li L, Ezzat A, Langford D, Esdaile JM, Kennedy C, Embley P, Caves D, Hopkins T, Cibere J. Reliability of hip examination tests for femoroacetabular impingement. Arthritis Care Res. 2013;65(10):1690–6.

    Google Scholar 

  47. Maslowski E, et al. The diagnostic validity of hip provocation maneuvers to detect intra-articular hip pathology. PM R. 2010;2(3):174–81.

    Article  PubMed  Google Scholar 

  48. Beck M, Leunig M, Parvizi J, et al. Anterior femoroacetabular impingement: Part II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004;418:67–73.

    Article  PubMed  Google Scholar 

  49. Siebenrock KA, Schoeniger R, Ganz R. Anterior femoro-acetabular impingement due to acetabular retroversion. J Bone Joint Surg Am. 2003;85A:278–86.

    Google Scholar 

  50. Larkin B, van Holsbeeck M, Koueiter D, Zaltz I. What is the impingement-free range of motion of the asymptomatic hip in young adult males? Clin Orthop Relat Res. 2015;473(4):1284–8.

    Article  PubMed  Google Scholar 

  51. Kubiak-Langer M, Tannast M, Murphy SB, Siebenrock KA, Langlotz F. Range of motion in anterior femoroacetabular impingement. Clin Orthop Relat Res. 2007;458:117–24.

    CAS  PubMed  Google Scholar 

  52. Khanduja V, Villar RN. Hip arthroscopy in the elite athlete. ISAKOS. 2013; Abstract presentation.

    Google Scholar 

  53. Ober FR. Back strain and sciatica. JAMA. 1935;1(04):1580–1.

    Article  Google Scholar 

  54. Skendzel JG, Weber AE, Ross JR, Larson CM, Leunig M, Kelly BT, Bedi A. The approach to the evaluation and surgical treatment of mechanical hip pain in the young patient: AAOS exhibit selection. [Review]. J Bone Joint Surg Am. 2013;95(18):e133.

    Article  PubMed  Google Scholar 

  55. Philippon MJ, Stubbs AJ, Schenker ML, et al. Arthroscopic management of femoroacetabular impingement: osteoplasty technique and literature review. Am J Sports Med. 2007;35(9):1571–80.

    Article  PubMed  Google Scholar 

  56. Haddad FS, Konan S. Femoroacetabular impingement: not just a square peg in a round hole. Bone Joint J. 2013;95-B(10):1297–8.

    Article  CAS  PubMed  Google Scholar 

  57. Laborie LB, Lehmann TG, Engesaeter IO, Engesaeter LB, Rosendahl K. Is a positive femoroacetabular impingement test a common finding in healthy young adults? Clin Orthop Relat Res. 2013;471(7):2267–77.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Prather H, Harris-Hayes M, Hunt DM, Steger-May K, Mathew V, Clohisy JC. Reliability and agreement of hip range of motion and provocative physical examination tests in asymptomatic volunteers. PM R. 2010;2:888–95.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Reiman MP, Thorberg K. Femoroacetabular impingement surgery: are we moving too fast and too far beyond the evidence? Br J Sports Med. 2015;49:782–4.

    Article  PubMed  Google Scholar 

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Correspondence to Vikas Khanduja MA, MSc, FRCS, FRCS (Orth) .

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Viswanath, A., Khanduja, V. (2017). Clinical Diagnosis of FAI: An Evidence-Based Approach to History and Physical Examination of the Hip. In: Ayeni, O., Karlsson, J., Philippon, M., Safran, M. (eds) Diagnosis and Management of Femoroacetabular Impingement. Springer, Cham. https://doi.org/10.1007/978-3-319-32000-7_3

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  • DOI: https://doi.org/10.1007/978-3-319-32000-7_3

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