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Paper 1
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
A 37 year old semi-professional footballer attends the orthopaedic clinic due to left hip pain which is causing him difficulty when playing. Following clinical review, radiographs and subsequent MRI, a diagnosis of cam femoroacetabular impingement is made.
Hip and knee
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Femoroacetabular impingement has recently been recognised as a cause of hip pain in the young adult and may lead to secondary hip OA. The non-spherical portion of the femoral head is assumed to exert abnormal shear and compressive forces on the corresponding portion of the acetabular cartilage during deep hip flexion with internal rotation. Patients typically present with groin pain, and MRI-arthrograms typically reveal acetabular rim lesions and aberrant femoral head morphology.
Hip physical examination extension loss and radiographic osseous findings in patients with low back pain and nonarthritic hips
Published in Baylor University Medical Center Proceedings, 2022
Richard Feng, Munif Hatem, Scott J. Nimmons, Ashley Disantis, RobRoy L. Martin, Hal David Martin
Pathologies limiting hip flexion, especially femoroacetabular impingement, have been frequent subjects of orthopedic hip research over the last three decades.1 However, pathologies limiting hip extension (HE) are more important for activities that require an upright posture.2,3 While a loss of HE in nonarthritic hips is traditionally linked to tightness of the musculotendinous structures anterior to the hip joint,4–6 osseous etiologies such as ischiofemoral impingement and abnormal femoral torsion can also limit HE.7–11 The association between hip and spine abnormalities is known as hip-spine syndrome, and limitation in HE has been associated with low back pain (LBP).8,12 Given the potential link between osseus abnormalities and limited HE, the purpose of this study was to assess radiographic osseous findings in nonarthritic hips of patients with hip pain, LBP, and limited HE. A secondary purpose was to determine the utility of adding abduction and internal and external rotation to HE during the physical examination to assess the osseous contribution to limited HE.
Physical therapy management of a patient with persistent groin pain after total hip arthroplasty and iliopsoas tenotomy: a case report
Published in Physiotherapy Theory and Practice, 2022
Surgical methods for addressing hip impingement syndrome after THA include acetabular revision and iliopsoas tenotomy (Chalmers et al., 2017). A study by Chalmers et al. (2017) compared operative and nonoperative treatment of hip impingement syndrome after THA; 50% of patients experienced relief after nonoperative treatment compared with 76% in the operative group. However, nonoperative treatment strategies in that study primarily consisted of cortisone injection. Cortisone injections risk weakening the tendon structure and have been associated with poor long-term outcomes in other body regions (Mellor et al., 2018; Olaussen et al., 2013), so they may not be ideal as a stand-alone strategy for nonoperative care. Operative treatment also has direct and indirect risks. In a study of 1870 mostly young adults undergoing arthroscopic hip surgery, significant increases were found in comorbidities, such as chronic pain, substance abuse, metabolic syndrome, systemic arthropathy, and sleep disorders, in the 2 years after surgery (Rhon et al., 2019). Although physical therapy is often recommended for femoroacetabular impingement syndrome (Griffin et al., 2016, 2018; Mansell et al., 2018; Wall, Fernandez, Griffin, and Foster, 2013), it is inconsistently recommended for hip impingement after THA (Henderson and Lachiewicz, 2012).
Correspondence: Isometric hip strength impairments in patients with hip dysplasia are improved but not normalized 1 year after periacetabular osteotomy: a cohort study of 82 patients
Published in Acta Orthopaedica, 2021
Mingjin Zhong, Weimin Zhu, Jacobsen Julie Sandell, Jakobsen Stig Storgaard, Søballe Kjeld, Hölmich Per, Thorborg Kristian
Point 1: The healthy volunteers were asymptomatic and excluded in case of pain, comorbidity, previous trauma or surgery. Radiology was used only in the patient population as it was considered unethical to expose the asymptomatic population to radiation. Therefore, “asymptomatic” would have been a better term than “healthy” volunteers. Regarding imaging findings, we agree that imaging alone cannot be used to determine whether (or not) participants are healthy. Instead a combination of symptoms, clinical signs and imaging should be used to assess the presence of “hip disease”, as agreed for femoroacetabular impingement syndrome (Griffin et al. 2016). This is why the findings of positive FADIR/FABER tests do not indicate whether participants are healthy. Painful FADIR tests have been documented in 12–15% of asymptomatic participants (Czuppon et al. 2017); this is most likely due to the high sensitivity and false positive rate of this test (Reiman et al. 2013). We consider the FADIR test to be positive only if it replicates known symptoms (Troelsen et al. 2009). Therefore, in the asymptomatic volunteers, it would have been less confusing if we had described whether a test was painful instead of labeling the test as positive or negative. In the case of missing “hidden” pathology in the asymptomatic volunteers, the muscle strength deficit seen in the patients in our study might have been larger, but this would not have changed our conclusion that “isometric hip muscle strength is impaired in patients with symptomatic dysplastic hips.”