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Hip Impingement: Symptoms, Causes & Treatment

  • Synopsis: Information regarding hip impingement syndrome, symptoms include stiffness in the groin or front of thigh, and loss of full range of hip motion.

Quote: "A person may have hip impingement for years without knowing it, simply because it is often times not painful in its early stages."

Main Document

A person's hip is the joint where their thigh bone meets their pelvis. It is called a, 'ball-and-socket,' joint because the ball-like top of the thigh bone fits into a cup-like area within the person's pelvis. Usually, the ball glides smoothly within the socket, although an issue with the ball-and-socket may interfere with smooth motion. The issue may cause hip impingement or, 'femoro acetabular impingement (FAI).' It is thought to be a major cause of early osteoarthritis of the hip, especially in people who are over the age of forty.

Hip Impingement Syndrome, or Femoroacetabular Impingement (FAI), may affect the hip joint in young and middle-aged adults and occurs when the ball shaped femoral head rubs abnormally or does not permit a normal range of motion in the acetabular socket. Damage can occur to the articular cartilage, or labral cartilage, or both. FAI is regarded as a cause of premature hip osteoarthritis. Treatment options range from conservative to arthroscopic to open surgery.

Symptoms of Hip Impingement

A person may have hip impingement for years without knowing it, simply because it is often times not painful in its early stages. When hip impingement causes symptoms, it might be referred to as, 'hip impingement syndrome.' The main symptoms include stiffness in the person's groin or front of their thigh, as well as a loss of their hip's full range of motion.

At first, a person might only feel pain when they move their hip near to its limitations. As the condition progresses; however, an affected person may experience pain with more subtle activities such as walking up a hill or sitting for an extended period of time. Pain usually happens at night, or when the person walks on flat ground, suggesting the cartilage which cushions the ball and socket has started to break down and wear away, a condition known as, 'osteoarthritis.'

Causes of Hip Impingement

A couple of main causes of hip impingement exist. A deformity of the ball at the top of the femur referred to as, 'cam impingement,' is one of these. If the head is not shaped as it should be, a part of the head may jam in the socket when the person's hip is bent. It may happen during activities such as riding a bicycle or tying your shoes.

A deformity of the socket or, 'pincer impingement,' is another cause. If the front rim of the socket called the, 'acetabulum,' sticks out too far, the area of the thigh bone just below the ball called the, 'neck of the femur,' might bump into the rim of the socket during usual hip flexion movement. In other instances there is an issue with both the ball and the socket. Additional issues that may cause hip impingement include conditions like:

Legg-Calve-Perthes Disease: A disease in which the ball part of a person's hip joint does not receive enough blood, causing the bone to perish.

Coxa Vara: Coxa Vara is an unusual condition in which the person's thigh bone and ball do not grow at the same pace in children. The discrepancy leads to deformity of the person's hip joint.

Slipped Capital Femoral Epiphysis: A separation of the ball from the person's thigh bone at the upper growing end or, 'growth plate,' of the bone in teenagers. It is more common in children who are obese.

Tests and Diagnosis of Hip Impingement

If you experience symptoms of hip impingement, a doctor can diagnose the issue based upon your description of your symptoms, the findings of imaging tests, as well as a physical examination. The tests might include one or more of the ones below:

X-ray: an X-ray is a test that produces images of internal structures on film. They can show irregularities in the shape of the ball or top of the thigh bone, or excess bone around the rim of the socket.

Magnetic Resonance Imaging (MRI): An MRI is a procedure that uses large magnets, radio waves and a computer to produce detailed images of tissue inside a person's body. An MRI may show fraying or tears of the cartilage, to include that which runs along the rim of the socket.

CT Scan: A CT scan is a technique that combines special X-ray equipment with sophisticated computers to produce multiple images of the inside of a person's body. The images can be examined on a computer, in print format, or transferred to a compact disk. A CT or MRI can help a doctor to decide whether a person needs surgery.

Treating Hip Impingement

Treatment for hip impingement should start with resting the hip that is affected. It should modify your activities to avoid moving the joint in a way that causes the person pain. Exercising as recommend by your doctor or physical therapist to strengthen the muscles that support your hip is another part of treatment, as is taking anti-inflammatory and pain medications.

If these types of treatments fail to relieve your pain, a doctor might recommend hip impingement surgery. The type of surgery a person needs depends on the issue causing hip impingement and how much cartilage damage has happened.

If the hip that is affected does not have too much cartilage damage, a surgeon may use tools to reshape the ball and/or the outside edge of the socket that is catching on the thigh bone. In a technique called, 'micro-fracture,' a surgeon might also cut away the frayed cartilage that is causing pain, or drill holes into patches of bone where cartilage has worn away with the goal of simulating cartilage growth. Micro-fracture is being used less often than it had been.

Often times surgery for hip impingement can be performed arthroscopically. Arthroscopic surgery is a technique involving the insertion of a lighted scope and thin tools through small incisions over a person's hip instead of making a large incision. Arthroscopy is usually an outpatient surgery, meaning you can return home on the same day as the surgery.

The earlier you have surgery, the greater the chances you will recover completely. Yet even if cartilage has been damaged, surgery might still reduce pain while improving your range of motion. If cartilage damage is severe; however, hip replacement may be the only treatment that will relieve pain while improving function. There are promising treatments, including one in which parts of your own blood are injected into joints to stimulate cartilage growth.

Hip Impingement

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