Information on sports injuries of the hip joint

06 January 2022
Dr. Elviz Qasımov

Femoroacetabular impingement syndrome.

The hip joint is formed by the femoral head and the acetabulum. Congenital or acquired bony protrusions of one of these two bones cause restriction of movement in the joint. This condition is called femoroacetabular impingement syndrome. Deformities that occur in the bones during movement result in damage to the articular cartilage of the head of femoral bone and the articular lip (labrum) of the acetabulum. Femoroacetabular impingement syndrome occurs most often in people who live an active lifestyle and participate in sports.

In the illustration below, you can see that when you bend the hip joint after a certain angle, the hip bone collides with the pelvic bone. In a healthy body this impact is softer.

Picture: impact point

There are two main types of impacts: Cam and Pincer.

Cam impingement: in this type of impingement, the head of femoral bone loses its ball-like shape and takes a mushroom shape. In this form, the convex part of the head of femoral bone contacts the acetabulum during hip flexion. After a long time, the head of femoral bone damages the articular surface of the acetabulum and leads to premature calcification and osteoarthritis.

Pincer impingement: In this type of impingement, the acetabulum is deeper and more backward than normal. This causes the acetabulum to surround the head of femoral bone too much and reduce the angle of motion. This causes friction in the joint.

Sometimes these two types of impingement occur at the same time, and this condition is called mixed impingement.

Due to the fact that in the early stage of the disease, pain quickly goes away, patients refuse to go to the doctor. However, as the disease progresses, long-term pain, continued pain at rest, nocturnal pain, and eventually calcifications, which limit the amount of movement in the joint, are noted. In addition, the presence of pain in the patient’s lumbar spine may indicate femoroacetabular impingement syndrome. Because with this disease, the pain extends to the sacroiliac area and to the projection of the greater trochanter of the femur.

Femoroacetabular impingement syndrome can be confused with hip dysplasia, lumbar vertebral pain, radiculopathy in the back, bursitis of the greater trochanter of the femur, pear muscle syndrome, iliopsoas muscle syndrome, gynecological conditions, tension of adjacent muscles, etc.

Femoroacetabular impingement syndrome is more common in patients who participate in hockey, horseracing, yoga, soccer, acrobatics, cycling, weight lifting, etc.

A thorough history and instrumental diagnosis is necessary to make a correct diagnosis. Conventional X-ray examination can reveal Cam and Pincer type collision syndrome. Magnetic resonance imaging can detect damage to the articular lip of the acetabulum.

If there are difficulties at the time of diagnosis, performing local anesthesia at the hip joint is important. After a local anesthetic is injected into the hip joint and a steroid is injected, three possible outcomes can be expected.

  1. If the pain does not go away, then it is not coming from the hip joint.
  2. If the pain occurs again 24-48 hours after the injection, the source of the pain is the hip joint. These patients require surgical treatment.
  3. If the pain goes away for a long time, the pain is due to swelling of the hip joint. Steroids relieve the swelling and as a result the pain disappears. Such patients should be treated conservatively, but if there is no effect, you should turn to surgical methods of treatment.

Treatment for hip injuries

The first step in the treatment of femoroacetabular impingement syndrome is conservative treatment. Ligaments and pelvic stabilizer muscles are strengthened with physical therapy methods. Along with this, nonsteroidal anti-inflammatory drugs are taken orally, in order to relieve the pain syndrome on a variable or permanent basis. If conservative treatment is ineffective, surgical methods of treatment are used.

Surgical treatment is performed using open surgery or arthroscopy. After open surgery, the patient is recommended to use a crutch for 6 months. For several days after surgery, the patient may experience severe pain.

Since arthroscopic surgery results in less tissue damage, early patient activation is possible, and rehabilitation time is short, which shows the advantage of this method of surgery. Surgical intervention is performed through 2-3 punctures, 1 cm in length.

Failure to treat patients who suffer from femoroacetabular impingement syndrome can lead to cartilage damage in the hip joint and the occurrence of defects in the joint.

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