Week 1 Lecture 1

• Pain with loading/activity • Limitation of AROM and PROM (Equal proportion) • Loss of function • Assorted secondary soft tissue effects • Deformity in later stages • Pain, loss of joint mobility

(flexed, adducted and ER’d) Open pack position Minimimised joint compression & congruency -Associated or secondary effects on muscle length Gait: Weak hip abductors Reduced hip abductor action Reduced compressive force on hip t/f pain Compensated trendelenburg leaning COM closer to hip joint Impingement Altered EF ( earlier in ROM, pathological) Physiological ROM loss in CAPSULAR PATTERN -Loss of IR > extension > abduction > flexion > ER Reduced PAMS

-Education/advice on joint care Active restl pacing, pharamacotherapy, holistic management (wght, diet, sleep) • Restore/maintain joint mobility and alignment Passive mobilization, active exercise, aquatic exercise Address muscle length impairment -Optimise lower quarter muscle performance Especially gluteal function and strength -Optimise motor patterning Can include walking aid prescription -Optimise general fitness Unloaded CV exercise – cycling, aquarobics

• Harris hip score • Patient specific functional scale • Walking distance, distance/time or WB’ing time tolerated • Pain and/or stiffness – Rest and during activity

Result in abnormal engagement between femoral head & acetabulum due to underlying hip morphology & NOT abnormal motion ( during motion of hip) Common dynamic factors: Loss of spherity of femoral head (CAM) Acetabular overcoverage (PINCER) Femoral retroversion Femoral varus

Factors which cause abnormal stress & assymetric load B/n femoral head and acetabulum in AXIALLY LOADED POSITION result of sub optimal congruency b/n femoral head & socket assymetrical wear of chondral surfaces * does NOT require motion across the hip to be painful • Developmental dysplasia(underdeveloped acetabulum T/f locally elevated contact pressures on AC + static overload > cartilage degeneration.

Methods of diagnosis: MRI, FABER/FADIR, Athroscopy (gold standard), CT Scan, Plain radiographs Clinical features FAI: -Majority (50-60%) with FAI report insidious onset of symptoms (Sx). -Pain onset following traumatic episode and acute symptoms without a traumatic event are also reported -Pain is the most common complaint -groin/anteromedial thigh area is the most common location of pain 81-83% -Sx also reported in lateral hip, buttock, thigh, and Lx region -Mechanical symptoms and feelings of instability are also reported -Sx usually worsen with sports and particular ADLs -C sign for symptom location

Clinical features FAI: -Majority (50-60%) with FAI report insidious onset of symptoms (Sx). -Pain onset following traumatic episode and acute symptoms without a traumatic event are also reported • Pain is the most common complaint • groin/anteromedial thigh area is the most common location of pain 81-83% • Sx also reported in lateral hip, buttock, thigh, and Lx region • Mechanical symptoms and feelings of instability are also reported • Sx usually worsen with sports and particular ADLs • C sign for symptom location

Hip pain when Morphological abnormalities with acetabulum and or femur cause abnormal contact between femoral head and acetabulum leading to compression/impingement + potential tearing of the acetabular labrum CAM impingement – non-spherical head When abnormally shaped femoral head/neck contacts a normal acetabulum PINCER impingement – excessive acetabular cover when abnormally shaped acetabulum contacts a normal femoral head/neck

Hip pain when Morphological abnormalities with acetabulum and or femur cause abnormal contact between femoral head and acetabulum leading to compression/impingement + potential tearing of the acetabular labrum CAM impingement – non-spherical head When abnormally shaped femoral head/neck contacts a normal acetabulum PINCER impingement – excessive acetabular cover when abnormally shaped acetabulum contacts a normal femoral head/neck

-Acetabular retroversion Opening of acetabulum does not face normal anterolateral direction but is inclined more posterolaterally Crossover/figure 8 sign Increased risk of focal FAI

Angle between shaft axis and NOF axis in frontal/coronal plane

Angle between NOF axis & femoral condyle axis in a Transverse plane

approx 15 degrees anteversion

(an angle of torsion) of greater that 15 degrees anteversion Distal femur is excessively externally rotate relative to femoral head and neck in transverse plane Feet (externally rotated) duck feet Increased functional external rotation and decreased functional internal rotation

(an angle of torsion) less than 5 degrees anteversion Distal femur is excessively internally rotated relative to femoral head & neck in transverse plane Feet ( internally rotated) pigeon toed Increased functional internal rotation and decreased functional external rotation

MRI, FABER/FADIR, Athroscopy (gold standard), CT Scan, Plain radiographs

Non traumatic 74% Insideous onset with gradual increasing pain Due to repetative microtrauma (twisting EOR) Direct Trauma Axial loading in flexion

Insideous onset + repetative microtrauma Pain involving a particular triggering event • Anterior injuries (hyperextension w external rotation) • Posterior injuries( axial loading on a flexed hip) Secondary to developmental dysplasia

Poor primary blood supply Anterior labral injuries - least boney contraints anteriorly - region subject to most stress - mechanically weakest

Methods of diagnosis: Athroscopy (gold standard) MRI CT Scan ( similar sensitivity) FABER/FADIR( quadrant) Plain radiographs

Anterior hip/groin pain (ant labral tear) +- trochanteric/gluteal pain ( posterior labral tear) Deep & sharp(acute) or dull (Chronic) activity induced or positional eg prolonged sitting Mechanical signs (click, clunk, catching withactivity ROM) Trendelenburg gait - >2 years duration of symptoms - ROM unrewarding/unremarkable - Provocative tests FABER/FADIR