Is referral or physical therapy (PT) necessary for a patient with cam morphology of the hip in the absence of pain?

From the Guidelines

Referral or physical therapy is not necessary for a patient with cam morphology of the hip who has no pain. Cam morphology is an anatomical variation where the femoral head-neck junction has an abnormal shape, but this finding alone without symptoms does not require intervention. Many individuals with cam morphology remain asymptomatic throughout their lives. The current standard of care is to monitor these patients and only consider treatment if they develop symptoms such as pain, limited range of motion, or functional limitations. If symptoms do develop, then physical therapy focusing on hip strengthening, core stability, and movement pattern correction would be appropriate, along with possible referral to an orthopedic specialist. The reasoning behind this approach is that structural abnormalities on imaging often do not correlate with clinical symptoms, and unnecessary treatment may expose patients to risks without clear benefits. Regular physical activity and maintaining healthy weight are generally recommended for overall joint health, but specific PT exercises or specialist referral should be reserved for when symptoms arise that affect quality of life or function, as suggested by the International Hip-related Pain Research Network 1.

Some key points to consider in the management of patients with cam morphology of the hip include:

• The absence of pain or symptoms does not necessitate intervention 1
• Monitoring for the development of symptoms is recommended 1
• Physical therapy may be beneficial if symptoms develop, focusing on hip strengthening, core stability, and movement pattern correction 1
• Referral to an orthopedic specialist may be necessary if symptoms persist or worsen 1
• Regular physical activity and maintaining a healthy weight are recommended for overall joint health, but specific PT exercises or specialist referral should be reserved for when symptoms arise that affect quality of life or function 1

It is essential to prioritize the patient's quality of life and functional abilities when making decisions about referral or physical therapy, and to consider the potential risks and benefits of intervention in the absence of symptoms, as highlighted by the EULAR recommendations for pain management in inflammatory arthritis and osteoarthritis 1.

From the Research

Referral or Physical Therapy for Cam Morphology of the Hip without Pain

• The presence of cam morphology in the hip does not necessarily require referral or physical therapy (PT) if the patient is asymptomatic 2, 3.
• Studies have shown that a significant proportion of individuals with cam morphology do not experience hip pain, and the presence of cam morphology alone is not a definitive indicator of the need for referral or PT 4, 3.
• The decision to refer or provide PT should be based on the presence of symptoms, such as hip pain, and the impact of the condition on the patient's daily activities and quality of life 5, 6.
• In the absence of pain, regular monitoring and assessment of the patient's condition may be sufficient, rather than immediate referral or PT 2, 3.

Factors to Consider

• The size and location of the cam morphology, as well as the patient's activity level and occupation, may influence the likelihood of developing hip pain 2, 6.
• Decreased internal rotation and an elevated alpha angle have been associated with an increased risk of developing hip pain in individuals with cam morphology 2, 3.
• The patient's overall health and medical history should also be taken into account when determining the need for referral or PT 5, 4.

Research Findings

• A study of asymptomatic volunteers found that 14% had cam-type femoroacetabular impingement morphology, with a higher prevalence in men than women 3.
• Another study found that 47% of a general population sample had cam hip morphology, with no significant correlation between cam morphology and hip pain 4.
• A prospective study of young skiers found that cam morphology was present in 47.2% of participants, but there was no correlation between cam morphology and hip pain at baseline or follow-up 6.