From the Guidelines
Femoroacetabular impingement (FAI) typically presents with groin pain that worsens with activity, especially movements involving hip flexion and rotation, as reported in the most recent study by 1. The symptoms of FAI can be varied, but common symptoms include:
- Pain during prolonged sitting, getting in and out of cars, putting on socks and shoes, or during sports that require deep hip flexion
- A sharp, catching sensation in the hip or a dull ache that develops after activity
- Limited internal rotation of the hip, particularly when the hip is flexed to 90 degrees
- Pain reproduced with the FADIR test (flexion, adduction, internal rotation)
- Clicking, locking, or giving way sensations in the hip
- Pain radiating to the lateral hip, buttock, or anterior thigh These symptoms typically develop gradually over time rather than from a specific injury, as noted in the study by 1.
Diagnostic Approach
A comprehensive diagnostic approach is recommended, including patient symptoms, clinical signs, and diagnostic imaging, as suggested by 1. The diagnostic utility of clinical examination and diagnostic imaging in isolation is limited, and a comprehensive approach is necessary to accurately diagnose FAI, as reported by 1.
Management
Initial management of FAI includes:
- Activity modification
- Physical therapy focusing on core strengthening and hip stabilization
- Anti-inflammatory medications like ibuprofen (400-800mg three times daily with food) for pain relief, as mentioned in the example answer If conservative measures fail after 3-6 months, referral to an orthopedic surgeon for consideration of arthroscopic surgery may be appropriate, as noted in the example answer. It is essential to prioritize the most recent and highest quality study, which in this case is 1, to ensure the best possible outcome in terms of morbidity, mortality, and quality of life.
From the Research
Symptoms of Femoroacetabular Impingement (FAI)
The symptoms of FAI include:
- Pain, particularly in the groin area 2, 3, 4
- Clicking, catching, or buckling of the hip 2
- Stiffness and limited range of motion of the hip 2
- Giving way of the hip 2
- Discomfort with hip flexion, adduction, and internal rotation 5
- Slow-onset, persistent groin pain 4
Clinical Presentation
Patients with FAI often present with specific clinical signs, including:
- A positive FADIR test (flexion, adduction, internal rotation) 4
- A positive impingement sign 4
- Abnormalities in hip motion and function 6, 5
Diagnosis and Treatment
FAI can be diagnosed using a combination of patient symptoms, physical examination, and imaging findings, including:
- Orthogonal hip and pelvis X-ray views 2
- Magnetic resonance imaging/magnetic resonance arthrogram imaging 2
- Plain radiograph of the pelvis 4 Treatment options for FAI include conservative management, such as physical therapy and activity modification, as well as surgical management, including hip arthroscopy 2, 3, 6, 4