Femoroacetabular impingement: a consideration in younger adults with hip pain

Femoroacetabular Impingement: A Retrospective Case Study With 8-Year Follow-Up

OBJECTIVE

The purpose of this case report is to describe a patient with femoroacetabular impingement (FAI) who was initially misdiagnosed and treated for a hip flexor strain.

CLINICAL FEATURES

A 36-year-old male patient presented with insidious onset of progressive anterior right hip and groin pain of 7 years' duration. He was diagnosed with a right-sided hip flexor muscle strain and was discharged from care 1 month later. The patient then returned to the office 8 years later for treatment of unrelated lower back pain. This time, the doctor of chiropractic learned that the patient was misdiagnosed years before. The patient's past radiographs in fact revealed FAI, including severe hip joint osteoarthritis on the right and mild osteoarthritis on the left. As a result, the patient had undergone right hip joint replacement surgery. Recent radiographs also revealed FAI in the contralateral hip.

INTERVENTION AND OUTCOME

After investigating for FAI, the doctor of chiropractic was able to identify through symptomatology, history, physical examination, and radiographs the presence of FAI in the patient's left hip. An "active surveillance" approach is being taken.

CONCLUSION

This case illustrates the importance of an increasing awareness of FAI, as doctors of chiropractic are frequently the primary contact for patients with this condition.

Conservative management of an elite ice hockey goaltender with femoroacetabular impingement (FAI): a case report

OBJECTIVE

To detail the presentation of an elite male ice hockey goaltender with cam-type femoroacetabular impingement (FAI) and acetabular labral tears. This case will outline the prevalence, clinical presentation, imaging criteria, pathomechanics, and management of FAI, with specific emphasis on the ice hockey goaltender.

CLINICAL FEATURES

A 22-year old retired ice hockey goaltender presented to a chiropractor after being diagnosed by an orthopaedic surgeon with MRI confirmed left longitudinal and chondral flap acetabular labral tears and cam-type femoroacetabular impingement (FAI). As the patient was not a candidate for surgical intervention, a multimodal conservative treatment approach including manual therapy, electroacupuncture and rehabilitation exercises were implemented.

SUMMARY

FAI is prevalent in ice hockey players, particularly with goaltenders. Both skating and position-dependent hip joint mechanics involved in ice hockey may exacerbate or contribute to acquired and congenital forms of symptomatic FAI. As such, practitioners managing this population must address sport-specific demands in manual therapy, rehabilitation and physical training, to improve functional outcomes and prevent future injury.