FEMORO-ACETABULARIMPINGEMENT

James Kingsmill

2015

BACKGROUND INFO

0:05

3:00

OUTLINEAnatomy

Causes

Symptoms

Treatments

Where does AT fit in?

ANATOMY OF A HIP

Acetabulum

FemoralHead

Labrum

Cartilage

LigamentumTeres

TYPES OF FAICam

Pincer

Mixed

CAUSES

...CORRECTION

PREDISPOSINGFACTORS

YOUNG

...often

ACTIVE

...usually

MALE

...mostly

ACTIVITIESFootball

Dancing

Martial Arts

MEANING...Large Hip ROM

Axial Loading of Hip

Torsional Forces

SYMPTOMS

WALKING PATTERNS

ANTALGIC GAIT

TRENDELENBURG GAIT

BRANDENBURG GATE

POSITIVE IMPINGEMENT TEST90% of FAI sufferers test positive

Volunteer?

FALSE POSITIVES(OTHER POSSIBLE CAUSES)

Hip dysplasia

Avascular necrosisYou mean when your mentor turns into a zombie?

No, that's avuncular necrosis.

Slipped Capital Femoral EpiphysisIs that a thing?

Legg-Calvé-Perthes DiseaseStop making these up.

DIAGNOSIS

XRAYMRIMRA

CT SCAN

DAMAGECartilage damage

Labral tears

Osteoarthritis

TREATMENTS

NON-SURGICALNSAIDs

Cortisone

Physiotherapy

Massage

Root cause?

SURGICALJoint Reshaping

Labral Repair

Cartilage Regrowth

Ligament Repair

TYPESOPEN SURGERYARTHROSCOPY

OPEN SURGERYTurn away now if you're squeamish

Seriously

ARTHROSCOPYIt's not any more pleasant

POST-OPERATIVETREATMENT

Motor Control Strategies

Hip Weakness

Postural Misalignment

INITIAL REGIMEIMPROVING ROM

Light stretching

CORE STABILISATION

TrA, Pelvic Floor

GLUTEAL ACTIVATION

Bridging, Clams, Mule Kicks, Drinking Bird

ADVANCED REGIMEFUNCTIONAL MOVEMENTS

Squats, Lunges

STABILITY EXERCISES

Wobble Boards, Dynadiscs

IMPACT EXERCISES

Hopping, Landing

WHERE DO WE COMEIN?

DIAGNOSIS AND REFERRAL

REHABILITATION"Generally, motor control retraining is more important than

strength or power of individual muscles."

- Fowler Kennedy Sports Medicine Clinic

AT TEACHERS ARE EXPERTS AT:Observing movement patterns

Retraining motor control

Rewiring the software

WHAT ARE WE NOT EXPERTS AT?

CONCLUSIONQUESTIONS?

REFERENCESFemoral Acetabular Impingement, Pate (http://dcpracticeinsights.net/mpacms/dc/article.php?id=53605)

Femoroacetabular Impingement, Magill et al (http://benthamopen.com/contents/pdf/TOSMJ/TOSMJ-4-75.)pdf

Surgical Treatment of Femoroacetabular Impingement, AMA(http://www.bcbsks.com/customerservice/Providers/MedicalPolicies/policies/policies/SurgicalTreatment_FemoroacetabularImpingement_2014-10-15.pdf)

Radiographic Prevalence of Femoroacetabular Impingement in a Young Population with Hip Complaints Is High, Ochoa et al(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3049607)

Current concepts in management of femoroacetabular impingement, Wilson et al (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3557322)

Hip Arthroscopy Protocol for Femoroacetabular Impingement, Fowler Kennedy Sports Medicine Clinic (http://fowlerkennedy.com/wp-content/uploads/2013/04/Hip_Protocol_for_Arthroscopy_of_Femoroacetabular_Impingement.pdf)

Femoro-acetabular Impingement (FAI), running-physio.com (http://www.running-physio.com/femoro-acetabular-impingement-fai)

Hip FAI and Labral Tear: Diagnosis to Treatment (https://hipfai.wordpress.com)

Femoroacetabular Impingement – Etiology, Diagnosis, and Treatment of FAI, Reinold (http://www.mikereinold.com/2011/03/femoroacetabular-impingement-etiology-diagnosis-and-treatment-of-fai.html)

FemoroAcetabular Impingement (FAI), Park Clinic Orthopaedics (http://www.parkclinic.com.au/home/conditions-treatment/hip/femoroacetabular-impingement-fai)

Slipped capital femoral epiphysis, Wikipedia (http://en.wikipedia.org/wiki/Slipped_capital_femoral_epiphysis)

Legg–Calvé–Perthes disease, Wikipedia (http://en.wikipedia.org/wiki/Legg%E2%80%93Calv%C3%A9%E2%80%93Perthes_disease)

Septic Arthritis, Wikipedia (http://en.wikipedia.org/wiki/Septic_arthritis)

Hip Dysplasia (Human), Wikipedia (http://en.wikipedia.org/wiki/Hip_dysplasia_(human))