Hip Impingement Syndrome

The hips are defined as two large ball and socket joints. For optimal function, the ball of the femur should be able to move smoothly within the socket of the pelvis without interference. Unfortunately, hip impingement syndrome, also known as femoroacetabular impingement (FAI)- can develop with changes in the shape of the cartilage within the hip joints.  Ultimately, this can lead to hip pain and dysfunction. Whether you’re an athlete or want to be able to walk and squat without hip pain, hip impingement can make it hard to do the things you love. Today, we will dive into the potential symptoms, causes, risk factors, ways to diagnose, and how to get started with treatment for FAI.

Hip Impingement Symptoms

Hip impingement is often referred to as hip impingement syndrome once symptoms are evident. This is because initial hip impingement is not typically accompanied by any symptoms like pain. Over time, with a progression of joint damage and deformity, pain will most likely develop. The most telltale sign of this syndrome is groin pain with weight bearing activity. Additionally, here are some other signs to watch out for:

• Hip pain in the front, side, or back (groin, buttocks, etc.)
• Dull or achy hip pain
• Sharp hip pain with certain weight-bearing activities
• A sensation of clicking, locking, or catching in the hip joint
• Pain with walking or flexing the hip, such as squatting
• Decreased hip range of motion
• Pain following long periods of sitting
• Difficulty walking up an incline or hill

Learn About Treating Symptoms

Causes

When it comes to hip impingement syndrome, there are two primary causes and anatomical areas that can be affected that are important to understand and differentiate.

Deformity of the Ball (known as a cam impingement)

The soft cartilage that covers the ball of the hip joint at the top of the femur can become misshapen. Sometimes, even the bone itself can become deformed as well. This can lead to jamming in the hip when the affected area articulates with the socket of the joint- most common with bending the hip.

Deformity of the Socket (known as a pincer impingement)

A rim of cartilage lines the edge of the hip socket (called the labrum) to provide additional stability to the hip. If this rim is too large, sticks out too far, or becomes damaged it can lead to pinching in the hip. Most often, the pinching occurs between the neck of the thigh bone (the shaft of bone just below the ball) and the acetabulum.

Additionally, there are a few rarer health related issues that can cause hip impingement syndrome as well. These are most common in childhood and include:

• Poor circulation that compromises blood flow to the hip from Legg-Calve-Perthes disease
• Abnormal hip and bone growth from a condition called Coxa Vara
• A disrupted growth plate usually due to childhood obesity called slipped capital femoral epiphysis

Risk Factors

There are a handful of activities and other underlying issues that can increase your risk of hip impingement syndrome. Since we discussed that the onset of symptoms are often a later sign of hip impingement, understanding your risk factors can help you get a diagnosis as early as possible to prevent any unnecessary long term effects. Risk factors could include one or more of the following:

• Sports that require repetitive hip range of motion and high impact- including football, downhill skiing, weight lifting, and hockey
• Heavy labor and lifting for an occupation
• Repetitive hip flexion motion with daily activities 
• Anatomical abnormalities of the hip at birth that affect the structure of the hip joint; such as the depth of the socket and the angle of the femoral head
• Rheumatoid arthritis (RA) or some other form of chronic inflammation that affects the hips
• Hip dislocation at birth
• Trauma to the hip with a fall, car accident, sport, etc. 
• Childhood complications that affect normal growth of the hip joint (as discussed above)

Diagnosing

Proper management of symptoms is key, especially since it has been found to lead to the early onset of osteoarthritis in people under the age of 40. To determine the cause of your hip pain and whether you have hip impingement, it’s best to schedule an appointment with an orthopedic doctor. They will conduct an in depth medical exam that looks at your history and physical presentation. This typically includes looking at lower body strength, hip range of motion, areas of pain, and more. Plus, there are a few special tests that can be used to determine if you have hip impingement syndrome.

Additionally, if needed your doctor can order diagnostic imaging tests to rule out other potential issues or determine the extent of damage within the hip joint itself. An X-ray can rule out fractures and bone spurs, while a magnetic resonance imaging (MRI) or CT scan can assess soft tissue damage.

Hip Impingement Test

The most common orthopedic test that can help determine if FAI is evident is called the FADIR test (flexion adduction internal rotation test). This test involves your doctor passively moving your hip up toward your chest while bringing your leg across the body and knee inward. Onset of symptoms like pain or catching are a positive side. Combining this test with other indicators like limited range of motion and weakness can help the doctor correctly identify your hip issues.

Can Hip Impingement Go Away?

In general, the underlying causes of hip impingement will not go away with treatment- unless hip surgery (most often an arthroscopy) is utilized. However, symptoms can often be well managed and hip mobility restored with the right conservative treatment. Treatment options might include physical therapy, rest, anti-inflammatory medication, injections, and activity modification. Understanding hip impingement syndrome and making adjustments can ensure that you get to continue living life the fullest without the frustrations of hip pain looming over your head.

Get in touch with your doctor at the first sign of hip dysfunction for the best outcomes. Although, it is never too late to seek care and take back control of your life.