Groin pain & Femoro-acetabular impingement (Hip Impingement)

The area where your trunk meets your thigh is the groin. Groin pain is a fairly common problem and the causes can be within the hip, around the hip or from the lower abdomen and pelvis.

The most common cause by far is tendon strains, sprains and tendonitis.

The other potential causes are from within the hip joint – femoro-acetabular impingement (FAI), avascular necrosis, or from the spine.

Other causes such as hernia and testicular problems (in males), need to be ruled out.

 

Femoroacetabular Impingement (FAI)

 

What is femoro-acetabular impingement (FAI)?

 

Femoroacetabular impingement (FAI) is a condition where the bones of the hip are abnormally shaped. Because they do not fit together perfectly, the hip bones rub against each other and cause damage to the joint.

The hip joint is a ball and socket joint, where the ball sits in the socket. This allows movement in different directions. Normally the ball and socket are well matched in shape and this allows normal painfree movement. In FAI, the ball may be shaped abnormally (cam lesion), the edges of the socket may be (pincer) or it can be a combination of both (combined).This mismatch may result in the soft tissues in the hip getting ‘pinched’ in certain positions of the limb, resulting in wear and tear and secondary changes.

 

 

 

 

 

 

 

 

 

 

 

 

 

(Left) Pincer impingement. (Right) Cam impingement.

 

How does it progress?

 

It is not known how many people may have FAI. Some people may live long, active lives with FAI and never have problems. When symptoms develop, however, it usually indicates that there is damage to the cartilage or labrum and the disease is likely to progress. Symptoms may include pain, stiffness, and limping.

 

What is the cause of this?

 

FAI occurs because the hip bones do not form normally during the childhood growing years. It is the deformity of a cam bone spur, pincer bone spur, or both, that leads to joint damage and pain. When the hip bones are shaped abnormally, there is little that can be done to prevent FAI.Because athletically active people may work the hip joint more vigorously, they may begin to experience pain earlier than those who are less active. However, exercise per se does not cause FAI.What are the symptoms?People with FAI usually have pain in the groin area, although the pain sometimes may be more toward the outside of the hip. Sharp stabbing pain may occur with turning, twisting, and squatting, but sometimes, it is just a dull ache.

 

What are the treatment options?

 

Non-surgical treatment

 

The first line of non-surgical treatment is to identify the activities and positions which causes the symptoms. A short period of rest and activity modifications, supplemented with anti-inflammatory medicines may relieve the symptoms. Physiotherapy may also help to get back to activities and build up strength in a controlled manner.If this does not settle the symptoms then further investigations may be warranted – these include X rays, CT and MRI scans.

 

Surgical Treatment

 

If tests show joint damage caused by FAI and your pain is not relieved by nonsurgical treatment, your doctor may recommend surgery.Many FAI problems can be treated with arthroscopic surgery. Arthroscopic procedures are done with small incisions and thin instruments. The surgeon uses a small camera, called an arthroscope, to view inside the hip.During arthroscopy, your doctor can repair or clean out any damage to the labrum and articular cartilage. He or she can correct the FAI by trimming the bony rim of the acetabulum and also shaving down the bump on the femoral head. Some severe cases may require an open operation with a larger incision to accomplish this. While there is a small chance that surgery might not help, it is currently the best way to treat painful FAI.

 

 

 

 

 

 

 

 

 

(Left) During arthroscopy, your surgeon inserts an arthroscope through a small incision about the size of a buttonhole. (Right) Other instruments are inserted through separate incisions to treat the problem.

 

Future DevelopmentsAs the results of surgery & technology improves, doctors will probably recommend earlier surgery for FAI.

 

 

Dr Vinod Kumar Abu Dhabi

Sports surgeon Abu Dhabi

Shoulder surgeon Abu Dhabi

NMC Royal Hospital