What kind of treatment is recommended for someone who has signs of femoroacetabular impingement (on X-rays) but no symptoms? That describes me. I had an X-ray taken for something else but they found this impingement. The radiologist called it an "incidental finding" but I'd still like to know what to do if anything.
It sounds like you may have a condition known as femoroacetabular impingement or (FAI) or simply hip impingement. Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed.
Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.
FAI as an "incidental" finding just means the radiologist was examining the X-rays looking for something else. It could have been a low back problem or even an abdominal condition. In any case, while looking for something else, the radiologist noticed the impingement condition. Treatment (if any) for the impingement may depend on the type and severity of the problem.
For more complete information on femoroacetabular impingement, see our Patient Guide to Femoroacetabular Impingement available at http://www.eorthopod.com/content/femoroacetabular-impingement
Information on anatomy, causes, complete diagnosis, and treatment is provided. Both conservative (nonoperative) care and orthopedic surgery are discussed. The type of problem you describe falls into a bit of a gray zone just now. The best treatment approach remains unknown for someone who has impingement but without the symptoms of pain and limited motion.
Researchers from Belgium have recently been able to identify some features of this condition that suggest the need for more research. They were able to see that the control group (people with normal hips and no symptoms) had no risks that might predict the development of femoroacetabular impingement (FAI). Patients in the group without symptoms but obvious changes seen on X-rays were more likely to develop hip impingement compared with the control group but less likely when compared with the group who already had known FAI.
It's clear that people without symptoms and no sign of hip problems don't need any further treatment or intervention. At the same time, those with painful, limited hip motion and clearly documented femoroacetabular impingement (FAI) need careful management. Surgery is often done to reshape the femoral head and reduce the risk of osteoarthritis.
But what should be done to best aid those individuals in the middle group? These are the folks like yourself who have some anatomic changes in the hip suggestive of FAI but no symptoms yet. The authors suggest more research is needed before suggestions and guidelines can be issued.
Questions to be answered by future studies include: 1) Is there any cartilage damage occurring in people with signs of impingement but no symptoms? 2) Should sports participation be discouraged? 3) Or is it only necessary to limit the use of certain hip positions? 4) Will the group with signs of FAI but no symptoms eventually develop a full blown case of FAI?
Emmanual A. Audenaert, MD, et al. Hip Morphological Characteristics and Range of Internal Rotation in Femoroacetabular Impingement. In The American Journal of Sports Medicine. June 2012. Vol. 40. No. 6. Pp. 1329-1336.
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