Clinical Presentation

The most common complaint in the clinical history of a patient with FAI is anterior groin pain exacerbated by hip flexion. Patients complain of pain with prolonged sitting and with putting on shoes and socks, and also difficulty with getting into and out of a car. During physical examination, sharp groin pain is classically elicited when the hip is flexed to 90° and internally rotated. This "impingement sign" is thought to be triggered when the bony prominence at the junction of the femoral head and neck hits into the acetabulum and labral tissue. Nerve endings present in the labrum may trigger pain sensation with this examination [17]. Another test for FAI places the patient supine and the hip in a figure-four or flexed-abducted externally rotated (FABER) position. The clinician should measure or visually observe the distance between the lateral genicular line and the examination table. Typically, this distance is increased in patients with FAI, and lateral pain may be reported during the test. A thorough hip examination should be performed in addition to these provocative maneuvers. A complete history, gait analysis, motor strength testing, and range-of-motion testing should be performed in all patients [18].

A complete radiologic workup of a patient with FAI includes two plain film views (supine anterior-posterior [AP] pelvis and crosstable lateral) and magnetic resonance (MR) arthrography enhanced with gadolinium contrast. The AP radiograph should be evaluated for a crossover sign, which may be indicative of a retroverted acetabulum, and a posterior wall sign, which may be indicative of coxa profunda [13,19]. The crosstable lateral radiograph offers a good view for assessing femoral head-neck offset, and degree of femoral neck anteversion

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