Impingement – hip

Impingement Hip: Description

Impingement-hip syndrome is a mechanical constriction between the femoral head of the femur and the acetabulum (acetabulum) formed by the pelvic bone. Bony changes make sure that the cartilaginous clavicle (labrum), which otherwise closes the acetabular cup, is pinched. Especially when bending or spreading the hip joint, this can cause severe pain in the groin, which can radiate up to the thigh. Depending on the origin of the bony changes, a distinction is made between pincer-impingement-hip syndrome and cam-impingement-hip syndrome.

Pincer impingement hip

In pincer-impingement-hip syndrome, the femoral neck is normally configured. The acetabular cup, on the other hand, has the deformed shape of a grasping forceps (pincer = grasping forceps) and literally takes the hip head “into the forceps”. Through this increased roofing of the condyle within the joint space of the hip joint head and the pan roof hit each other easily. The result is a painful mechanical disability of the hip joint. Pincer impingement hip syndrome is more common in women between the ages of 30 and 40 years.

Cam impingement hip

In the healthy, the femoral neck has a sidecut below the femoral head, giving the hip joint head more freedom of movement in the joint capsule. Cam-impingement-hip syndrome (engl. Cam = camshaft) has lost the sidecut by a proliferation of the femoral neck bone. The bone ridge narrows the joint space, which favors the painful rubbing together of the femoral neck head and the labrum of the acetabulum. Cam-impingement-hip syndrome usually affects young, physically active men, with footballers suffering from it particularly frequently.

Impingement Hip: Symptoms

At the beginning, symptoms of impingement-hip syndrome are often very slow. Patients report sporadically occurring hip pain. The groin pain radiates often in the thigh and strengthens under load. Climbing stairs and staying in a seated position when driving a car can cause pain for those affected. Turning the angled leg inwards (internal rotation with 90 degrees of flexion) also causes pain in the majority of cases or aggravates it. The affected persons therefore often take a restraint, in which they turn the affected leg slightly outward (external rotation).

Impingement Hip: Causes and Risk Factors

Impingement-hip syndrome is most often caused by the bony deformation of the acetabulum. The pelvic bone (os-ilium) forms a cup-shaped socket that forms the hip together with the femoral head of the femur. The osseous components of the hip joint can cause bone spurs that lead to mechanical tightness. Since the hip joints of young athletes are exposed to increased physical stress, they are most often affected by an impingement-hip syndrome.

However, many of the pincer-impingement and cam-impingement cases are not well understood. The load-dependent, bony structural changes, however, are detectable in most of those affected. Another possible explanation for bony deformity is the assumption that a growth disturbance in adolescence leads to a faulty occlusion of the growth plates.

Impingement hip: examination and diagnosis

The right contact for suspected impingement-hip syndrome is a specialist in orthopedics and trauma surgery. This first raises in a detailed conversation with you your medical history (anamnesis). He will ask you the following questions:

• Do you do sports and if yes, which ones?
• What are the restrictions on movement in the hip joint?
• Do you remember an injury or heavy burden associated with the onset of pain?
• Does the pain increase when you turn the leg inwards?

The doctor will examine you physically after the interview. He tests the flexibility of the hip joint by asking you to move the leg to different positions. In addition, the doctor will press the bent leg against the edge of the acetabulum, which usually causes the typical pain.

Imaging techniques for the detection of an impingement-hip syndrome are an X-ray examination of the pelvis, magnetic resonance imaging (MRI) and an ultrasound examination (ultrasonography).

Impingement-hip syndrome: X-ray examination

If an impingement-hip syndrome is suspected, X-ray examination is the most important diagnostic tool. It is also easy to perform and inexpensive. On an x-ray, structural changes of the bones can be detected very accurately. Your specialist in orthopedics and trauma surgery will either conduct the examination yourself (if he owns his own x-ray unit) or you will have to refer a specialist in radiology and then discuss the findings with you.

Impingement Hip Syndrome: Magnetic Resonance Imaging (MRI)

Magnetic resonance imaging (MRI), also called magnetic resonance imaging, allows an accurate representation of the soft tissues surrounding the hip joint. Tendons, muscles, bursae and cartilage can be represented very high resolution. The images are produced by magnetic resonance tomography through the combination of radio waves and magnetic fields. Before a planned operative reconstructive procedure, an MRI is particularly well suited to better assess the operating conditions and to better plan the planned procedure.

Impingement-hip syndrome: sonography (ultrasound)

Ultrasound is a very simple and cost-effective method of examination, with the help of which, for example, inflammation-induced fluid accumulation within the bursa and muscular structures can be represented. Bones, on the other hand, can not be imaged sufficiently well in ultrasound. Sonography is therefore usually only used as a supplementary examination method for impingement-hip syndrome and not as a primary diagnosis.

Impingement hip: treatment

The therapy concept for impingement-hip syndrome depends on the triggering cause. Conservative therapies such as immobilization of the joint, painkillers, physiotherapy and avoiding triggering factors can relieve the symptoms, but can not eliminate the cause. This requires surgery (causal therapy).

Conservative therapy of impingement hip syndrome

In the early stages of the disease, conservative therapies are particularly important. Your goal is to relieve the pain without invasive procedures. Anti-inflammatory analgesics such as acetylsalicylic acid or ibuprofen help. In addition, fango packs, baths and electrotherapy for many sufferers can improve the symptoms. Specific physiotherapy exercises can help to strengthen the surrounding muscles, widen the joint space and thus reduce the pain.

Causal therapy of impingement hip syndrome

The causal approach to therapy is to treat and eliminate the triggering cause of the disease. In the case of impingement-hip syndrome, structural bone changes can be removed as part of an operation (arthroscopy). The pain usually improves as soon as the mechanical tightness has been removed by the operation. Especially in young patients, surgery is recommended to minimize the risk of joint stiffness in the course. The surgical procedure of first choice is arthroscopy.

Arthroscopy (joint mirroring): Arthroscopy is the surgical procedure of choice and has replaced open surgery. It is a low-risk, minimally invasive method that involves making two to three small (about one centimeter) skin incisions around the hip joint. A camera with an integrated light source and special surgical equipment can be inserted through the skin incisions in the joint and allow a reflection – the exact representation of the entire joint and the detection of damage. Afterwards, the existing changes can be eliminated directly during the procedure. For example, protruding bone spurs are abraded, cartilage damage is removed and repaired. Damaged or torn tendons can also be sutured and thus reconstructed as part of arthroscopy. The skin incisions are closed with only a few stitches and leave only very subtle scars.

Impingement hip: disease course and prognosis

Seven to ten days after an arthroscopy of the hip joint should initially only a partial load with a maximum of 20 to 30 kilograms done. If a necking of the donor neck occurred during arthroscopy, the maximum partial load is even valid for three to four weeks (21 to 28 days). After all, the bone takes longer to restructure to accommodate the new static conditions.

Following arthroscopy, regular physiotherapy should be given immediately. A load of jumps should be made twelve weeks after surgery of the hip joint. Sports that relieve the hip joint, such as swimming and cycling, are allowed six weeks after surgery. Six months after surgery, all sports are usually possible again.

Only if treated early can consequential damage be caused by the Impingement hipSuccessfully prevent syndrome.