Femoroacetabular Impingement and Acetabular Labral Tears - Part 2: Clinical Diagnosis, Physical Examination and Imaging

Abstract

The clinical diagnosis of femoral acetabular impingement (FAI) continues to evolve as the understanding of normal and pathological hips progresses. Femoral acetabular impingement is currently defined as a syndrome in which the diagnosis consists of the combination of a previously-obtained comprehensive clinical history, followed by a consistent and standardized physical examination with specific orthopedic maneuvers. Additionally, radiographic and tomographic examinations are used for the morphological evaluation of the hip, and to ascertain the existence of sequelae of childhood hip diseases and the presence of osteoarthritis. The understanding of the femoral and acetabular morphologies and versions associated with images of labral and osteochondral lesions obtained through magnetic resonance imaging (MRI) contributes to the confirmation of this syndrome in symptomatic patients, and helps in the exclusion of differential diagnoses such as iliopsoas tendon snaps, subspine impingement, ischiofemoral impingement, and other hip joint pathologies.

Keywords: diagnosis; femoroacetabular impingement; hip; radiography.

Fig. 1

(A) Pelvic version with the patient standing up and (B) sitting down. Pelvic version ranged 29° (from -7° to 22°). 1. T12/S1 lordosis: 21°, 2. SVA: 81 mm, 3. Sacral slope: 35°, 4. Pelvic view: 28°, 5. Pelvic version: -7°, 6. Cam gravitational line: 50 mm, 7. Sacral slope: 7°, 8. Pelvic view: 28°, 9. Pelvic version: 22°

Fig. 2

(A) Positioning with hip flexion to achieve straightening of the lumbar lordosis. (B) DIRI maneuver, in which the examined hip is flexed (in this case the left hip), followed by internal rotation and adduction. (C) DIRE maneuver: in this case, with the lumbar spine already straightened, left hip abduction and concomitant internal rotation are performed to evaluate injuries or impingement at the upper and posterior regions.

Fig. 3

Radiographic hip views in FAI research. (A) Anteroposterior view. (B) Ducroquet view. (C) Dunn view for the visualization of cam-type deformity. Note the rectification and prominence of the neck-head transition region. (D) X-ray image in Lequesne position.

Fig. 1

(A) versão pélvica em pé. (B) Versão pélvica sentado. A variação da versão pélvica foi de 29° (de -7° a 22°).

Fig. 2

(A) posicionamento com flexão do quadril para se conseguir a retificação da lordose lombar. (B) manobra de Diri, na qual se realiza a flexão do quadril examinado, neste caso, o quadril esquerdo, seguido de rotação interna e adução. (C) Manobra de Dire: neste caso, com a coluna lombar já retificada, realiza-se a abdução do quadril esquerdo e a rotação interna concomitante, a fim de se avaliar lesões ou impacto nas regiões superior e posterior.

Fig. 3

Incidências radiográficas do quadril na pesquisa de IFA. (A) incidência anteroposterior. (B) incidência de Ducroquet. (C) Incidência de Dunn para visualização do came. Observe a retificação e a proeminência da região transição colo-cabeça. (D) imagem radiográfica da posição de Lequesne.