Steroid Injection For Hip Impingement (Femoral acetabular impingement)
Femoral acetabular impingement (FAI) is a condition in which there is abnormal contact (impingement) between the ball and socket of the hip joint (femoral head and acetabulum respectively). Over time, this can lead to pain and has been associated with damage to the labrum, which is the layer of cartilage which lines the socket of the hip joint.
It is a common cause of groin pain in those who are 20-40 years old and is associated with poor muscle control around the hip joint (Cavatelli et al, 2011).
Symptoms of Femoral acetabular impingement
- A deep stiffness and pain in the hip/groin area. This can refer to the thigh, buttock and sometimes the low back.
- Aggravated by prolonged sitting, squatting and accelerating / twisting sports like football.
- May also experience restricted range of movement in the hip joint, pinching, clicking or catching.
Anatomy of the hip joint
The hip joint is a ball and socket joint which is formed by the ball-shaped head of the femur (top of the thigh bone) and the socket of the pelvis (known as the acetabulum). This allows for motion and gives stability needed to bear weight through the joint. Around the acetabulum there is a fibrocartilage ring which is known as the labrum. This deepens the socket and increases the stability of the joint.
There are two main types of hip impingement. Individuals may have either type or a combination of both. The two types of FAI are as follows:
Cam Impingement – this is caused when excessive bone grows at the edge of the femoral head, where it meets a part of the femur called the femoral neck. The excessive bone growth forms a bump which impacts onto the socket during certain hip movements. This type of impingement is most seen in young men.
Pincer Impingement – this is caused when excessive bone grows at the edge of the hip’s socket and creates an overhang, making the socket too deep in certain places.
How to diagnose
FAI has only recently been understood therefore in the past such patients may have been misdiagnosed and not managed appropriately.
It is important the condition is diagnosed early, as when FAI is left untreated, this has been associated with the development of secondary hip osteoarthritis (Zhang et al, 2015).
An expert physiotherapist will take a thorough history and assess your hip to determine the diagnosis.
They will perform a physical examination to help develop a diagnosis and treatment plan. The assessment will include checking your hip range of movement, strength and flexibility of the surrounding musculature and functional tests to assess biomechanics.
The physiotherapist may refer you to have an XRAY or an MRI scan to confirm the diagnosis.
Diagnostic ultrasound can be performed in the clinic to check inflammation of the outer edge of the hip joint which is associated with FAI and check surrounding soft tissue.
In general, FAI can be well managed with physiotherapy treatment and not require surgical intervention.
Physiotherapy will include:
- A personalised exercise program to strengthen, improve flexibility and motor control around the hip joint.
- Advice on activity modification and load management to reduce flare ups of pain.
If symptoms have not improved with physiotherapy, or if the pain is affecting your sleep, stopping you from performing everyday activities such as getting dressed or is limiting you from performing your physiotherapy exercises you may want to consider an ultrasound guided steroid injection.
Femoral Acetabular Impingement Injection therapy
If your pain does not settle with physiotherapy and is limiting your ability to perform your physiotherapy exercises, an ultrasound guided steroid injection may be appropriate for you.
Corticosteroid (a strong anti-inflammatory medicine) is injected into the hip under ultrasound guidance. This can help temporarily reduce pain and inflammation in the injured hip joint.
Casartelli,N.C., Maffiuletti, N.A., Item-Glatthorn, J.F., Staehli, S., Bizzini, M., Impellizzeri, F.M. and Leunig, M. 2011. Hip muscle weakness in patients with symptomatic femoroacetabular impingement. Osteoarthritis cartilage. 19(7), pp. 816-821.
Zhang, C., Linda, L., Forster, B.A., Kopec, J.A., Ratzlaff. C/. Halai, L., Cibere, J. and Esdaile, J.M. (2015) Femoroacetabular impingement and osteoarthritis of the hip. Canadian Family Physician. 61(12) pp. 1055-1060.