Hip and groin pain can be the result of a number of different pathologies and injuries and will usually present with pain, stiffness, weakness and reduced range of motion. A thorough assessment can determine whether the issue is inside or outside the hip joint, thus allowing specific interventions to to applied such as joint mobilisation, exercise and education/advice.
Intra-articular Physical Assessment
1. C-sign: Patients with FAI typically have anterolateral hip pain. They often cup the anterolateral hip with the thumb and forefinger in the shape of a “C,” termed the C-sign.
2. FADDIR: The flexion, internal rotation, and adduction (FADIR) test evaluates anterior rim FAI by passively flexing the hip to 90°, with adduction and internal rotation. The FADIR test is the most sensitive physical examination test for FAI.
3. FABER: The Flexion ABduction External Rotation (FABER) test is typically used as a provocation special test, but has also been used as a measurement of combined hip range of motion (ROM). It is thought that limited ROM with this measurement may be indicative of hip pathology.
4. Hip rotation ROM: Limited and painful internal rotation.
Extra-articular Physical Assessment
Point tenderness at greater trochanter: sign of gluteal tendinopathy with or without hip bursitis.Muscle testing: FAI patients had significantly lower MVC strength than controls for hip adduction (28%), flexion (26%),external rotation (18%) and abduction (11%).
Radiographic Assessment
Patients suspected of having FAI can have anteroposterior radiography of the pelvis and a modified Dunn view of the hip instead of standard hip radiography to assess for bony sources of impingement.
Patients whose history and examination are consistent with FAI should undergo magnetic resonance arthrography to evaluate for labrum and articular cartilage injury, and diagnostic injection of local anaesthetic to confirm that the source of pain is intra-articular.
At Sydney Muscle & Joint Clinic our approach is consistent, high quality and based on the best scientific knowledge. We deliver evidence-based physiotherapy, exercise physiology and chiropractic for a range of musculoskeletal conditions, which means you get an approach that is effective, safe, and efficient. Contact your local Penrith physio today.
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