User:Petersonjordan/sandbox

Femoroacetabular Impingement
Femoroacetabular Impingement (FAI), is a condition involving one or more anatomical abnormalities of the hip joint, which is a ball and socket joint. It is a common cause of hip pain and discomfort in young and middle-aged adults. It occurs when the ball shaped femoral head contacts the acetabulum abnormally or does not permit a normal range of motion in the acetabular socket. Damage can occur to the articular cartilage, or labral cartilage (soft tissue, ring-shaped bumper of the socket), or both. The condition may be symptomatic or asymptomatic and has been found to be a cause of osteoarthritis of the hip. Treatment options range from conservative management to surgery.

Anatomy
The hip joint is classified as a ball and socket joint, this type of synovial joint allows for multi-directional movement and rotation. There are two bones that make up the hip joint and create an articulation between the femur and pelvis. This articulation connects the axial skeleton with the lower extremity. The pelvic bone, also known as the innominate bone, is formed by three bones fused together: the ilium, ischium, and pubis. The musculature of the hip is divided into anterior hip muscles and posterior hip muscles. The major nerve supply that runs through the hip joint is the femoral nerve and the sciatic nerve.


 * 1) ^ Jump up to: a b
 * 2) ^
 * 3) ^
 * 4) ^
 * 5) ^
 * 6) ^ Egger, Anthony C.; Frangiamore, Salvatore; Rosneck, James (2016). "Wolters Kluwer Health - Article Landing Page". Sports Medicine and Arthroscopy Review. 24 (4): e53–e58. doi:10.1097/jsa.0000000000000126. PMID 27811519. Retrieved 2019-01-16.

Diagnosis
Clinical evaluation is the first step in diagnosis, but will rarely lead to the diagnosis on its own, due to inconsistent and vague nature of the pain. Childhood and current activity should be inquired about. Physical exam should also involve assessing passive internal rotation of the hip during flexion, as range of motion is reduced in proportion to the size of a cam lesion. Flexing the hip to 90 degrees, adducting, and internally rotating the hip, known as the FADDIR test, should also be performed. It is positive when it causes pain. The FABER test should also be preformed, this test involves flexing, abducting, and externally rotating the hip. The FABER test is useful when diagnosing concurrently with a labral pathology and is considered positive if the position elicits pain. Additional non-invasive ways to observe possible FAI is changes in gait that include a lower peak hip extension and internal rotation to compensate for bony growth. (help)
 * 1) ^ Starkey, Chad, 1959-. Examination of orthopedic & athletic injuries. Brown, Sara D., (Fourth edition ed.). Philadelphia. ISBN  9780803639188 . OCLC 893974504.

Prevention
Prevention is currently being investigated. The goal of prevention would be to avoid joint damage and premature hip osteoarthritis. Studies are examining the effectiveness of screening adolescents in school and targeting at-risk individuals for education, physical therapy and decreasing participation in possibly harmful activities/sports as referenced in the epidemiology section.

Treatment
Treatment of FAI can divided into those that are non-operative (conservative) and operative. Conservative treatment is often prescribed for those who have not yet received any therapy. Conservative treatment includes physical therapy, avoidance of those activities that produce pain, and nonsteroidal anti-inflammatory drugs. It may also include joint injections with cortisone or hyaluronic acid, particularly for those who wish to avoid surgery.

Physical therapy is implemented for the purpose of improving joint mobility, strengthening muscles surrounding the joint, correcting posture, and treating any other muscle or joint deficits that may be exacerbating the condition. A movement analysis may also be performed to identify specific movement patterns that may be causing injury. It should be noted, however, that studies to demonstrate the effectiveness of physical therapy are currently underway, with no conclusive results to date.

Operative treatment is generally recommended to those who continue to have symptoms. It involves the surgical correction of any bony abnormalities causing the impingement and correction of any soft tissue lesions, such as labral tears. The primary aim of surgery is to correct the fit of the femoral head and acetabulum to create a hip socket that reduces contact between the two, allowing a greater range of movement. This includes femoral head sculpting and/or trimming of the acetabular rim.

Surgery may be arthroscopic or open. A 2011 study analyzing current surgical methods for management of symptomatic femoral acetabular impingement, suggested that the arthroscopic method had surgical outcomes equal to or better than other methods with a lower rate of major complications when performed by experienced surgeons; consequently, the surgery is now rarely done open.

Outcomes of arthroscopic surgery are currently being studied, but have generally been positive. According to a 2019 meta-analysis, the risk of having surgery fail or need to be re operated on is about 5.5% whereas the complication rate is 1.7%. Additionally, patient reported outcomes show that approximately three to six months post-operative hip arthroscopy is when pain reduction and activities of daily life are improved. For sport function this timeline is about six months to a year. Failure of hip arthroscopy is more likely to fail in older patients, females, or those who have experienced the symptoms of FAI for a long period of time.

When surgery is performed on elite athletes, most are able to return their previous level of competition. These athletes also have a higher rate of return to sport than recreational and collegiate athletes.

Long term, randomized controlled trials evaluating the efficacy of conservative and operative treatments are underway. TAKE OUT

History
While the true diagnosis of FAI can be considered a relatively recent discovery, reports of damage to the femoroaceatabular region date back over a century ago in the orthopedic realm of medicine. It was not until the development of an open surgical dislocation procedure was developed that FAI was discovered as an anatomical difference and cause of osteoarthritis. Orthopedic surgeon Dr. Reinhold Ganz can be credited with this discovery in his 2003 publication that discussed the findings and relation to hip osteoarthritis.