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Hip impingement syndrome is a mechanical tightness between the femoral head of the femur and the acetabulum, which is formed by the pelvic bone. Bony changes ensure that the cartilaginous joint lip (labrum), which otherwise closes off the acetabulum, 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, the Pincer hip impingement Syndrome and the Cam hip impingement Syndrome are distinguished.
With pincer hip impingement syndrome, the femoral neck is configured normally. The acetabular cup, on the other hand, has the deformed shape of a pincer and takes the head of the hip literally "in the pliers". Due to this increased roofing of the joint head within the joint gap, the hip joint head and the socket roof lightly hit each other. The result is a painful mechanical obstruction of the hip joint. Pincer hip impingement syndrome occurs increasingly in women between the ages of 30 and 40.
In healthy people, the femoral neck has a waist below the femoral head, which gives the hip joint head more freedom of movement in the joint capsule. In the case of cam hip impingement syndrome (cam = camshaft), the waistline has been lost due to an overgrowth of the femoral neck bone. The bone bulge narrows the joint gap, which favors the painful rubbing of the femoral neck and the labrum of the acetabular roof. Young, sporty men usually suffer from cam hip impingement syndrome, with football players becoming particularly ill.
In the beginning, symptoms of Hip Impingement syndrome often appear only very gradually. The patients report sporadic pain in the hip joint. The pain in the groin often radiates into the thigh and intensifies under stress. Climbing stairs and staying in a sitting position while driving can cause pain to those affected. Turning the angled leg inwards (internal rotation with 90 degrees flexion) also triggers or intensifies pain in most cases. Those affected therefore often adopt a protective posture in which they turn the affected leg slightly outwards (external rotation).
In most cases, Hip Impingement syndrome arises from the bony deformity of the acetabular acetabulum: The pelvic cavity (Os Ilium) forms a cup-shaped acetabular cup that, together with the femoral head of the femur, forms the hip joint. Bone spurs can develop on the bony components of the hip joint, leading to mechanical tightness. Since the hip joints of young athletes are exposed to increased physical strain, they are particularly often affected by Hip Impingement syndrome.
However, many of the cases of pincer impingement and cam impingement have not yet been sufficiently clarified. The load-dependent, bony structural changes are, however, detectable in most of those affected. Another possible explanation for the bony deformity is the assumption that a growth disturbance in adolescence leads to an incorrect closure of the growth plates.
The right contact for suspected Hip Impingement syndrome is a specialist in orthopedics and trauma surgery. The doctor first collects your medical history (anamnesis) in a detailed discussion with you. He may ask you the following questions:
The doctor will examine you physically after the interview. He tests the mobility of the hip by asking you to move the leg in different positions. In addition, the doctor will press the bent leg against the edge of the acetabulum, which usually triggers the typical pain.
Imaging methods for the detection of an Hip Impingement syndrome are an x-ray examination of the pelvis, magnetic resonance imaging (MRI) and an ultrasound examination (sonography).
If an Hip Impingement syndrome is suspected, X-ray examination is the most important diagnostic tool. It is also easy to carry out and inexpensive. Structural changes in the bones can be detected very precisely on an x-ray. Your specialist in orthopedics and trauma surgery will either carry out the examination yourself (if you have your own X-ray machine) or refer you to a specialist in radiology and then discuss the findings with you.
Magnetic resonance imaging (MRI), also called magnetic resonance imaging, enables the soft tissues surrounding the hip joint to be displayed precisely. Tendons, muscles, bursa and cartilage can be displayed in high resolution. In magnetic resonance imaging, the images are created by combining radio waves and magnetic fields. Before a planned surgical, reconstructive intervention, an MRI is particularly well suited to better assess the operating conditions and to be able to better plan the planned procedure.
Sonography is a very simple and inexpensive method of examination, with the help of which, for example, inflammatory fluid accumulations within the bursa and muscular structures can be visualized. Bones, on the other hand, cannot be imaged sufficiently well using ultrasound. In the case of Hip Impingement syndrome, sonography therefore mostly serves only as a supplementary examination method and not for the primary diagnosis.
The therapy concept for Hip Impingement syndrome depends on the triggering cause. Conservative therapeutic approaches such as immobilization of the joint, pain relievers, physiotherapy and the avoidance of triggering factors can alleviate the symptoms, but not the cause. This requires surgery (causal therapy).
In the early stages of the disease, the conservative treatment options are particularly important. Your goal is to relieve pain without invasive surgery. Anti-inflammatory pain relievers such as acetylsalicylic acid or ibuprofen help with this. In addition, mud packs, baths and electrotherapy can improve the symptoms for many of those affected. Targeted physiotherapy exercises can help to strengthen the surrounding muscles, widen the joint space and thus reduce pain.
The causal therapy approach is about treating and eliminating the triggering cause of the disease. With Hip Impingement syndrome, the structural bone changes can be removed as part of a surgical intervention (arthroscopy). The pain usually improves as soon as the mechanical tightness has been removed by the operation. Surgery is particularly recommended for young patients to minimize the risk of joint stiffness in the course. The first-line surgical procedure is arthroscopy.
Arthroscopy (joint mirroring): Arthroscopy is the surgical method of first choice and has replaced open surgery. It is a low-risk, minimally invasive method in which two to three small (about one centimeter) large skin incisions are made in the area of the hip joint. A camera with an integrated light source and special surgical devices can be inserted into the joint via the skin incisions and allow mirroring - the exact representation of the entire joint and the detection of damage. The existing changes can then be eliminated directly during the procedure. For example, the protruding bone spurs are ground down, cartilage damage is removed and repaired. Damaged or torn tendons can also be sutured and reconstructed using arthroscopy. The skin incisions are closed with only a few seam stitches and leave only very subtle scars.
Seven to ten days after arthroscopy of the hip joint, only a partial load with a maximum of 20 to 30 kilograms should initially take place. If the femoral neck was fitted as part of arthroscopy, the maximum partial load even applies for three to four weeks (21 to 28 days). The bone takes a long time to restructure in order to adapt to the new static conditions.
Regular physiotherapy treatment should follow immediately after arthroscopy. Cracks should not be stressed until twelve weeks after an operation of the hip joint. Sports that relieve the strain on the hip joint, such as swimming and cycling, are allowed again just six weeks after the operation. As a rule, all sports are possible again six months after the operation.
Only with early treatment can consequential damage from Hip Impingement syndrome be successfully prevented.
