Most of the bone related conditions that we, in orthopedic practice face, usually occur due to physical trauma such as a fall, sports injury, or an accident of some sort. Yet, there are some conditions that hardly require any tangible, controllable reason to happen. These may be a tough challenge at times.
Such conditions need extra care especially when it comes to early detection and diagnosis. The reason is that just like any other condition, these can progress into more serious, complicated conditions that become just that much harder to treat and manage.
To understand this, let us first learn a little bit about the anatomy of the hip joint and how it is formed.
Our hip joint is a ball and socket joint which means that one bone acts as a ball that fits into another bone which acts as a socket.
In this case, the head of our femur acts as the ball which fits into the acetabulum of the hip bone which acts as a socket.
Now, the acetabulum has additional cartilage known as the labrum. It is the structure responsible for deepening the acetabulum to allow for greater ranges of motion of the hip joint.
CAM type of impingement is the one where the head of the femur, which is supposed to be circular and rounded, is not so rounded when compared to the lower part of the femur (the neck).
As a result, the deformed head damages the labrum which causes pain on movement as well as restricts the full range of motion of the joint.
The pincer type of impingement is the one where the femur is fine but it is the acetabulum that has excessive growth. It once again causes a much more restricted movement than normal as well as damaging the labrum which causes pain on movement.
The third type of pinching hip syndrome is the combined CAM and Pincer impingement. Here, both the head of the femur as well as the acetabulum are overgrown which results in the damaging of the labrum and the resulting movement associated pain as well as a restricted range of motion.
The causes of the pinching hip syndrome are rooted in the childhood (developmental) years of a person.
If the head of the femur fails to develop properly, it will cause the CAM impingement with the head of the femur getting stuck in the acetabulum upon bending the joint in activities such as sitting for long durations of time or riding a bicycle.
If the acetabulum fails to develop properly, it can cause the neck of the femur to hit against the acetabulum and consequently limiting the range of motion as well as damaging the labrum.
Other less common reasons can include Legg Calve Perthes disease. The head of the femur fails to get enough blood supply causing it to eventually wilt and die.
A Sipped Capital Femoral Epiphysis (SCFE) is a disease where the growth plate of the femur separates from the head of the femur thus resulting in a deformed femoral head.
Coxa vara is a condition in which the ball and socket of the hip joint grow at different rates. Consequently, both of them mismatch and fail to fit into each other.
Your doctor will prescribe some imaging tests for you to fully assess the situation of your hip joint and further make a decision regarding the best treatment course in your case.
X-rays are one of the mainstays of investigations. It is one of the most basic tests to assess the form and structure of the head of the femur and the acetabulum by getting their images on a film.
MRI (Magnetic Resonance Imaging) includes the use of large magnets and radio waves which produce an image on the computer. A contrast material will be injected into your joint to fully assess the cartilage situation of your joint such as any fraying or tears in the labrum.
CT Scans are a modified version of X-rays where they take a look at your bone in a three-dimensional plane to fully assess your treatment options as to whether you need surgery or not.
The most basic forms of treatment include giving adequate rest to your pinched hips to take off some of the workload off the hips and ease the associated pain.
You should modify your activities in a manner that you do not put your hip joint under too much pressure. Avoid any activities that may involve using your hip joint too much.
You can also get help from a physiotherapist. They can slowly soothe your pain by using a few basic techniques. Remember that these are just for symptomatic relief and do not play a substantial role in the actual treatment of the condition.
Finally, you can take anti-inflammatory medications along with pain medications to soothe the pain as much as you can on your own.
Your doctor may suggest an arthroscopic (key-hole) surgery that acts to directly treat the condition.
Arthroscopic surgery is a minimally invasive procedure that can be performed as a day surgery procedure, meaning that the patient goes home on the same day.
The surgeon will use a surgical camera and his tools to look into your hip and repair any damaged labrum or fix the overgrown bones.
It is an important procedure that should be undertaken in time so that we can prevent the disease from progressing further.
Progression of the disease can eventually cause osteoarthritis. In such a case, the only viable treatment option left is a hip replacement.
Pinching Hip Syndrome is a structural-developmental disorder of the hip joint that can be treated well if caught in the early stages before the condition has progressed into its more dangerous forms such as hip osteoarthritis.