Femero Acetabular Impingement Syndrome PINCER(Keywords: Femero Acetabular Impingement Syndrome PINCER, hip arthritis, chiropractic, hip dystrophy) FAIS is a condition of the hip joint, almost certainly with a strong hereditary link, which causes too-much-cover of the ball. The net result is a stiff, non-painful hip in the young adult, mimicking an arthritic hip, but with no arthritic change seen on X-ray. It comes in three forms: In the following two x-rays you can see a mild case of Pincer, in a 58-year old woman.
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HIP ARTHRITIS and Femero Acetabular Impingement Syndrome PINCERMost diseases come in mild and severe forms. You can have dangerous high, life-threatening blood pressure, and mildly raised BP.So too with Femero Acetabular Impingement Syndrome Pincer. In the above mild case there is minimal hip arthritis (the medical report states: "There are no bony abnormalities in the pelvis...". In reality there is clear evidence of a Pincer deformity bilaterally, as well as early sclerotic change in the left sacroiliac joint anatomy. In moderate and severe cases of Pincer the hip becomes prematurely arthritic leading to a total hip replacement.
PRESENTATION of Femero Acetabular Impingement Syndrome PINCERPain in the groin and front of the thigh begins insidiously. At first walking is not limited. In a severe case pain and disability begins in the teen years, but more usually in the forties and fifties. Hiking soon becomes impossible.It is often associated with pain in the low back, because the lumbar spine, pelvis, and upper leg share some very large muscles, and the upper anterior thigh is innervated from the upper lumbar spine. This sometimes makes for a chicken-and-egg situation. Did the pain begin in the back and radiate to the thigh. Or, is it a dodgy hip, and the radiation is actually from the hip to the back?
CLINICAL FINDINGS of Femero Acetabular Impingement Syndrome PINCERFlexion, adduction and internal and/or more usually external rotation of the hip is restricted. Diagnosed early, it's just stiff. No pain. Left to brew for a few years, and these movements become painful in and around the groin.Almost invariably some of the muscles in the groin become very painful. That could be the Iliopsoas muscle, the Pectineus, the Adductor magnus, the Sartorius... for you the patient what you will find is very tender muscles in the groin, and sometimes the buttock.
DIFFERENTIAL DIAGNOSIS of Femero Acetabular Impingement Syndrome PINCERYour chiropractor will be looking out for nerve conditions that may refer to the upper thigh. Well known are Meralgia Paresthetica and Maignes Syndrome... the femoral nerve stretch test may be positive, and then there may well be numbness, changes in reflexes and very occasionally weakness of the quadriceps muscles.Then of course an Inguinal hernia causes pain in the groin, and the area has many lymph nodes which may become infected, and very occasionally cancerous. All in all, pain in the groin must be taken seriously. Usually but not always it's a chiropractic condition, but a thorough examination is indicated.
Abnormalities often come in twos and threes. Mrs S, the 58-year old woman whose pelvis you saw above consulted me six weeks ago. She has had a life time of low back pain. She's been to physios, another chiropractor, orthopaedic- and neuro-surgeons. A difficult back.Five years ago she started getting significant pain in the right (and lesser extent left) groin and upper thigh. Nothing helped, and the condition gradually worsened so that she was having considerable difficulty walking. These are her back X-rays. You can see the scoliosis, and a severely degenerated lumbar joint at L3-L4:
My initial impression was a severely pinched nerve in the low back. At L3/L4 the pain would radiate to the front of the leg. Plus the Femoral nerve stretch test was positive. This has in many ways the appearance of a lumbar stenosis, a chronic narrowing of the spinal canal.
"Remember the patient can have more than one disease..." Dr G. Till, DC. However, ranges of motion of the hips were also limited and painful in the groins. Conclusion: Mrs S has two independent conditions both of which can and do cause pain in the front of the upper leg.
TREATMENT of Femero Acetabular Impingement Syndrome PINCERBy addressing BOTH the hip condition, and the lumbar stenosis, Mrs S says that after only six weeks she almost no pain in her legs and groins. She can walk normally, though she has yet to test the distance.Her low back aches, but isn't painful any more. I've made it plain: exercises for the hip and back daily, for life; heavy lifting is absolutely forbidden. She knows full well: the neurosurgeon told her, I've confirmed it, she sits on the verge of major spinal decompression surgery, a nasty business. Playing 'silly buggers' is not for her. Her biggest gripe: she can't lift the grandchildren. No, she can't, but they can sit on her lap, and she can hug them every day, and tell them stories about Hans Brinker, and how he saved Holland with his thumb!
IMMOBILISATION ARTHRITIS and Femero Acetabular Impingement Syndrome PINCERThere is now heaps of scientific evidence that joints not-in-normal-motion rapidly become arthritic. This is because the hyaline cartilage is starved of normal nutrition by the joint fixations.Chiropractic's approach is to get the joints moving again, rehab exercises done on a daily basis to keep them moving, and sound nutritional support. In particular, a chicken bones broth and fish soup ... which are rich in gelatine powder and the latter Omega-3 oil. For the vegetarian, and of course everybody, growing butternut squash which is also rich in Omega-3 is a must.
DEVELOPMENTAL HIP DYSPLASIAIn contrast, DDH has "too-little-cover" of the ball. The result is the same but different. Both DDH and FAIS give pain in the groin, both are pre-arthritic but DDH has a hip joint where the range of motion is greatly increased. They make wonderful dancers and gymnasts... which makes it very difficult for your chiropractor: s/he will be telling you that if you dance, duck and dive you are surely going to end up with an early total hip replacement. It's not an issue with FAIS pincer - with those stiff hips you simply obviously wouldn't choose a career in ballet. DEVELOPMENTAL HIP DYSPLASIA ...MIXED FAIS DDH syndromeVery occasionally FAIS and DDH may co-exist in the same hip producing confusing symptoms and pain, and a clinical challenge to all concerned. Stiffness of FAIS? Or the hypmobility of DDH? Or hip arthritis? MIXED FAIS DDH syndrome... Custom Search USEFUL LINKSFemero Acetabular Impingement Syndrome PINCERFEMERO ACETABULAR IMPINGEMENT SYNDROME Case File ...FAIS from a slightly different perspective... MONTHLY NEWSLETTER - sign up here...
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