| April 2006 Case of the Month | |
|
|
Compiled By: James Joseph, M.D.
History: 58 year old with chronic right hip pain.
Exam: MRI of the Hip. Sagittal T2, Coronal PD SPIR and Axial T2.
Findings: Sagittal T2 image demonstrates a focal chondral ulceration involving the anterosuperior acetabulum. Coronal PD SPIR image (more posteriorly) demonstrates a paralabral cyst with a tail extending into the labrum. This is indicative of a superior labral tear. Axial T2 images demonstrate spurring and an small anterosuperior dysplastic femoral "bumb" at the junction of the femoral head and neck.
Diagnosis: Femoroacetabular Impingement (Cam Type)
Discussion: Cam type femoroacetabular impingement results from repetitive osseous impingement of the lateral femoral head and neck against the anterosuperior acetabulum. The impingement results in anterosuperior acetabular chondromalacia, often with associated underlying subchondral fibrovascular reaction and fibrocystic changes. Associated superior labral tears are common. A dysplastic femoral bump at the anterosuperior aspect of the junction of the femoral head and neck is often present, predisposing to this condition.
Femoroacetabular impingement is a condition occurring mainly in young and middle aged adults. It results in chronic, recurrent hip pain that typically occurs during hip flexion and internal rotation. The pain is most commonly felt in the groin. Femoroacetaqbular impingement is a common cause of premature osteoarthritis.
Conservative methods of treatment such as anti-inflammatory medication, non weight bearing and physical therapy can be attempted. However, surgery is usually necessary since osteoarthritis will progress without surgical management. Labral tears are commonly associated with femoroacetabular impingement and require surgical therapy. Resection osteoplasty of the dysplastic bump at the femoral head and neck junction can be performed to correct the underlying mechanical problem. Occasionally in longstanding cases, total hip replacement may be required due to the development of severe osteoarthritis.
|
|
References:
- Kassarjian A, Yoon LS, Belzile E et. al. Triad of Arthrographic Findings in Patients with Cam-Type Femoroacetabular Impingement. Radiology 2005; 236: 588-592.
- Stoller DW, Tirman TS, Bredella MA. Diagnostic Imaging Orthopaedics. Amirsys Inc. Salt Lake City, UT. 2004.
| |
© 2007 ProScan Imaging, LLC. All rights reserved worldwide. | |
