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Picture

Cam vs. Pincer Impingement

2/27/2015

3 Comments

 
The final days before the OCS examination are upon me. As I answer different practice exam questions, I often come across answers not fully explained in my readings. In these instances I search the internet for reputable sources to gather further information on the question or diagnosis. Recently there was a question on femoral-acetabular impingement (FAI) and cartilage breakdown. To answer the question, a thorough understanding of cam vs. pincer lesions, hip mechanics, aggravating factors, and how the abnormal stresses cause breakdown of the cartilage were all necessary. In this post, I am going to discuss the two types of FAI. I recommend checking out the link as well because it shows MRI and x-ray imaging of the hip with great explanations of what pathology you are viewing. 
Youtube Animation
Overview
FAI is a common pathoanatomic problem due to abnormal contact between the femoral head and acetabular rim. In a normal hip, the femur translates in the acetabulum without interruption. Stresses are dissipated throughout the labrum, minimizing the risk of breakdown. In FAI, abnormal stresses are placed between the femoral head/neck and the acetabular rim. These abnormal stresses are the sensation of 'impingement' the patient reports when you bring them into hip flexion or IR. The source of pain can either be due to abnormal shape of the femoral head-neck junction (Cam-type) or more prominent acetabular rim (Pincer-type). 
Cam- Type FAI
-Generally occurs in young athletic males
-Commonly caused by femoral retroversion

Pincer-Type FAI
-More common in middle aged women
-Caused by acetabular retroversion, coxa profunda, and other causes
Both cam and pincer lesions clinically present with groin pain during or after flexion type movements. They have increased pain with sitting due to ROM impairments in hip flexion and internal rotation. Upon functional assessment, gait abnormalities may be present as well as deviations with squatting movements. Due to the abnormal shape of the femoral head or acetabulum, labral tears and cartilage breakdown is usually the result of FAI. To diagnose FAI, imaging is required. Clinically, the labral anterior impingement test or labral posterior impingement test can be used to assist the therapist understanding what structure is involved. As with all things physical therapy, we cannot change the anatomy, but knowing an individual has FAI will give us a better understanding of how to treat their movement dysfunction.

-Jim
3 Comments
Erson Religioso III link
2/27/2015 08:10:13 pm

I'd say you can perform movement testing but ultimately it's only the treatment and education that matters. You only need to know this for the OCS. Clinically it won't matter.

Reply
Jim
2/28/2015 01:07:53 am

Dr. E,

Thank you for the comment. Chris and I were having a similar conversation a few days ago. Understanding the anatomy and pathology is important because it gives you a frame of reference, but ultimately we are not treating the anatomical problem. I don't want to say this post was for my own benefit, but sometimes knowledge gets locked in easier when I spend any appreciable amount of time writing on the subject. Studying for the OCS has given me a much deeper knowledge of anatomy and pathology, but I am very excited to stop studying this material so I can resume focusing more intently on other materials (my fellowship coursework and your eclectic medbridge vids for example) that directly relate to my clinical practice. It's unfortunate how counter-intuitive that statement is.

As always, thanks for following - Jim

Reply
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10/3/2024 08:24:10 am

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  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test