Impingement: When the hip is jammed

The hip joint is one of the largest and, .most importantly, one of the most loaded joints in the human body. As recent studies have shown, physically active people generate up to 500,000,000 loading cycles (steps) over the course of an active life that the joint must withstand! With this in mind, who would be surprised if something breaks or wears down?
In most circumstances early failure of the hip joint goes togeather with an “ImpingemenT”.

Impingement is a painful condition, which often starst with a sudden sharp pain in the groin or inguinae. Only over time it can convert in an ongoing painfull condition. Various structures of the hip can be involved: the labrum, bony structures, cartilage, scar tissue, and in rare cases, the pubofemoral ligament. Sometimes it is not possible to determine the precise site of origin of the pain.

A schematic representation of hip impingement (FAI)

It is very tipically that it is a jamming, stabbing pain or dull pain that cannot be precisely localized!

Generally, two main types of hip impingement are known: cam impingement and pincer impingement. In my opinion, however, there is a third type that is completely different from the two wellknown classes of impingement, namely, traumatic hip impingement.

Traumatic impingement is a purely accident-related injury involving the labrum: the ring of soft, elastic tissue that follows the outside rim of the socket of your hip joint. In traumatic labral injury, the labral tissue is torn in an otherwise completely normal hip. If diagnosed early, the torn labrum can be repaired arthroscopically (link: hip arthroscopy). Once healing is completed, the hip is "really healed", meaning there is no specific risk of early degeneration or hip arthritis.

An insignificant accident is frequently the initiating event.

Especially in active athletes, particularly soccer and ice hockey players, this mechanism occurs often and just as frequently at a young age.

Athletes are however accustomed to accepting certain level of pain and because of this, even today, a correct diagnosis of impingement is still often overlooked by many doctors – even those specialized in sport medicine. Treatment is frequently provided for a diagnosis such as a “pulled abductor muscle,” a “soft groin” or a hernia, but even more adventurous diagnoses have ben heard. Several times, we have seen women whose ovary was removed. Of course, this had no impact on the eliminating the actual hip pain!

Especially for accident-related ruptures of the hip labrum, early arthroscopic treatment is absolutely important in order to prevent additional damage, especially to prevent the development of arthritis! Open surgery should be avoided at all cost, particularly for such situations.