Hip impingement

More room for movement again

Pain in the hip area is often caused as a result of wear and tear on the hip joint. In young adults, the culprit can sometimes be a poor fit between the femoral head and the acetabular cup. If the shapes of the femoral head and acetabular cup are not precisely coordinated, the bone of the femur can make contact with the edge of the cup (impingement). 

Our experienced consultants here at Schoen Clinic specialise in the diagnosis and treatment of hip impingement. If the cause of the pain is determined early, further damage can be avoided. This also prevents subsequent joint wear in the hip.

Causes & symptoms

Impingement of the hip: What types are there?

A distinction is made between two types of hip joint damage:
  • Pincer impingement:
    In women aged between 30 and 40, the acetabular cup is often too low. The head of the femur itself is normal in shape. In cross-section, the picture looks like a pair of pincers. The hip bone holds the femur like the tool's lever arms. Sometimes, the cup is also aligned backwards instead of directly in the direction of the femur. The femoral neck then impinges on the edge of the cup. The femur then reacts to this by producing additional bone material and the impingement site becomes thicker. This makes the situation worse. The elastic lip on the acetabular cup increasingly disappears until finally only the hard bone is left. Once the protective cartilage layer is increasingly worn away, the cup gets deeper. Ultimately, this can result in pain on even the smallest movements.
  • Cam impingement:
    Young people often suffer from this form of hip impingement. In this case, the femur is the cause. Bony thickening, or a "bump" in the area of the femoral neck causes the head of the femur to be pressed into the cup with every movement. The shearing forces experienced during sports such as ice hockey or football then tear away the cartilage in the acetabular cup. However in many cases, the larger femoral head also damages the lip of the acetabular cup rim. If ultimately only bone rubs against bone, the joint wears away and arthrosis develops. The high forces involved also mean that the cartilage wears away faster than with pincer-type impingement.

In most patients, doctors see an interim form of the condition somewhere between cam and pincer impingement.

Causes: Triggers for hip impingement

Structural deformities can cause hip impingement. Performance sports increase the risk of developing the condition. Developmental problems and injuries can also sometimes lead to deformities of the hip joint. 

Symptoms: These symptoms occur with hip impingement

It often begins with a deep-seated pain in the groin which occurs during sport or after long car journeys, for example. The patient is often no longer able to fully flex the thigh. The general mobility of the hip can be restricted. Long periods of sitting, for example at a workstation, often cause pain in the hip region.

Diagnostics

Diagnosis: How we diagnose hip impingement

To begin with, we carry out an in-depth consultation regarding the pain you are experiencing. We then carry out a comprehensive physical examination. On top of this, we perform imaging procedures such as X-rays and MRI scans.

The MRI scan shows the wear and tear on the cartilage

Using MRI technology, we are able to more effectively detect damage to the cartilage and the acetabular rim.
Sometimes patients have symptoms that are not directly associated with the joint. To treat these, we are able to inject an analgesic that blocks the relevant nerve endings directly into the joint.