29-Year-Old With Chronic Hip Pain

Differential Diagnosis

• Osteoarthritis of the hip joint
• Femoroacetabular impingement syndrome
• Osteonecrosis of the hip joint
• Femoral head fracture

Diagnosis

The imaging above demonstrates a decreased offset and pistol grip deformity of the femoral head/neck junction. The correct diagnosis is femoroacetabular impingement (FAI) syndrome, cam morphology. There are two morphologies of FAI: cam and pincer. Cam is more common in young men, and pincer is more common in middle-aged women.

What to Look For

• Risk factors include high impact sports (especially in adolescents), overuse activity, previous slipped capital femoral epiphysis, and post-traumatic deformities
• The most common symptom is groin pain related to movement and/or position

Pearls for Urgent Care Management

• X-ray is the appropriate first line imaging modality, however, magnetic resonance imaging may be needed to make the diagnosis
• Treatment includes activity moderation, physical therapy, and non-steroidal anti-inflammatory drugs
• If symptoms do not improve with conservative management, surgery may be needed, and orthopedic referral is indicated

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