clinical case hip pain dr shrenik shah SHREY HOSPITAL www.eswtindia.in

M/ 40 radiographer had persistent hip pain since 1 year Unable to sit cross legged ADL not much affected No rest pain or sleepless nights No fever or constitutional signs All lab investigations were normal Clinical picture

XRAY

Femoroacetabular impingement The impingement causes repeated minor damage to the labrum & edge of the acetabulum. This results in labral tears (which can be painful) & damage to the cartilage lining the hip joint

DIFFERENTIAL DIAGNOSIS OF fai • Low back pain • Trochanteric bursitis • Piriformis syndrome • Sports hernia (abdominal muscle strain) • Groin or thigh strains • Iliopsoas tendinosis DIFFERENTIAL DIAGNOSIS OF fai

impingement test for problems in the front of the hip. reverse impingement test for problems in the back of the hip. Provocative tests

MRI

Treatment of FAi Non operative Surgery A less active lifestyle, possibly with cortisone injections, physiotherapy advice or rest. (Although a good physiotherapy program focusing on hip strengthening may be beneficial, the stretching associated with yoga may make the symptoms worse). Arthroscopic hip debridement Open surgery Treatment of FAi

ESWT- extracorporeal shock wave therapy- orthotripsy WWW.ESWTINDIA.IN

FINAL RESULT 9 months follow up No pain Nearly full range of movements Does swimming daily Fit to to do all duties FINAL RESULT 9 months follow up

CASE 2 X ray M/62 Dr having Diabetes, hypertension, obesity and Asthama chronic LBP and left trochanteric pain radiating to thigh and knee Inability to sit cross legged and squatt Spine Xrays and MRI were normal Pain progressive with limp ADL affected due to limitation of flexion of left hip

Case 2 MRI MR arthrography

ESWT

FINAL RESULT AT 1 YEAR

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