1. CLINICAL CASE HIP PAIN DR SHRENIK SHAH SHREY HOSPITAL www.eswtindia.in

2. CLINICAL PICTURE  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

3. XRAY

4. 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

5. DIFFERENTIAL DIAGNOSIS OF FAI  Low back pain Trochanteric bursitis Piriformis syndrome Sports hernia (abdominal muscle strain) Groin or thigh strains Iliopsoas tendinosis

6. PROVOCATIVE TESTS  impingement test for problems in the front of the hip.  reverse impingement test for problems in the back of the hip.

7. MRI

8. TREATMENT OF FAI Non operative  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). Surgery  Arthroscopic hip debridement  Open surgery

9. ESWT- EXTRACORPOREAL SHOCK WAVE THERAPY- ORTHOTRIPSY WWW.ESWTINDIA.IN

10. FINAL RESULT 9 MONTHS FOLLOW UP No pain Nearly full range of movements Does swimming daily Fit to to do all duties

11. CASE 2  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 X ray

12. Case 2 MRIMR arthrography

13. ESWT

14. FINAL RESULT AT 1 YEAR

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