Hip Impingement (FAI) & Gluteal Tendinopathy
Hip Impingement (FAI) & Gluteal Tendinopathy
Advanced · 12 chapters · 144 MCQs · 144 flashcards · Illustrated
Hip Impingement (FAI) & Gluteal Tendinopathy - complete clinical course for physiotherapy students and clinicians.
What you'll learn
Chapter 1: Foundations: Hip Anatomy, Biomechanics and Neurovascular Relevance
Chapter 2: Pathomechanics of Femoroacetabular Impingement and Gluteal Tendon Overload
By the end of this chapter, you should be able to: - Describe the structural and morphological variants that predispose to femoroacetabular impingement (FAI) - Explain how abnormal hip mechanics load the gluteal tendons and acetabular…
Chapter 3: Subjective Assessment: History, Pain Mapping and Symptom Behaviour
The hip is a ball-and-socket joint whose stability depends on bony morphology, the labrum, the capsule, and dynamic muscular control.
Chapter 4: Clinical Tests: Impingement, Provocation, Strength and Movement Analysis
Chapter 5: Imaging Interpretation and Red Flag Screening
This chapter covers how physiotherapists interpret hip imaging in the context of femoroacetabular impingement (FAI) and gluteal tendinopathy (GT), and how to screen for conditions that require medical referral before any rehabilitation…
Chapter 6: Staged Management I: Irritability Control and Early Pain Modulation
The gluteus medius and minimus insert onto the lateral and anterior facets of the greater trochanter. Their tendons form a broad, layered attachment, and the gluteus minimus contributes a significant anterior fibre group.
Chapter 7: Staged Management II: Progressive Loading and Capacity Building
Chapter 8: Progressions, Load Monitoring and Criteria-Based Advancement
Chapter 9: Special Considerations: Athletes, Females, Hip Surgery and Comorbidities
Femoroacetabular impingement (FAI) and gluteal tendinopathy rarely occur in isolation in the populations covered in this chapter.
Chapter 10: Outcome Measures and Return-to-Sport or Return-to-Work Criteria
Outcome measurement in femoroacetabular impingement (FAI) and gluteal tendinopathy must reflect the underlying tissue problem.
Chapter 11: Clinical Pearls, Common Pitfalls and Evidence Controversies
Femoroacetabular impingement (FAI) is a conflict between the femoral head-neck junction and the acetabular rim during hip motion. Three morphological phenotypes are recognised.
Chapter 12: Case-Based Reasoning, Course Summary and Key References
Practice questions
5 sample MCQs from this course. Tap a question to see the answer.
A 28-year-old male semi-professional footballer reports a 4-month history of insidious left groin pain that is worse after long training sessions and when squatting deeply. On examination, passive hip internal rotation in 90° of flexion is limited to 15° on the left and pain is reproduced at end range. He has been avoiding kicking and reports difficulty getting out of a low car seat.
1. Which bony morphology is characterised by an abnormal, aspherical femoral head-neck junction that contacts the acetabular rim during hip flexion and internal rotation?
- A. Pincer morphology
- B. Acetabular dysplasia
- C. Cam morphology
- D. Femoral retroversion
Show answer
Answer: C. Cam morphology is an aspherical loss of the normal femoral head-neck offset, typically at the anterosuperior junction, and it is common in young active males. Pincer morphology involves acetabular overcoverage, and dysplasia and retroversion describe different structural problems.
A 34-year-old female netball player reports 3 weeks of lateral hip pain. She shades a single area about the size of her palm over the greater trochanter on her body chart. She cannot lie on the affected side at night and pain is provoked by single-leg stance.
2. Which pain-mapping and symptom-behaviour finding is most consistent with a gluteal tendinopathy pattern rather than a referred lumbar pattern?
- A. Well-localised lateral hip pain over the greater trochanter, provoked by single-leg loading and by lying on the affected side
- B. Diffuse pain shaded across the whole buttock and posterior thigh with no defined boundary
- C. Pain shaded below the knee with pins and needles that worsen with coughing and sneezing
- D. Pain that is constant, unchanged by activity, and shaded over the anterior groin crease
Show answer
Answer: A. Gluteal tendinopathy typically produces a well-localised lateral pain area over the greater trochanter that is provoked by single-leg loading and lying on the affected side. Diffuse, distal or neurological-type patterns point towards a lumbar or neural source and need to be screened separately.
A 24-year-old male footballer reports 8 months of anterior hip pain on deep flexion and when putting on his socks. FADIR is positive and internal rotation in 90° flexion is limited to 50. His orthopaedic report mentions a 'raised head–neck offset' and a measurement taken on a Dunn view radiograph.
3. Which radiographic measurement is used to quantify the head–neck asphericity described in this report?
- A. Alpha angle
- B. Lateral centre-edge angle
- C. Tönnis angle (acetabular roof inclination)
- D. Neck-shaft angle
Show answer
Answer: A. The alpha angle is measured on axial or Dunn views and quantifies loss of femoral head–neck concavity. Values above about 55° suggest cam morphology. The lateral centre-edge angle and Tönnis angle describe acetabular coverage and roof inclination, and the neck-shaft angle describes proximal femoral geometry.
A 41-year-old man reports 4 weeks of deep lateral hip pain after increasing his cycling distance. He rates his pain 7/10 when rising from chairs, and his symptoms take most of the following day to settle. He also wakes at night when lying on the affected side.
4. Which description best characterises the irritability level of this presentation?
- A. Pain lasting beyond 24 hours after activity, with night pain and reduced function, indicating high irritability
- B. Pain only during single-leg stance that resolves within 5 minutes, indicating low irritability
- C. Pain relieved immediately by activity, indicating an insensitive presentation
- D. Pain limited to end-range rotation testing with no functional limitation
Show answer
Answer: A. Irritability is judged by the magnitude, duration and 24-hour behaviour of symptoms, including night pain and a prolonged flare after loading. This man's symptoms persist beyond 24 hours and disturb sleep and function, so he is highly irritable and needs load modification. The other options describe low-irritability or non-functional patterns.
A 24-year-old male soccer player is 3 weeks after hip arthroscopy with labral repair and capsular plication. He reports pain with deep squatting and when pivoting, and he is partially weight-bearing with crutches. He wants to know which movements are safe to start now.
5. Which activity restriction is most appropriate during this early post-operative phase?
- A. Avoid combined end-range hip flexion, adduction and internal rotation under load while the repair heals
- B. Begin unrestricted sprint training to maintain cardiovascular fitness
- C. Perform heavy loaded squats to full depth to regain quadriceps strength
- D. Start pivoting drills on the operated limb to prepare for return to play
Show answer
Answer: A. After labral repair and capsular plication, the repair is vulnerable to the combined end-range flexion, adduction and internal rotation positions. Early restrictions protect the repair while low-load strengthening and cycling within comfortable range are typically permitted.
Flashcards
What is the normal range of the lateral center-edge angle (Wiberg), and what does a value above 40 degrees suggest?
The normal lateral center-edge angle is approximately 25 to 35 degrees. A value above 40 degrees suggests acetabular overcoverage, which is associated with pincer-type FAI. Excessive coverage can lead to femoroacetabular contact and labral stress.
What is the C-sign in pain mapping, and what does it suggest?
The C-sign is a pain drawing where the patient outlines the hip with a C-shaped hand placement, with fingers around the lateral hip and extending toward the groin. This pattern suggests intra-articular or deep hip pathology, such as FAI or labral pain. It is distinguished from the E-sign, which tends to point toward posterior or spinal sources.
How is the FABER (Patrick) test set up, and what do groin pain and sacroiliac pain suggest on loading?
The patient lies supine with the hip flexed, abducted and externally rotated so the ankle rests on the opposite knee, then the examiner applies gentle downward pressure to the flexed knee. Groin pain on loading points to intra-articular hip pathology, while pain in the buttock or posterior pelvis near the sacroiliac joint suggests SIJ involvement. Interpretation should consider which region reproduces symptoms rather than the test alone.
Describe the FADIR test and how a positive result is interpreted in femoroacetabular impingement.
With the patient supine, the examiner flexes the hip to about 90°, then adducts and internally rotates it while applying downward pressure through the femur. Reproduction of anterior groin pain is considered a positive result, which suggests femoroacetabular impingement, where the femoral head-neck junction contacts the acetabular rim. The test is sensitive but not very specific, so it is best interpreted alongside other findings and imaging.
How is the FADIR test performed, and how is a positive result interpreted in femoroacetabular impingement?
The hip is passively taken into flexion, adduction, and internal rotation, usually with the patient supine. Reproduction of the patient's familiar anterior groin pain is positive and suggests FAI or labral pathology. It is highly sensitive but less specific, so it is interpreted alongside imaging and other clinical findings.
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