A 38-year-old male patient was seen for right-sided coxalgia of one and a half years' duration, with mechanical characteristics. He reported pain with physical exercise and slight limitation of mobility in certain postures. A mechanic by profession, in his spare time he used to cycle (40 km a day at weekends), run 3 times a week for 50 minutes and walk for an hour on non-running days. The pain has progressively increased, and at present he only walks.
Physical examination revealed pain on palpation in the middle third of the right inguinal region with pain on flexion, adduction and rotation, especially internal rotation (positive shock manoeuvre). The hip joint balance is 110o flexion bilaterally, internal rotation of 10o right, 40o left and external rotation of 30o right, 40o left. Muscle balance on the Daniels scale is 5/5 global bilateral. There is no pain on palpation of sciatic points and the Valleix, Fabere, Lasegue and Bragard manoeuvres are negative. There was also no pain on palpation of the iliotibial band and the Ober test was negative. In the gait examination, we observed an absence of claudication and monopodal alternating right-left support is stable, with negative Trendelenburg. The patient had pain on walking with forced flexion of the hip and knee. The simple anteroposterior (AP) X-ray showed a hump-shaped deformity in the right femoral cervico-cephalic region. The requested blood count, biochemistry, thyroid hormones, antibodies and acute phase reactants were normal.

In view of these findings, an MRI of the hip was requested, which showed slight subchondral alteration, with bone oedema in the right hip, with cortical irregularity and slight synovitis in the joint interline, with distension of the ilio-psoas bursa. The femoral head has a small bony islet and the alpha angle is greater than 50o. Arthrography shows a pinching of the antero-superior and postero-inferior joint interline, an incipient femoral osteophyte collar with small antero-superior subchondral lesions of the femoral head and small foci of oedema in the anterosuperior acetabulum. There is no avascular necrosis or lesions in the labrum. A juxta-articular cystic lesion is also visualised in relation to the greater trochanter.

With the diagnosis of LEVA type femoroacetabular impingement syndrome (also known as CAM), the patient was prescribed magnet therapy treatment (15 sessions) to improve the pain symptoms and bone trophism. Pharmacological treatment is prescribed with an association of oral glucosamine-chondroitin sulphate 400 mg every 12 hours for 3 months and non-steroidal anti-inflammatory drugs on demand if pain is present. She was instructed to rest in sports to avoid shock to the joint, with controlled active physical activity, recommending not exceeding 90 degrees of hip flexion and avoiding rotations.
Referred to the arthroscopy unit of the traumatology department for assessment of arthroscopic surgery.

