A 38-year-old male patient was evaluated in consultation due to a year and a half history of right hip pain with mechanical characteristics.
Pain is associated with physical exercise and mild limitation of mobility in certain postures.
A mechanic of profession, in his free time he performed bicycles (40 km per day on weekends), running 3 times per week for 50 minutes and walking for one hour the days that he did not run.
Pain is progressively increasing and is currently walking only.
Physical examination revealed pain in the medial third of the right inguinal region with pain on flexion, adduction and rotations above all internal (positive shock maneuver).
The hip joint balance is of flexion 110o bilateral, internal rotation of 10o right, 40o left and external rotation of 30o right, 40o left.
The muscle balance in Daniels scale is 5/5 global bilateral.
There is no Valley pain, but the voiding score and the maneuvers ofix, Fabere, Lasegue and Bragard are negative.
Nor does it present pain related to palpation of the iliac crest and the Ober test is negative.
On gait examination, we observed absence of claudication and the right-to-left alternate monopodal support was stable, with negative Trendelenburg results.
You have gait pain with forced flexion of the hip and knee
Anteroposterior plain radiography (AP) showed a joroba-shaped deformity in the right cervical-cef femoral neck region.
Blood count, biochemistry, thyroid hormones, antibodies and acute phase reactants were normal.
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Associated findings were magnetic resonance imaging of the hip, which showed mild subchondral alteration, edema in the right hip, cortical irregularity and mild synovitis in the joint, with osseus gap between the hips.
The femoral head has a small bone islet and the alpha angle is greater than 50o.
Arthrography showed an anterior superior-anterior joint interline anterior and inferior anterolateral ligament, an incipient femoral osteophytic collar with small anterosuperior subchondral lesions of the femoral head edema and small foci.
No avascular necrosis or labrum lesions were observed.
A cystic juxtaarticular lesion in relation to the greater trochanter is also visualized.
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With the diagnosis of femoroacetabular impingement syndrome type VLE (also known as CAM), the patient is prescribed magnetotherapy (15), for clinical pain and improvement of bone voiding.
Pharmacological treatment was prescribed with the combination of glucosamine sulfate and oral chondroitin sulfate 400 mg every 12 hours for 3 months and nonsteroidal anti-inflammatory drugs on demand if the patient experienced pain.
Sports rest is indicated to avoid shock in the joint, with controlled active physical activity, recommending not to exceed 90 degrees of hip flexion and avoid rotations.
She was referred to the arthroscopic unit of the traumatology service for evaluation of arthroscopic surgery.
