0:00

31 male with, uh,

0:02

hip leg pain for 10 months, no known injury.

0:08

I'll do this a little bit differently and also hang up the, uh,

0:13

axial obliques that can help us, uh,

0:16

measure the alpha angle. Okay. But with this case,

0:21

there was also some, from what I remember,

0:25

acetabular tail, again, we see this, uh, ant superior sort of, uh,

0:30

incomplete cleft or,

0:32

or complete cleft on a couple of other images indicating a, a tear.

0:36

Here we have some, uh, slight cartilage abnormalities as well,

0:41

sort of anterior superiorly. And, um, also,

0:46

uh, going to the axial bleak image.

0:50

We can measure the alpha angle, but in all honesty, I kind of ballpark it, uh,

0:55

with, uh, using my mind's eye.

0:58

But normal is gonna be about 50 to 55 degrees. And here we have a,

1:03

basically an incongruity, uh, a large, uh, uh,

1:08

or not a large, uh, or ill-fitting, uh, femoral head that, uh, does not,

1:13

or is incongruous with the acetabular cup. So that, uh,

1:17

is the, so-called cam type deformity. The other, uh,

1:22

spectrum are where you have, uh,

1:24

acetabular abnormalities that's gonna lead to the pincer type, which, uh,

1:28

we'll talk about in the, in the next case or the corollary. But, uh,

1:32

as you can imagine, uh, you could have combinations of the two,

1:36

which it's called mixed type. And, uh, most,

1:39

a lot of the consensus these days is, is typically you're gonna have a, uh,

1:44

mixed type, uh, of, uh, femoral acetabular impingement. So you,

1:48

what you're looking for in the history is, uh, pain, uh,

1:52

especially with hip motion, obviously with internal rotation and a deduction,

1:56

uh, and flexion. Okay? And as you can imagine with incongruity between the,

2:01

uh, femoral head and the ace tablum, you get this, uh, um, uh,

2:06

injury to the, uh, the,

2:09

the acetabular labrum and the cartilage. Okay? Um,

2:14

and the thing to remember here, the, the things that I look for, uh,

2:17

are gonna be, uh, fibrocystic changes, uh, formerly known as pits,

2:22

pits or, uh, synovial herniation pits. Uh, the alpha angle,

2:27

which you can measure, uh, by dropping a circle,

2:32

okay? A best fit circle. Uh, and, uh,

2:35

typically you're gonna use the, the, uh, center cut. Okay?

2:40

And then the next thing you wanna do is draw,

2:44

draw a line through the center, okay? Of, uh,

2:49

of your circle down the, uh, center of the femoral neck.

2:53

And you're gonna draw another line.

2:57

You wanna draw a

2:58

Line, uh,

2:59

to where the circle first becomes discontinuous with the

3:04

femoral head surface,

3:06

and a normal angle between that line.

3:09

SubT tended with the circle and down the shaft of the femoral neck. If you can,

3:13

I imagine there, it's gonna be about 55, uh, degrees. Okay? But,

3:18

uh, in honesty, I kind of use the,

3:21

my mind's eye and I look for other findings that I had mentioned before,

3:25

including, uh, not only the condu and labral abnormalities, but, uh,

3:29

a little bump right here at the femoral head, hip and neck junction.

3:32

But also some of that, sometimes that fibrocystic changes, uh,

3:36

that often goes with these, uh, this, uh, cam type femoral acet attack,

3:40

impingement.