Femoroacetabular Impingement - Symptoms, Causes - Literature review Example

Name: University: Course: Tutor: Date: Femoroacetabular Impingement The hip joint is in form of ball-and-socket. Normally, the ball which is the femora head (the upper end of the thigh bone) fits perfectly into the socket (acetabulum), which is part of the entire pelvic bone to form a hip joint. The surface of the ball and the socket are covered by articular cartilage to reduce friction and facilitate movement (Dooley, 2008). A condition where the bones of the hip are abnormally shaped is called Femoroacetabular Impingement (FAI). Because the ball and the socket do not fit together perfectly, they cause damage by rubbing to each other. This may be due to development of bone spurs around the femoral head and/or along the acetabulum. This overgrowth causes the destruction of articular cartilage and allows the bones to interfere with each other (Gustav et al., 2007). According to (Chakraverty & Snelling, 2012 there are three types of Femoroacetabular Impingement, and this depends on where the deformity grows. They are Pincer, Cam and combined impingement. Pincer occurs when there is a bone overgrowth on the acetabulum. Cam is where the femoral head is not round and cannot rotate inside the acetabulum smoothly. Combined impingement means both the pincer and cam types happen. The symptoms for this condition include pain during movement, stiffness and limping. The symptoms can be seen early in people who engage in sports like athletics and other sports that involve much movement. It occurs due to failure of the hip bones to form normally during the childhood growing years (Gustav et al., 2007). When the above symptoms develop, it’s important that thepatient goes through diagnostic procedure to determine the underlying cause of discomfort. This can start with physical examination which involves patient’s history i.e. complaints of hip pain and loss of hip motion. The plain x-ray films can be used to determine the shape of ball and socket and assess the amount of space in the hip joint. The confirmatory diagnosis can be done by the MRI (Magnetic Resonance Imaging) (Gustav et al., 2007). MRI scan is a radiology technology that uses magnetism, radio waves, and a computer to produce images of body structures. It has the power to detect tiny changes of structures within the body and it’s an accurate method of disease detection in the body. MRI of the hip is a means of evaluating the internal structures of the hip joint (Chin & Peh, 2012). Coil selection for MRI of the hip Coils are part of the MRI machine that create magnetic fields or detect changing magnetic fields by voltage induced in the wire. A coil consists of loops of conductive wire, looped around the core of the coil. One fact used in selecting a coil is that a perfect coil should produce a uniform magnetic field without much radiation. We also choose a coil that enable reduced image construction time (Chakraverty & Snelling, 2012). Different coils are used in trying to detect different conditions. Some of the common MRI coils include; MRI head coils, Transmit receive coils, knee MRI coils, specialized extremity coils, dedicated bilateral coils, etc. Coil section in hip MRI can depend on the patient’s size. In small patients, a surface, spine, or head coil can be appropriate while in larger patients, cardiac, torso, or body coil can be used. The surface coil provides detailed information of the hip such as acetabular labra and articular cartilage (Sampath & Osman 2008). Patient positioning for the MRI of the hip Before MRI starts, metallic objects such as watches and anything with magnetic contents are not allowed in. This is because MRI uses a powerful magnet and such things will interfere (Chakraverty & Snelling, 2012). The patient will be examined supine and feet first in a closed MRI unit. This position is preferred because it is well tolerated and also facilitates the positioning of the surface coils (Beltran, et al., 2002). The patient is asked to remain very still to improve the images.The test can take between 12 minutes to 90 minutes. Each test consist several sequences of data gathered over 2 to 10 minutes (Chin & Peh, 2012). Tennis Elbow Tennis Elbow is a condition that causes pain around the outside of the elbow. In most cases, it comes as a result of over use of the muscles and tendons that hold the elbow together. It can be noticed in form of pain in the upper forearm when bending the arm, when twisting the arm or when gripping small items (Gustav et al., 2007). The elbow joint is attached to muscles that help in the movement of the arm. The tendons in the elbow join the bones and muscles together and control the muscles of the arm. Tennis elbow is believed to be caused by overuse of muscles that help in straightening the wrist. This overuse damages these muscles as a result of repeating the same motions over and over. The tendon usually involved in tennis elbow is called the extensor carpi radialis brevis (Chin & Peh, 2012). It’s common in people who involve in the activities that require vigorous repetitive movement of the arm. In most cases it affects the people between the ages of twenty and fifty. This does not mean that it won’t affect anyone, especially if they are exposed to the conditions associated with it. Sometimes it can come without any vigorous use of the arm. There is no particular cause known for this. Tennis elbow starts as a small pain but gradually increases over time (Chakraverty & Snelling, 2012). As suggested by Chakraverty & Snelling (2012), during examination, the patient’s history informs what triggered the pain. Depending on what the history and physical examination says, the doctor may recommend some tests. One of the tests that may be recommended is MRI scan just to confirm that the pain is not due to other causes such as arthritis. The elbow MRI demonstrates increased signal intensity of the origin of the extensor carpi radialis brevis tendon. The consistency of this signal intensity with the tendinosis indicates tennis elbow. Increased bone marrow signals increased fluid. The above findings together with the presence of a more focal area of increased signal, consistent with a large partial thickness tear confirm tennis elbow (Gustav et al., 2007). Tennis elbow condition can resolve itself, particularly if the causing factors can be avoided. Tendon rest should be able to eliminate the pain after the tears heal. The rest required depends on how severe the problem had become. This means that the sooner one discovers the problem the better. If the pain is much, the anti-inflammatory drugs may be used (Beltran, et al., 2002). Coil selection for the MRI of the elbow For the MRI of the elbow, we can use specialised extremity MRI coil. The extremity coil fits the elbow well and it has a flexible-wrap- around design for easy positioning and good fit. It is easy to use in supine/ forearm pronated position and therefore ensures the patient comfort (Chin & Peh, 2012). The elbow causes a number of challenges during MRI. But the position believed to be the most reliable is supine or forearm pronated position. This is so because most patients are comfortable in this position and therefore it minimises elbow movement. This ensures that the imaging process is not interfered with. The position also allows proper positioning of the MRI machine and therefore it is seen as reliable (Chakraverty & Snelling, 2012). Clinical presentation of Calcifying Tendonitis The condition where small calcium deposits from within the tendons of the rotator cuff is called calcific tendonitis. It is associated with acute pain in the shoulders. It occurs mostly in middle aged people (30-60 years) and mostly women (Gustav et al., 2007). The pain is usually of rapid onset, often with precipitation cause. The pain is felt on anterolateral aspect of the shoulder and it worsens with overhead activities. The pain can be severe at times. It causes the shoulder to be tender anterolaterally with some restriction in movement. They interfere with sleep sometimes. External rotation will be possible and this differentiates it from frozen shoulder (Chin & Peh, 2012). Development and Cause of Calcifying Tendonitis Calcifying Tendonitis develops in three stages. The first stage is called Precalcification stage. At this point, there are no symptoms felt. This is the time when the changes begin to take place at the point where the calcification will take place. The second stage is called the Calcific stage. At this stage, the calcium is excreted from cells and then it coalesces in the calcium deposits. At the beginning it is not painful (resting phase) but after sometime it becomes painful. This most painful phase is called restorative phase. Patients normally look for treatment at this point (Chakraverty & Snelling, 2012). Then the third stage is called post-calcific stage. Calcium deposits disappear leaving a normal rotator cuff tendon. This condition can be treated using physical exercises. This makes the joint strong, flexible and reduces the irritation. Anti-inflammatory drugs can be used to manage the pain. Sometimes surgery can be performed if other methods fail to resolve the pain (Chin & Peh, 2012). The cause of this condition is not yet clearly known. Sometimes it’s thought that tear and aging causes calcification. Researchers think that calcium deposits form because there is no enough oxygen to the tendon tissue. Some people still feel the pressure in the tendons can damage them causing calcium deposits to form. However, the evidence to support these arguments is not clear (Gustav et al., 2007). Appearance on X-Ray and MRI Apart from physical symptoms, calcification can be diagnosed using x-ray and MRI scan. On the x-ray, calsific deposits are visible and appear as discrete lumps or cloudy areas. This appearance is seen when they are in the re-absorption process, normally the time when they are the most painful. When in the resting phase they are crystalline but when in the reabsorption phase they are like toothpaste (Gustav et al., 2007). The shoulder coil is used in diagnosing calcific deposits. It is easier to use on the shoulder and it’s more comfortable for patients. The patients lie down and the cup moulds onto their shoulders. The fit is better and the signals are strong. For T1, hypo intense homogeneous signal, a thickened adjacent tendon and enhancement surrounding deposits may be seen. For T2, hypo intense homogeneous deposits, peripherally present hyper intense signals, and hyper intense subacromial- subdeltoidbursal fluid may be seen (Chakraverty & Snelling, 2012). References Chin, G. & Peh, W. (2012). Pictorial essay: Pitfalls in magnetic resonance imaging of the shoulder. Canadian Association of Radiologists Journal 63(1): 247-259. Beltran, J., et al., (2002). MRI of the hip. Applied Radiology, 31(11): 10-22. Dooley, P. (2008). Femoroacetabular impingement syndrome: Nonarthritic hip pain in young adults. Can Fam Physician, 54 (1): 42–7. Chakraverty, J. & Snelling, N. (2012). Anterior hip pain-Have you considered femoroacetabular impingement?. International Journal of Osteopathic Medicine, 15 (1): 22-27. Gustav, A., Sylvain, D. & Froehlich, M., et al., (2007). MR arthrography of the shoulder, hip, and wrist: evaluation of contrast dynamics and image quality with increasing injection-to-imaging time. AJR Am J Roentgenol., 88:1081-8. Read More