Ultrasound-Guided Cortisone Injections for Femoroacetabular Hip Impingement

 

Introduction

Femoroacetabular hip impingement (FAI) is a condition affecting the hip joint, where abnormal contact between the femoral head and the acetabulum leads to pain, reduced range of motion, and potential joint damage. It is commonly seen in athletes and active individuals, but it can also affect people with structural variations in their hip anatomy.

FAI occurs when the hip bones develop an irregular shape, causing them to rub against each other during movement. This repetitive impingement may result in cartilage damage, labral tears, and early hip osteoarthritis.

Ultrasound-guided cortisone injections are considered in cases where pain and inflammation persist despite conservative management. This blog provides a detailed overview of FAI, including its anatomy, pathology, symptoms, diagnosis, and treatment, with a focus on the role of cortisone injections in symptom management.



Anatomy of the Hip Joint

The hip joint is a ball-and-socket joint, providing stability and a wide range of movement. It consists of:

  • Femoral Head – The rounded top of the femur (thigh bone) that fits into the acetabulum.
  • Acetabulum – A cup-shaped socket in the pelvis that holds the femoral head.
  • Articular Cartilage – A smooth tissue covering the joint surfaces to facilitate pain-free movement.
  • Labrum – A ring of cartilage surrounding the acetabulum that deepens the socket and stabilises the joint.

Types of Hip Impingement

FAI is classified into three main types:

  1. Cam Impingement – The femoral head is not perfectly round, leading to abnormal contact with the acetabulum.
  2. Pincer Impingement – The acetabulum is overgrown, covering too much of the femoral head and causing excessive contact.
  3. Mixed Impingement – A combination of both cam and pincer types.

Repetitive friction between these structures can result in cartilage damage, labral tears, and joint inflammation.

Pathology of Femoroacetabular Hip Impingement

FAI develops due to abnormal bone morphology, leading to:

  • Increased stress on the labrum and cartilage.
  • Progressive joint damage and osteoarthritis if left untreated.
  • Labral tears, which may contribute to hip instability.

FAI-related damage occurs gradually, with initial symptoms being mild but worsening over time.

Symptoms of Femoroacetabular Hip Impingement

  • Deep groin pain, particularly after prolonged sitting or activity.
  • Hip stiffness, especially in the morning or after inactivity.
  • Limited range of motion, particularly with hip flexion and rotation.
  • Clicking or locking sensations in the hip joint.
  • Pain during high-impact activities, such as running, squatting, or climbing stairs.

Symptoms may progress if untreated, leading to chronic pain and reduced mobility.

Diagnosis of Femoroacetabular Hip Impingement

Clinical Assessment

A clinician will evaluate the hip joint by:

  • Assessing range of motion and reproducing symptoms with specific hip movements.
  • Performing the FADIR test (hip flexion, adduction, and internal rotation), which may provoke pain.
  • Examining gait patterns to check for compensatory movements.

Imaging Studies

  • Ultrasound – Can assess soft tissue inflammation and guide injections for targeted pain relief.

Management of Femoroacetabular Hip Impingement

Conservative Treatment

  • Activity Modification – Avoiding movements that aggravate symptoms.
  • If symptoms persist despite conservative care, ultrasound-guided cortisone injections may be considered.

Ultrasound-Guided Cortisone Injections for FAI

What Are Cortisone Injections?

Cortisone is a potent anti-inflammatory steroid used to reduce pain and swelling in musculoskeletal conditions.

Why Use Ultrasound Guidance?

  • Ensures precise placement of the injection into the affected area.
  • Minimises the risk of injecting nearby structures.
  • Improves accuracy and effectiveness of treatment.

Procedure

  1. The clinician uses ultrasound imaging to visualise the hip joint.
  2. The skin is cleaned, and a local anaesthetic is applied.
  3. A fine needle is inserted under ultrasound guidance into the hip joint.
  4. A mixture of cortisone and local anaesthetic is injected.

Following the procedure, patients are advised to rest and gradually return to activities.

Mechanism of Action of Cortisone Injections

Cortisone works by:

  • Suppressing inflammation within the hip joint.
  • Reducing pain sensitivity by inhibiting inflammatory mediators.
  • Improving movement tolerance, allowing engagement in physiotherapy.

While cortisone injections do not alter bone structure, they can help manage pain and support rehabilitation efforts.

Benefits of Cortisone Injections for FAI

  • Provides targeted pain relief for hip discomfort.
  • Minimally invasive alternative to surgery.
  • Reduces inflammation, allowing for better joint function.
  • Enables participation in rehabilitation without severe pain.

Although cortisone injections provide temporary relief, they can be part of a comprehensive treatment plan for managing FAI.

Conclusion

Femoroacetabular hip impingement is a progressive condition that can lead to hip pain, reduced mobility, and long-term joint damage if left untreated. While conservative treatments such as physiotherapy and pain relief medications are often the first line of management, ultrasound-guided cortisone injections can be an effective option for individuals experiencing persistent pain and inflammation.

At Alton Pain Clinic, clinicians provide precise, ultrasound-guided injections to help manage FAI-related symptoms. If you are experiencing ongoing hip discomfort or mobility limitations, a consultation may help determine the most suitable treatment approach.

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