Clinical evaluation is the first step in diagnosis, but will rarely lead to the diagnosis on its own, due to inconsistent and vague nature of the pain. Childhood and current activity should be inquired about. Physical exam should also involve assessing passive internal rotation of the hip during flexion, as range of motion is reduced in proportion to the size of a cam lesion. Flexing the hip to 90 degrees, adducting, and internally rotating the hip, known as the FADDIR test, should also be performed. It is positive when it causes pain. The FABER test should also be performed, this test involves flexing, abducting, and externally rotating the hip. The FABER test is useful when diagnosing concurrently with a labral pathology and is considered positive if the position elicits pain. Additional non-invasive ways to observe possible<unk>  is changes in gait that include a lower peak hip extension and internal rotation to compensate for bony growth. X-ray Radiograph of a cam type<unk> . Radiograph of a pincer type<unk> . Projectional radiography ("X-ray")is often considered first line for<unk> . Anterior-posterior pelvis and a lateral image of the hip in question should be attained. A 45-degree Dunn view is also recommended. + Measurements of<unk>  on X-ray. Measurement Image Target Normal value Center-edge angle of Wiberg left The superior-lateral coverage of the femoral head. * >20° (55 years old) * >40° indicates overcoverage Crossing ratio 170px Percentage of acetabular walls crossing. Normal acetabulum is oriented in anteversion. Its value ranges from 15 to 20° in the equatorial plane of the acetabulum and decreases gradually towards the acetabular roof, where normal values range from 0 to 5°. Retroversion of the upper part of the acetabulum has been related with pincer type<unk> . In radiography the presence of a “crossover sign” is produced when the posterior wall of the acetabulum crosses the anterior wall before reaching the acetabular roof. It is a sign of acetabular retroversion and it has been linked with overcoverage and pincer<unk> . Nevertheless, this sign has been described in 6% of the normal population. Therefore, more important than its presence is the percentage of crossing. 10 mm Offset percentage Femoral head-neck offset related to femoral head diameter >0.18 * less indicates high risk of cam type<unk>  Tönnis angle 170px Slope of the sourcil (the sclerotic weight-bearing portion of the acetabulum) 0 to 10° * >10° is a risk factor for instability * 12° is a risk factor for instability * <-6° is a risk factor for pincer<unk>  Other modalities MRI imaging may follow, particularly if there is no specific evidence on radiographs, producing a three-dimensional reconstruction of the joint for better definition, to evaluate the hip cartilage, or measure hip socket angles (e.g. the alpha-angle as described by Nötzli in 2-D and by Siebenrock in 3-D). MR arthrogram had been used in the past, as it was more sensitive for picking up soft tissue lesions; however, due to improvement in technology, MRI is now considered comparable for picking up such lesions. CT is not usually used due to radiation exposure and no benefit above MRI. It is possible to perform dynamic simulation of hip motion with CT or MRI assisting to establish whether, where, and to what extent,<unk>  is occurring. The diagnosis is often made in conjunction with a labral tear. Differential Diagnosis * Piriformis syndrome or strain * Labral tear without<unk>  * Adductor muscle strain * Sciatica * Athletic pubalgia * Gluteus medius/minimus or illiopsoas tendinopathy * Stress fracture * Femoral head osteonecrosis * Other<unk> s, including anterior inferior iliac spine, ischiofemoral and iliopsoas * Loose body in the joint (intra-articular body)
Femoroacetabular impingement
Patellar subluxation syndrome
Retrocalcaneal bursitis
Greater trochanteric pain syndrome
Patellar dislocation
Patellofemoral pain syndrome
Facet joint arthrosis
Knee dislocation