Ultrasound-Guided Cortisone Injections for Femoroacetabular Hip Impingement

 

Introduction

The hip joint is one of the largest and most important joints in the human body, responsible for enabling a wide range of motion and supporting daily activities such as walking, running, and sitting. When problems develop in the hip, they can significantly affect mobility, comfort, and quality of life. One such condition is Femoroacetabular Hip Impingement (FAI), a mechanical disorder of the hip joint that can cause pain, stiffness, and functional limitations.

FAI is increasingly recognised in both athletes and the general population as a source of hip and groin discomfort. It arises due to abnormal contact between the femoral head (the ball) and the acetabulum (the socket of the hip joint), leading to irritation and stress on the joint structures. Over time, this can affect cartilage and soft tissue, and in some individuals, may be associated with the development of longer-term joint changes.

Among the management options available, ultrasound-guided cortisone injections can be used as part of a treatment strategy to address the inflammation associated with FAI. At Joint Injections, these procedures are performed with precision and care by experienced clinicians using high-resolution ultrasound guidance.

This blog explores Femoroacetabular Hip Impingement in depth, covering its anatomy, pathology, symptoms, diagnosis, and management options, while also explaining the role of ultrasound-guided cortisone injections and their mechanism of action.

Anatomy of the Hip Joint

To understand FAI, it is helpful to review the basic anatomy of the hip.

  • The Femoral Head: The ball-shaped upper end of the thigh bone (femur).
  • The Acetabulum: The cup-shaped socket of the pelvis into which the femoral head fits.
  • The Labrum: A ring of fibrocartilage around the acetabulum that deepens the socket, improves stability, and provides cushioning.
  • Articular Cartilage: A smooth layer covering both the femoral head and the acetabulum, reducing friction during movement.
  • Supporting Structures: The capsule, ligaments, and surrounding muscles provide additional strength and mobility.

The hip joint is classified as a ball-and-socket synovial joint, designed for both stability and range of motion. When the ball and socket do not fit together properly, abnormal stresses occur, contributing to the pathology of FAI.

Pathology of Femoroacetabular Hip Impingement

FAI occurs when the femoral head and acetabulum come into abnormal contact during movement. This repetitive impingement can irritate the labrum, cartilage, and surrounding tissues.

There are two main types of FAI:

  1. Cam Impingement
  • Occurs when the femoral head is not perfectly round.
  • The aspherical portion grinds against the acetabulum, leading to labral and cartilage damage.
  1. Pincer Impingement
  • Occurs when the acetabulum covers too much of the femoral head.
  • This excessive coverage causes the labrum to be pinched between the rim of the socket and the femoral head.
  1. Mixed Impingement
  • Many individuals have features of both cam and pincer impingement.

Over time, repetitive mechanical stress may result in labral tears, cartilage thinning, or joint irritation.

Symptoms of Femoroacetabular Hip Impingement

Individuals with FAI often report:

  • Groin pain, particularly when sitting, squatting, or twisting.
  • Stiffness in the hip joint.
  • Reduced range of motion, especially with hip flexion and internal rotation.
  • Clicking, catching, or locking sensations in the hip.
  • Discomfort during physical activities, particularly sports that involve running or kicking.

Symptoms may range from mild and intermittent to persistent and disruptive.

Causes and Risk Factors

FAI develops due to structural variations in the hip joint. While the exact cause is not always clear, several contributing factors are recognised:

  • Developmental differences in bone shape during growth.
  • Repetitive movements in sports, particularly those involving hip flexion and rotation (e.g., football, hockey, martial arts).
  • Genetic predisposition.
  • Previous injury or trauma to the hip joint.

Diagnosis

Diagnosis of FAI is made using a combination of clinical history, physical examination, and imaging.

  1. History Taking
  • A clinician may ask about the nature, duration, and triggers of pain, as well as any impact on daily activities.
  1. Physical Examination
  • Special tests such as the impingement test (flexion, adduction, and internal rotation of the hip) may reproduce symptoms.
  1. Imaging
  • MRI can detect labral tears and cartilage changes.
  • Ultrasound is used in guiding targeted injections into the hip joint for diagnostic or therapeutic purposes.

Management of Femoroacetabular Hip Impingement

Management depends on the severity of symptoms, structural findings, and impact on function. Approaches can include:

Lifestyle and Activity Modification

  • Avoiding positions or movements that aggravate symptoms.
  • Adapting exercise routines to reduce hip strain.

Image-Guided Injections

  • Ultrasound-guided cortisone injections can be used to deliver anti-inflammatory medication directly into the hip joint.
  • These injections can also play a diagnostic role, helping to confirm the source of pain.

Ultrasound-Guided Cortisone Injections

At Joint Injections, cortisone injections are performed under ultrasound guidance for precision and safety.

Ultrasound guidance enables the clinician to:

  • Visualise the hip joint in real-time.
  • Accurately guide the needle to the intended area.
  • Minimise the risk of injuring surrounding structures.

Mechanism of Action of Cortisone

Cortisone is a corticosteroid medication with anti-inflammatory properties. When injected into the hip joint under ultrasound guidance, it works by:

  • Reducing local inflammation in the irritated joint tissues.
  • Decreasing the release of inflammatory chemicals.
  • Helping to calm the irritation in structures such as the labrum or capsule.

By targeting inflammation, cortisone injections may provide relief from the discomfort associated with FAI, allowing individuals to better engage with rehabilitation strategies.

Role of the Clinician in Injections

Clinicians performing these injections are trained to use ultrasound technology to ensure accuracy. The expertise of the clinician is important in both diagnosing the problem and carrying out the procedure safely.

Summary

Femoroacetabular Hip Impingement is a mechanical condition of the hip joint that can cause groin pain, stiffness, and reduced function. It occurs due to abnormal contact between the femoral head and acetabulum, leading to irritation of the joint structures.

Management options range from activity modification and physiotherapy to image-guided injections and, in some cases, surgery.

At Joint Injections, ultrasound-guided cortisone injections are one of the options available for addressing inflammation in FAI. These procedures are performed with precision by experienced clinicians, with the aim of improving comfort and enabling patients to continue with their rehabilitation.

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