Ultrasound-Guided Cortisone Injections for Femoroacetabular Hip Impingement

 

Introduction

The hip joint is one of the most important weight-bearing joints in the body, supporting movement, balance, and mobility. When problems arise in the hip, they can significantly affect daily activities and overall quality of life. One such condition is Femoroacetabular Hip Impingement (FAI), a mechanical disorder of the hip joint that can lead to discomfort, stiffness, and functional difficulties.

FAI is increasingly recognised in both active individuals and the wider population. It develops when there is abnormal contact between the ball (femoral head) and socket (acetabulum) of the hip joint, which irritates the surrounding tissues. Over time, this can place strain on the cartilage and labrum.

At Alton Pain Clinic, ultrasound-guided cortisone injections can be offered as part of the management strategy for individuals with FAI. These injections are carried out with precision using high-resolution ultrasound to ensure accuracy and safety.

This blog explains Femoroacetabular Hip Impingement in detail, from anatomy and pathology to diagnosis and management, while also exploring how ultrasound-guided cortisone injections work and their role in care.

Anatomy of the Hip Joint

The hip joint is a ball-and-socket joint formed between:

  • Femoral Head — the rounded top of the thigh bone.
  • Acetabulum — the socket in the pelvis that houses the femoral head.
  • Labrum — a fibrocartilaginous rim around the acetabulum that increases stability and provides cushioning.
  • Articular Cartilage — smooth tissue that reduces friction between the bones.
  • Supporting Structures — including ligaments, capsule, and surrounding muscles that provide stability and mobility.

This combination allows the hip to perform a wide range of motion. However, if the femoral head and acetabulum do not align smoothly, abnormal contact occurs, leading to FAI.

Pathology of Femoroacetabular Hip Impingement

FAI results from irregular contact between the femoral head and acetabulum during movement. This repetitive impingement can irritate the labrum, cartilage, and joint capsule.

Types of FAI include:

  1. Cam Impingement — caused by an aspherical femoral head that does not fit properly in the acetabulum.
  2. Pincer Impingement — caused by excessive coverage of the acetabulum over the femoral head, leading to labral pinching.
  3. Mixed Impingement — a combination of both cam and pincer features, commonly seen in many patients.

Over time, repeated stress can cause labral irritation, cartilage wear, and inflammation.

Symptoms

Individuals with FAI may experience:

  • Groin pain, particularly when sitting, squatting, or twisting.
  • Stiffness and reduced flexibility in the hip.
  • Limited range of motion, especially during hip flexion and rotation.
  • Clicking, catching, or locking sensations.
  • Discomfort during activities such as running, climbing, or sports involving hip movements.

Causes and Risk Factors

Factors contributing to FAI may include:

  • Differences in bone development during growth.
  • Repetitive movements involving hip flexion and rotation.
  • Sports participation, especially in football, hockey, or martial arts.
  • Genetic predisposition.
  • Previous hip injury or trauma.

Diagnosis

Diagnosis of FAI typically involves:

  1. History Taking — exploring symptoms, triggers, and functional limitations.
  2. Clinical Examination — including impingement tests (hip flexion, adduction, and internal rotation)
  3. Imaging:

Ultrasound for guiding targeted injections.

Management of Femoroacetabular Hip Impingement

Management depends on symptom severity and functional limitations. Options include:

Lifestyle and Activity Adjustment

Avoiding repetitive or aggravating movements.

Image-Guided Injections

At Alton Pain Clinic, ultrasound-guided cortisone injections can be used to address inflammation in the hip joint. They also help in diagnostic assessment by confirming whether the hip joint is the source of pain.

Ultrasound-Guided Cortisone Injections

At Alton Pain Clinic, cortisone injections are carried out under ultrasound guidance, allowing precise delivery into the joint. Ultrasound ensures:

  • Accurate visualisation of the hip in real-time.
  • Safe placement of the needle.
  • Avoidance of surrounding structures.

Mechanism of Action of Cortisone

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

  • Reduces local inflammation by calming overactive immune responses.
  • Decreases the production of inflammatory mediators.
  • Helps to reduce irritation of the joint capsule and labrum.

By addressing inflammation, cortisone injections may support patients in engaging with physiotherapy and other rehabilitation strategies.

Role of the Clinician

At Alton Pain Clinic, all procedures are performed by experienced clinicians trained in ultrasound-guided techniques. Their role includes accurate diagnosis, safe delivery of injections, and supporting patients with an individualised management plan.

Summary

Femoroacetabular Hip Impingement is a condition caused by abnormal contact between the femoral head and acetabulum, leading to joint irritation and discomfort. Symptoms often include groin pain, stiffness, and reduced mobility, especially during activity.

Management strategies range from physiotherapy and lifestyle modification to image-guided injections and surgery in selected cases.

At Alton Pain Clinic, ultrasound-guided cortisone injections are one of the options available to address hip inflammation with precision and accuracy, supporting patients as part of a wider care plan.

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