Current RMA Instruments
| Reasonable Hypothesis SOP | 42 of 2017 |
| Balance of Probabilities SOP | 43 of 2017 |
SOP bulletin information on new SOPs
ICD Coding
- ICD-9-CM Codes: 719.85, 755.63
- ICD-10-AM Codes: M25.85, Q65.8
Brief description
This is a disorder of the hip in young and middle-aged adults, in which there is abnormal contact between the ball and the socket of the hip joint, leading to damage to the joint. The main clinical features are pain, which may be felt in the groin, around the hip, or in the lower back, and loss of range of motion of the hip.
Confirming the diagnosis
Diagnosis is based on the clinical history, findings on examination of the hip, and radiological imaging showing cam morphology of the femoral head/neck or pincer morphology of the acetabulum.
The relevant medical specialist is an orthopaedic surgeon.
Additional "diagnoses" covered by SOP
- Hip "dysplasia" with cam or pincer changes - these are developmental or congenital anatomical variants that give rise to the femoroacetabular impingement. They are not diseases or injuries in their own right and do not warrant separate diagnosis. They may be included in the diagnostic label given for femoroacetabular impingement syndrome - e.g. Right femoroacetabular impingement with cam lesion.
Conditions that may be covered by the SOP
- "Degenerative" labral tear (non-traumatic) of the hip - a non-traumatic (degenerative) labral tear is a common finding on imaging (CT or MRI) of the hip. It may be an associated feature of femoroacetabular impingement, an incidental finding of no clinical significance, or a component of osteoarthritis of the hip. It may be included as part of the diagnostic label given for femoroacetabular impingement syndrome when both are present - e.g. Right hip femoroacetabular impingement with degenerative labral tear. Note - it should generally not be diagnosed as a standalone condition.
Conditions excluded from SOP
- Chondral defect of the hip joint* - acute articular cartilage tear SOP
- Degenerative labral tear associated with osteoarthritis of the hip* - osteoarthritis SOP
- Osteoarthritis* of the hip
- Traumatic labral tear of the hip* - labral tear SOP
* another SOP applies - the SOP has the same name unless otherwise specified
Clinical onset
Clinical onset will be when symptoms (chiefly pain) attributable to femoroacetabular impingement syndrome first developed.
Clinical worsening
Symptoms may improve with a decrease in activities that involve using the hip at the limits of its range of motion, but are likely to recur if such activities are resumed. Clinical worsening may be evidenced by an increase in the level of symptoms. Development of osteoarthritis of the affected hip represents a new onset of osteoarthritis, not a worsening of femoroacetabular impingement syndrome. Appropriate treatment involves an initially conservative approach, with e.g. physiotherapy. Surgery may be warranted in some cases.