General Guideline Principles for Femoracetabular Impingement
“Hip Impingement” or Labral Tears for workers compensation patients
The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Femoracetabular Impingement, “Hip Impingement” or Labral Tears.
These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.
The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.
Femoracetabular Impingement, “Hip Impingement” or Labral Tears
Introduction of Femoracetabular Impingement, “Hip Impingement” or Labral Tears
Diagnostic Criteria for Non-Red Flag Conditions
The evaluation criteria for femoroacetabular impingement or labral tears are summarised in the section that follows.
An overview of the clinical criteria for evaluating femoroacetabular impingement or labral tears is provided below.
Femoracetabular Impingement, “Hip Impingement” or Labral Tears
Introduction of Femoracetabular Impingement, “Hip Impingement” or Labral Tears
The evaluation criteria for femoroacetabular impingement or labral tears are summarised here.
Diagnostic Studies of Femoracetabular Impingement, “Hip Impingement” or Labral Tears for workers compensation patients
- MR Arthrogram
MR Arthrogram is recommended for identifying labral tears or femoroacetabular impingement in individuals with subacute or persistent hip discomfort. Patients with symptoms of subacute or chronic hip pain or those who have a clinical suspicion of femoroacetabular impingement, labral tears, or other issues with the hip joint. Frequency, dose, and duration: Typically, only one arthrogram is required.
Rationale: MRA is useful in assessing and confirming labral tears or femoroacetabular impingement. Compared to other imaging techniques, enhanced MR arthrogram is advised for diagnosing femoroacetabular impingement since it allows for better labral examination.
- MRI
MRI of Femoracetabular Impingement, “Hip Impingement” or Labral Tear is recommended When there is diagnostic ambiguity regarding the cause of certain patients’ subacute or chronic lateral hip pain, in order to aid in accurate diagnosis.
- Ultrasound
Ultrasound of Femoracetabular Impingement, “Hip Impingement” or Labral Tears is recommended for diagnosing individuals with labral tears or femoroacetabular impingement.
Indications: Patients whose hip pain is assumed to be caused by labral tears or impingement. Although arthrogram and MRI are typically the primary diagnostic procedures, ultrasonography can be useful in certain situations.
Frequency/Dose/Duration: Usually just once. The use of ultrasound is advised in order to assess and confirm labral tears or femoroacetabular impingement.
Medications of Femoracetabular Impingement, “Hip Impingement” or Labral Tears
Ibuprofen, naproxen, or other NSAIDs from an earlier generation are suggested as first-line treatments for the majority of patients. For patients who are not candidates for NSAIDs, acetaminophen (or the analogue paracetamol) may be a viable alternative, even if the majority of research indicates it is just marginally less effective than NSAIDs.
There is proof that NSAIDs are less dangerous and just as effective in treating pain as opioids, such as tramadol.
- Non-Steroidal Anti-inflammatory Drugs (NSAIDs)
Non-Steroidal Anti-inflammatory Drugs (NSAIDs) are recommended for the treatment of femoroacetabular impingement and labral tears
Indications –NSAIDs are advised as a treatment for femoroacetabular impingement and labral tears. First, try over-the-counter (OTC) medications to see whether they work.
Frequency/Duration – Use as necessary may be appropriate for numerous patients
Indications for Discontinuation – Resolution of femoroacetabular impingement and labral tears, ineffectiveness, or emergence of side effects requiring termination.
- NSAIDs for Patients at High Risk of Gastrointestinal Bleeding
NSAIDs for Patients at High Risk of Gastrointestinal Bleeding is recommended Misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors are used concurrently by individuals who are at high risk of gastrointestinal bleeding.
Indications – Cytoprotective drugs should be taken into consideration for patients with a high-risk factor profile who also have indications for NSAIDs, especially if a prolonged course of treatment is planned. Patients who have a history of gastrointestinal bleeding in the past, the elderly, diabetics, and smokers are at risk.
Frequency/Dose/Duration – H2 blockers, misoprostol, sucralfate, and proton pump inhibitors are advised. dosage recommendations from the manufacturer. It is generally accepted that there are no significant differences in effectiveness for preventing gastrointestinal bleeding.
Indications for Discontinuation – Intolerance, the emergence of negative effects, or the stopping of NSAIDs.
- NSAIDs for Patients at Risk for Cardiovascular Adverse Effects
NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended The first-line treatment options of acetaminophen or aspirin seem to be the safest in terms of cardiovascular side effects. If necessary, non-selective NSAIDs are recommended to COX-2-specific medications.
To reduce the chance that an NSAID will negate the protective effects of low-dose aspirin in individuals receiving it for primary or secondary cardiovascular disease prevention, the NSAID should be taken at least 30 minutes after or eight hours before the daily aspirin.
- Acetaminophen for Treatment of Femoroacetabular Impingement or Labral Tears
Acetaminophen for Treatment of Femoroacetabular Impingement or Labral Tears are recommended for the treatment of femoroacetabular impingement and labral tears, especially in patients who are contraindicated for NSAIDs.
Indications – All patients, including acute, subacute, chronic, and post-operative ones, who have femoroacetabular impingement pain or labral tears.
Dose/Frequency – As per the manufacturer’s recommendations; can be used as required. Over four gm/day, there is evidence of liver toxicity.
Indications for Discontinuation – pain, side effects, or intolerance are gone.
Rationale for Recommendations – Generic ibuprofen, naproxen, or other NSAIDs from an earlier generation are suggested as first-line treatments for the majority of patients. One of the other generic drugs should be used as a second-line treatment.
Although the majority of the research indicates that acetaminophen is only slightly less effective for those with arthrosis, it may still be a viable solution for these patients. There is proof that NSAIDs are less impairing and just as effective at treating pain as opioids (including tramadol).
- Opioids of Femoracetabular Impingement, “Hip Impingement” or Labral Tears
Opioids of Femoracetabular Impingement, “Hip Impingement” or Labral Tears is recommended for patients with femoroacetabular impingement or labral tears for the short term (less than a week).
Rationale for Recommendations – Opioids have serious side effects, including poor tolerance, constipation, sleepiness, impaired judgement, memory loss, and the potential for overuse or dependency, which has been observed in up to 35% of patients.
Patients should be warned against using machinery or motor vehicles and aware of these possible side effects prior to receiving an opioid prescription. Opioids should only be used in cases of extreme pain because they don’t seem to be any more efficient than less dangerous analgesics at treating the majority of musculoskeletal symptoms.
Recommended – for select treatment of patients with postoperative femoroacetabular impingement or labral tears.
Indications – An opioid should be used for a brief period of time—a few days to no more than one week—to treat post-operative femoroacetabular impingement or labral tears. Following surgery, a small nocturnal dose of opioids may be beneficial.
Prior to using opioids, the majority of patients should try NSAIDs and acetaminophen for pain relief. It is advised to stop using opioids as soon as possible.
Frequency/Dose/Duration – Typically, patients only need a few days to a week’s worth of treatment.
Indications for Discontinuation – Resolution of the pain, adequate pain management with other medications, ineffectiveness, or the emergence of side effects necessitating termination.
Treatments of Femoracetabular Impingement, “Hip Impingement” or Labral Tears
Rehabilitation Programs
Rehabilitation (supervised formal therapy) needed after a work-related injury should be concentrated on regaining the functional ability needed to meet the patient’s daily and work obligations and enable them to return to work, with the goal of returning the injured worker to their pre-injury status to the extent that is practical.
Active therapy calls for the patient to put in an internal effort to finish a particular activity or assignment. The procedures known as passive therapy rely on modalities that are administered by a therapist rather than the patient exerting any effort on their side.
Passive therapies are typically seen as a way to speed up an active therapy programme and achieve concurrently objective functional gains. Over passive interventions, active initiatives should be prioritised.
To sustain improvement levels, the patient should be advised to continue both active and passive therapies at home as an extension of the therapeutic process.
To aid functional improvements, assistive devices may be used as an adjuvant measure in the rehabilitation strategy.
Therapeutic Exercise – Physical or Occupational Therapy
Therapeutic Exercise – Physical or Occupational Therapy is recommended for labral tears or femoroacetabular impingement, especially postoperatively, as well as to make up for any strength deficiencies.
Frequency/Dose/Duration –With verification of continued objective functional progress, the total number of visits may be as low as two to three for individuals with minor functional deficits or as high as 12 to 15 for those with more severe deficits.
If there is evidence of functional improvement toward particular objective functional goals (such as increasing range of motion or improving capacity to conduct work activities), more than 12 to 15 visits may be necessary to address persistent functional impairments.
A home exercise regimen should be created as part of the rehabilitation strategy and carried out alongside the therapy.
Indications for Discontinuation – reduced pain and improved function following surgery, intolerance, ineffectiveness, or non-compliance.
Injection Therapy of Femoracetabular Impingement, “Hip Impingement” or Labral Tears
Local Glucocorticosteroid Injections
Local Glucocorticosteroid Injections are recommended for the treatment of labral tears or hip impingement in a subset of individuals.
Indications: NSAIDs and activity restriction are typically not effective over a few weeks of treatment for hip impingement or labral tears.
Frequency/Dose/Duration: Typically, just one injection is made. If there is incomplete improvement (improved function and decreased discomfort), a second injection might be suggested.
Surgery of Femoracetabular Impingement, “Hip Impingement” or Labral Tears
- Arthroscopy
Arthroscopy is recommended for patients who failed conservative therapy and are believed to respond best to arthroscopy, to diagnose and treat patients with hip pain if there is a suspicion of labral tear, intraarticular body, femoracetabular impingement, or there are other subacute or chronic mechanical symptoms.
Indications: Patients with hip discomfort who may also have subacute or long-term mechanical symptoms, such as an intraarticular body, femoroacetabular impingement, or a labral tear.
Rationale: Hip arthroscopy is increasingly used to treat a variety of hip conditions, particularly those with mechanical symptoms. Foreign body removal and symptomatic labral tears have both been reported to be successfully treated. Another potential indication is femoroacetabular impingement.
- Surgical Repair
Surgical Repair is recommended for cases of hip impingement or labral tears that don’t respond well to conservative treatment and either don’t respond well to arthroscopic repair or are thought to respond best to an open approach.
Indications/Rationale: Patients with hip pain who may have a labral tear, an intraarticular body, a femoroacetabular impingement, or other mechanical symptoms are likely to respond well to an open treatment strategy.
Other of Femoracetabular Impingement, “Hip Impingement” or Labral Tears
Walking Aid: Cane / Crutches / Walker
Walking Aid: Cane / Crutches / Walker is recommended for a restricted group of patients with labral tears or moderate to severe femoroacetabular impingement.
Indications: Labral tears or disabling, moderate to severe femoroacetabular impingement may be treated when the benefits of increased mobility outweigh the hazards of advancing senility.
Indications for Discontinuation: Resolution (e.g., post-operative recovery).
Rationale: Crutches and canes may be beneficial for acute injuries during the recuperation and/or rehabilitation phase to improve functional status (e.g., from wheelchair to walker to cane). Crutches may paradoxically exacerbate disability through debility in cases of chronic hip pain.
In those situations, the establishment or upkeep of recommendations for the use of crutches or canes should be carefully weighed against potential dangers.
What our office can do if you have workers compensation Femoracetabular Impingement, “Hip Impingement” or Labral Tears
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