Navigating the nonarthritic hip: Labral tears and femoroacetabular impingement

Hip pain is a common symptom presented to primary care physicians. The diagnosis is often difficult when the pain is not associated with arthritic changes. Patients with nonarthritic hip pain, more specifically femoroacetabular impingement, typically present with anterior hip pain that is worse in the position of impingement. Physical examination is typically positive for decreased range of motion and pain using the flexion, adduction, and internal rotation test. Diagnosis can be made with a thorough history, a physical examination, and radiographic imaging with anteroposterior pelvis and modified Dunn views. MRI arthrography should be avoided in any patient with signs of osteoarthritis on initial films. First-line treatment is nonoperative and can be commenced pending referral to orthopaedics. Proper workup, including history, physical examination, and appropriate imaging, can help identify patients who may be suitable for hip arthroscopic surgery and provide timely referral to an orthopaedic surgeon.