Piriformis Syndrome or SIJ Pain? Your Hip Joint Could Be the Real Cause

[00:00:00]So, you've probably got an FAI.

[00:00:03]So, before I move on, I always say just write down what you think this is.

[00:00:06]Okay, so, you know, it says it's an impingement, like a shoulder impingement. You know, where the supraspinatus is getting impinged underneath the acromion process.

[00:00:15]So, this is a bit different um cuz it relates to the hip joint. So, a femur ball in the socket, okay, acetabulum.

[00:00:21]You have a socket here.

[00:00:22]So, it's catching within an impingement.

[00:00:25]Different types. The main one is what we call a cam lesion.

[00:00:29]So, first type, like a cam. Relates to a camshaft on an engine. You can see this thickened area just here.

[00:00:35]Um normally, if this is seen on x-ray, I'll show you an x-ray picture shortly.

[00:00:39]You have to debride this. You have to shave this bit. So, normally, a friend of mine who was a hip surgeon says, "If you've got a labral tear, you've probably got a cam lesion." So, when you have surgery, we normally shave this, yeah, and then repair or remove your labral tear, depending what um the surgeon decides on. So, that's the first type, which is the most common, a cam. You've also got what we call a pincer lesion here. You can see it overhangs.

[00:01:04]And then you can have a combination of both.

[00:01:06]So, you can have a cam and pincer lesion at the same time.

[00:01:10]Um which is still an impingement around that sort of area, around here. Okay, so, it catches and the labral tear is obviously in here. So, as I said to you before, if you've got one, as in a labral tear, you've probably got a cam or well, more likely a cam lesion is what I've seen. Have a look at this case study.

[00:01:29]So, this is a 30-year-old professional hockey player complained of increasing right hip pain. So, it's hard to say where exactly it was. Um so, you know, it may be just a bit generic, just around the hip sort of area. Could be more groin. Could be more lateral hip.

[00:01:44]Could be more buttock pain, but just around the hip area. So, some of the tests you can do um flexion and internal rotation. You can call this like the fair test. So, FAI, also flexion, adduction with internal rotation. You can also also call it the Fadir test. Um similar, just more letters. Okay, so Fadir, so flexion, adduction with internal rotation. And McGill has a test called the scour test. So, they're all sort of similar. Um I do have some YouTube videos on this. Okay, so just look at the Fair test. Um there is one called the Faber test as well that can be positive. And according to the Mitchell study, Faber test is one of the most positive uh in the majority of these labral tears. I'm not saying it's like that for me. Um but it has been, you know, uh with some pathology in the hip, Faber test. Faber's means flexion, abduction with external rotation. If you're wondering what the Faber, almost like the figure of four test, okay? And now, for me, it's more of a hip joint pathology.

[00:02:40]On X-ray with this gentleman, with this hockey player, you can see, okay?

[00:02:47]Just here, we have this extra bit of cam thickening bone just on there.

[00:02:52]Okay, so you can see it on X-ray.

[00:02:54]Actually, obviously, you can see it, but it won't show the labrum.

[00:02:58]But you can see the cam lesion just on there.

[00:03:02]Another X-ray from a different angle, it was an oblique one. So, you're going to show it. A frontal X-ray. Yeah, and then you can just see the bump. Let's go back to my pen.

[00:03:12]You can just see it there.

[00:03:13]Okay.

[00:03:15]And also, it's the cam lesion inside looks pretty clear.

[00:03:17]Yeah, around there.

[00:03:19]Okay, so you can just see the bump on there. I'm not a radiologist, it's not really my thing to read X-rays as such. Um so, I normally just look at the report from the radiologist and see what they have said. We have Robin and John and me decide like an MR. You know, some people send me very very pictures, images, etc., but you know, I can have a look, but um I'm not a radiologist. I don't do it all day every day. So, it's better just to read the report and just see what they say.