Sequel to anterior hip pain..cam-type inmpingement and > alpha angle..

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Here’s a case I need some input on ..(Ted?) 40 yr old flexible hip runner fell on tail bone Jan 2011. Left ant hip and flank pain persisted 4 mo later. Had x-ray negative . Saw PT……….helped get pain down to where she only notices it when she runs. Comes in to me 11/1/11 Rigidity in all lumbar joints/T-L area too.Pain with Fabere(ant hip); end range passiv/active hip flexion; pain w/ circumduction: L si jt fixation: hip glide non painful;> trochntr non tender; busa non tender.No excessive pronation balanced feet in gait; no hypo jts in feet; no hypo joints in knee; psoas +1/4; piriformis hypertonic; glute med. 1/4; erectors /QL hypertonic. Tx 3x/wk 1.5 wks..fabere negative, gets some lbk and bi sciatic pain (NICE!!.(sarcasm))..1wk later this resolves. TX..lbk/pelv/thorx manip./ long axis hip mobilsn/manip.; medial acetab area ultrasound, soft tissue 2 units affected muscles; lumbar stab, glut facil exercises, no running. After 3 weeks no lbk pain but hip hasn’t changed from above…order MRI MRI Findings.. “No labral detachment. Moderate sized joint effusion with distention of capsule both lat and posterior in an almost cyst like pattern. Cannot exclude paralabral cyst or occult tear.Recommend Arthrogram. “ Abnormal Femoral head/neck angle with alpha angle elevated at almost 80 degrees. There is a femoral head/neck junction bump ( osteophyte ) seen anteriorly which may be contributing to labral hypertrophy and pathology. Normal femeral anteversion.” “ Findings consistant with likely cam type impingement process of left hip.” “Disc dissection L4-L-5 level.”…………….Rahul Desai, M.D. ( the hip specialist at EPIC ). As I understand, cam type impingements, aside from not being mentioned in Stonebrinks ortho classes J, occur when the femoral head is not as round as it should be, and the superior portion, which tends to be more bulbous, irritates and pinches the labrum. I haven’t spoken to Desai yet but he doesn’t mention a mixed type impingement and there is not a significant overhang of the superior lip of the acetabulumto fully incriminate a mixed impingement. I would assume this alpha angle and abnormal head/neck angle have been there since at least her late teens/ early 20’s and her fall on the tail bone in Jan this year caused it to become symptomatic. At this point I would like to proceed with an MR arthrogram while continuing with treatment…….some of these cases when troublesome can be resolved with arthroscopy …………. Any thoughts, suggestions or personal experiences welcomed!! Cheers, Simon Agger, D.C.