A 36-Year-Old Male with Chronic, Worsening Hip Pain

Differential Diagnosis

• Cam deformity of the femoral head/neck
• Pincer deformity
• Mixed-type deformity

Diagnosis

This patient was diagnosed with a mixed-type deformity, as he has a cam deformity of the femoral head/neck with added pincer type deformity, predisposing to femoral acetabular impingement.

Learnings/What to Look for

• Acetabular impingement types can be distinguished as follows:
  • Cam type (prominence of bone at junction of femoral head and neck reducing offset)
    • Pincer type (increased acetabular coverage most commonly due to osteophytosis)
    • Mixed type (as in this case)
• Cam-type bone build-up at the femoral head and neck can be seen (red arrow)
• Pincer type increased acetabular coverage can also be seen. There is spurring of the superolateral acetabular margin with a well-corticated ossicle (yellow arrow), as well as a rounded prominence of the anterolateral margin (green arrow)

Pearls for Urgent Care Management

• Conservative treatment includes rest, activity modification, anti-inflammatory medications, and sometimes physical therapy
  • If symptoms do not resolve or are severe at presentation, referral to an orthopedist for surgical consideration is warranted

Acknowledgment: Images and case presented by Experity Teleradiology (www.experityhealth.com/teleradiology).