The guidelines provided by the New York State Workers Compensation Board are intended to assist healthcare professionals in evaluating Femoracetabular Impingement, commonly referred to as “Hip Impingement,” or Labral Tears. These directives aim to support physicians and healthcare practitioners in determining the appropriate treatment for these conditions.
Healthcare professionals specializing in Femoracetabular Impingement, “Hip Impingement,” or Labral Tears can rely on the guidance provided by the Workers Compensation Board to make well-informed decisions about the most suitable level of care for their patients.
It is crucial to emphasize that these guidelines are not meant to replace clinical judgment or professional expertise. The ultimate decision regarding care should involve collaboration between the patient and their healthcare provider.
Femoracetabular Impingement, “Hip Impingement” or Labral Tears
The following criteria outlined provide a comprehensive insight into the clinical deliberations involved in assessing femoroacetabular impingement or labral tears.
Diagnostic Studies
MR Arthrogram
Consideration of a recommended MR Arthrogram becomes crucial in the diagnosis of femoroacetabular impingement or labral tears among patients experiencing subacute or chronic hip pain. This imaging procedure is particularly advised when there are symptoms or clinical suspicions related to hip joint issues.
Typically, a single arthrogram suffices in terms of frequency, dose, and duration. Opting for an MR Arthrogram is justified as it proves valuable in confirming and assessing femoroacetabular impingement or labral tears.
The enhanced MR arthrogram is especially advantageous for a more precise labral evaluation, making it the preferred choice for diagnosing femoroacetabular impingement over alternative imaging methods. The evidence supporting the use of MR Arthrogram in diagnosing femoroacetabular impingement is substantial.
MRI
MRI is also recommended for certain patients experiencing subacute or chronic lateral hip pain when the etiology is uncertain, aiding in achieving an accurate diagnosis.
Ultrasound
While generally not the primary diagnostic test, is recommended for evaluating patients suspected of having femoroacetabular impingement or labral tears. This is especially relevant in cases where an arthrogram and MRI are preferred. Despite its selective use, ultrasound can be beneficial in confirming and evaluating femoroacetabular impingement or labral tears, justifying its recommendation in specific situations.
Medications
For most folks, the go-to meds for starters are ibuprofen, naproxen, or other old-school NSAIDs. If you can’t swing those, acetaminophen (or its twin, paracetamol) might be a decent backup, although most signs point to it being a bit less potent. And get this: NSAIDs seem to work as well for kicking pain to the curb as opioids (like tramadol), and they’re not as buzz-killing.
NSAIDs
When it comes to dealing with labral tears and femoroacetabular impingement, the wise move is rolling with NSAIDs. These over-the-counter gems could do the trick, so it’s a good idea to give them a shot first. Use them as needed, and for many folks, that might just hit the sweet spot. Now, when the tears start healing up or the impingement chills out, or if the meds aren’t cutting it or are causing more trouble than they’re worth, it’s time to hit pause.
For those cruising into the danger zone of potential stomach woes from NSAIDs, it’s a smart call to team them up with some stomach-friendly sidekicks: misoprostol, sucralfate, histamine Type 2 receptor blockers, or proton pump inhibitors. Especially for the riskier crowd – those with a history of belly bleeds, the golden agers, diabetics, and smokers – this combo could be a game-changer. Pop those protectors as per the script, and there’s no significant betting on which one will do the trick. If your stomach’s throwing a fit, the side effects kick in, or NSAIDs need to clock out, it’s time to hit the brakes.
If you’ve got a heart that’s been through the wringer or you’re collecting risk factors like trading cards, it’s crucial to have a real heart-to-heart about NSAIDs for pain relief. We’re talking about folks with a ticket to the cardiovascular disease club or those who are practically regulars there. The go-to talk should weigh the pros and cons of NSAID therapy, and when it comes to playing it safe on the cardiovascular front, starting with the A-team of acetaminophen or aspirin seems to be the move. And hey, if you must dip into the NSAID pool, the non-selective ones are the safer bet compared to the COX-2 specific ones.
Now, for those juggling low-dose aspirin as a daily heart guardian, timing is everything. To make sure your NSAID isn’t playing the spoiler to aspirin’s heroics, pop the NSAID at least 30 minutes after or a cool eight hours before your daily aspirin routine.
Acetaminophen for Treatment of Femoroacetabular Impingement or Labral Tears
When it’s femoroacetabular impingement or labral tears on the menu, and NSAIDs are a no-go, acetaminophen steps up to the plate. This recommendation covers the whole spectrum – from fresh pain to the long-haul discomfort and even post-surgery scenarios. Follow the manufacturer’s instructions on dosage and frequency, and keep in mind that crossing the four-gram daily acetaminophen limit can stir up some liver trouble. If the pain bows out, side effects kick in, or your body’s just not feeling the acetaminophen vibe, it’s time to hit pause.
The reasoning behind these recommendations is pretty straightforward. Start with the old-school gang of ibuprofen, naproxen, or their pals for most folks. If that doesn’t cut it, switch gears to another generic option. When NSAIDs aren’t the play, acetaminophen is a decent alternative, even though the evidence leans towards it being a tad less effective for arthritis folks. And get this – NSAIDs can hold their own against opioids (and tramadol), minus the heavy-duty side effects.
Opioids
Using opioids to tackle femoroacetabular impingement or labral tears is a rarity. The suggestion is to limit their use to the short term – we’re talking less than a week – for patients dealing with these issues. Now, why the cautious stance? Opioids come with a baggage of significant side effects, like poor tolerance, constipation, drowsiness, clouded judgment, memory loss, and the potential for misuse or dependence, with reports suggesting up to 35% of patients may be affected. Before handing out a prescription for opioids, patients should be well-informed about these potential downsides and be advised against handling heavy machinery or driving. When it comes to managing most musculoskeletal symptoms, opioids don’t seem to outshine safer pain relievers, so their use should be reserved for cases of severe pain only.
Now, in the post-surgery scenario for femoroacetabular impingement or labral tears, opioids get a green light, but with caution. A short course, lasting a few days to no more than a week, is recommended, especially for managing post-operative pain. They might come in handy for brief nighttime relief. But here’s the kicker – before jumping on the opioid train, patients are encouraged to give NSAIDs or acetaminophen a shot for pain control. And the rule of thumb here is to bid farewell to opioids as soon as you can, keeping an eye on the resolution of pain, effective control with other meds, or the appearance of any side effects that call for a halt.
Treatments
Rehabilitation Programs
Getting back on your feet after a work-related injury calls for a focused rehab program that’s all about bringing back the abilities you need for your daily grind and job tasks. The goal here is to hustle towards getting you back to your pre-injury self as much as possible. When it comes to the therapy game, there are two players – active and passive. Active therapy needs you to put in the work, like doing specific exercises or tasks. On the flip side, passive therapy doesn’t demand much effort from you; it’s more about the therapist doing their thing with various modalities. Generally, passive interventions are seen as a way to boost progress in an active therapy plan, leading to some tangible functional gains. But here’s the scoop: the spotlight should be on the active stuff over the passive ones.
Now, the plot extends beyond the clinic. You’re expected to keep the therapy vibes going at home, both the active and passive routines, to keep that improvement momentum rolling. And hey, if needed, throw in some assistive devices as backup players to amp up your rehab game and snag those functional gains. It’s all about making strides towards your best self, one step at a time.
Therapeutic Exercise:
Engaging in Therapeutic Exercise, either through Physical or Occupational Therapy, is advised for individuals dealing with femoroacetabular impingement or labral tears, especially after surgery and to tackle any strength issues. The total number of therapy sessions can range from as few as two to three for those with mild functional deficits, up to 12 to 15 for those with more severe deficits, provided there’s consistent improvement in objective functionality.
In cases where ongoing deficits persist, more than 12 to 15 sessions might be recommended, depending on documented progress toward specific functional goals, such as increased range of motion or improved ability to perform work activities. It’s crucial to include a home exercise program as part of the overall rehabilitation plan, to be performed alongside therapy.
The decision to discontinue therapy depends on factors like enhanced function, reduced pain, successful post-operative healing, intolerance, lack of efficacy, or non-compliance.
Injection Therapy
For addressing hip impingement or labral tears in specific cases, Local Glucocorticosteroid Injections are suggested. These injections are considered when issues like hip impingement or labral tears persist despite several weeks of treatment involving activity modification and NSAIDs. Typically, a single injection is administered, but a second one may be contemplated if there’s incomplete improvement, evidenced by increased function and decreased pain. The use of local glucocorticosteroid injections for hip impingement is supported by available evidence.
Surgery
Arthroscopy
It’s recommended to employ diagnostic and treatment measures for patients experiencing hip pain when there’s a suspicion of a labral tear, intraarticular body, femoroacetabular impingement, or other subacute or chronic mechanical symptoms.
This is particularly applicable for those who haven’t responded well to conservative management and are deemed suitable for arthroscopy. Indications for this approach encompass patients with hip pain and suspected issues like labral tear, intraarticular body, femoroacetabular impingement, or other subacute or chronic mechanical symptoms.
The rationale behind this recommendation lies in the increasing use of hip arthroscopy for addressing various hip disorders, especially those presenting with mechanical symptoms. Successful treatment outcomes have been reported for symptomatic labral tears and the removal of foreign bodies.
Additionally, femoroacetabular impingement is recognized as a potential indication. The supporting evidence for utilizing arthroscopy in both diagnosing and treating patients with hip pain is well-documented.
Surgical Repair
It’s advisable for cases of hip impingement or labral tear that haven’t responded well to conservative treatments and have either failed arthroscopic repair or are considered best suited for an open approach.
The indications and rationale for this recommendation include patients experiencing hip pain with suspicions of labral tear, intraarticular body, femoroacetabular impingement, or other subacute or chronic mechanical symptoms that are deemed most effectively addressed through an open approach. The supporting evidence backs the recommendation for open surgical repair in cases of “hip impingement” or labral tear.
