Hip impingement · Labral tear · Vienna
Groin pain in your 20s, 30s or 40s – during sport, on long drives, in a squat? Behind it is often hip impingement (FAI) with a tear of the labrum, a condition misread as a "strain" for years. I clarify the cause, treat conservatively and give you an honest second opinion. If a hip arthroscopy is needed, I organise the procedure for you.
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In femoroacetabular impingement (FAI) the femoral head and the socket do not fit together optimally. Two forms – often combined: in the cam type the transition from head to neck is too bulky; in the pincer type the socket covers the head too far.
The result: with deep flexion and internal rotation the structures knock against each other. What gets pinched is above all the labrum – a fibrocartilage sealing ring that enlarges the socket and stabilises the joint. Over time the labrum tears, and the cartilage rim can also be damaged.
Groin pain on flexion: deep sitting, long drives, squatting, tying shoes
Load-related: after football, running, yoga, martial arts or strength training
The "C sign": patients grip the hip with their hand – the pain sits deep between groin and buttock
Occasionally: snapping, a catching sensation or sharp pain on rotation
Many impingement patients have an odyssey behind them – treated for a "groin strain", the back or the adductors. Yet the diagnosis is well within reach with a targeted work-up:
The impingement test (flexion + internal rotation, "FADIR") reproduces the typical groin pain. Plus range-of-motion testing in side comparison.
Shows the bone shape: cam deformity, socket coverage – and rules out early osteoarthritis.
Shows labrum and cartilage – for specific questions as an arthro-MRI with contrast in the joint.
Not every impingement needs surgery – but none should be ignored for years. The order is clear:
Targeted strengthening of the hip and core muscles, optimising movement patterns – and avoiding the provoking end positions (extremely deep squats, forced stretching). Many patients become lastingly comfortable this way.
A targeted injection into the hip joint calms the inflammation – and at the same time confirms that the pain really comes from the joint. Valuable information for every further decision.
If symptoms persist after 3–6 months of conservative treatment, keyhole surgery can remove the mechanical conflict: the torn labrum is refixed and the interfering bone shape (cam/pincer) corrected. Prerequisite: the cartilage is still largely intact – with advanced hip osteoarthritis, arthroscopy achieves nothing, and I tell you that honestly.
This highly specialised operation I do not perform myself — but if it is indicated, I am glad to organise it for you.
The repeated impact between head and socket damages the labrum and cartilage rim – exactly where hip osteoarthritis begins years later in many patients. A pronounced, symptomatic impingement in a young person is therefore more than a nuisance: it is a chance to protect the joint while it is still healthy.
That does not mean every abnormal bone shape needs treatment – many people with a cam deformity never develop symptoms. What counts is the combination of symptoms, examination findings and imaging.
Why patients with hip pain come to me
Groin pain in young, active people that occurs mainly with deep hip flexion – sitting low, driving, squatting, sport – is the typical picture of hip impingement (FAI), often with an accompanying tear of the labrum. It is frequently misdiagnosed for years as a groin strain or back problem. A targeted examination with an impingement test and imaging brings clarity.
In femoroacetabular impingement (FAI) the femoral head and the socket do not fit together optimally: either the transition from head to neck is too bulky (cam type), the socket covers the head too far (pincer type) – or both. During flexion and rotation the structures knock against each other and pinch the labrum and the cartilage rim.
No – torn labral tissue does not grow back together. But that does not automatically mean surgery: many patients become lastingly comfortable with physiotherapy, adapted loading and, if needed, an injection. If symptoms persist or the bone shape is clearly abnormal, a hip arthroscopy can repair the labrum and correct the bone shape.
When relevant pain persists despite 3–6 months of consistent conservative treatment, imaging shows a clear impingement shape and labral damage, and the cartilage is still largely intact. A hip arthroscopy can then remove the mechanical conflict – also with the aim of preventing later osteoarthritis.
For office work usually 2–3 weeks, for physically demanding jobs 6–8 weeks or longer. In the first weeks you partially weight-bear with crutches, accompanied by physiotherapy. Return to sport is stepwise from about 3 months, contact sports later.
The risk is increased: the repeated impact damages the labrum and cartilage rim, which can promote the development of osteoarthritis – especially with a pronounced cam type. Not every impingement becomes arthritis, but persistent symptoms should be clarified while the cartilage is still healthy.
The earlier an impingement is recognised, the better your hip joint can be protected. Get it clarified – instead of guessing for years. In English.
1040 Vienna: +43 1 585 62 60 · 1020 Vienna: +43 1 890 45 20
By prior appointment only · 1040 Vienna-Wieden (Große Neugasse 28/2) · 1020 Vienna-Leopoldstadt (Vorgartenstrasse 206c)