Prefer to watch? 4-minute lesson13 slides · same content, shorter

1 · SNAPSHOT

Femoroacetabular Impingement Syndrome (FAI — Cam / Pincer) body chart — Illustrative, not diagnostic. Canva body chart for Femoroacetabular Impingement Syndrome (FAI — Cam / Pincer).

Who: Young, active adults. Cutting, pivoting and deep-flexion sports; also anyone who sits a lot and squats heavy.
What: FAI syndrome — a motion-related clinical disorder of the hip.
How it behaves: Deep anterior groin pain or a "pinch" with hip flexion or rotation. Worse with prolonged sitting, squatting, pivoting. Clicking or catching possible. Eased by rest and by avoiding flexion.

The one thing to take from this page:

It is a syndrome, not a shape. Symptoms AND signs AND imaging findings — all three. Cam morphology on a scan without symptoms and signs is a shape, and telling someone it's a diagnosis changes what they believe about their hip for years.

The Warwick triad

Component	What it means
Symptoms	Motion- or position-related hip or groin pain; may include clicking, catching, locking, stiffness, giving way
Signs	Positive FADIR, reduced internal rotation in flexion
Imaging findings	Cam or pincer morphology
All three	= FAI syndrome. Any two = something else, or nothing

⚠️ No Australian guideline exists. The anchors are international consensus statements, not graded practice guidelines. An Australian randomised trial exists; a guideline does not.

2 · SE — THE SUBJECTIVE PATTERN (the 70%)

Five stages, in your course's order. You are looking for a position-related joint story, and screening hard for the two things that aren't this.

MAIN PROBLEM

"It pinches deep in my groin when I squat."
"Sitting in the car kills it."
"It catches when I turn."

BODY CHART

Deep and anterior. The C-sign — cupping the hip between thumb and fingers — is the classic gesture.
Not the adductor origin, not the symphysis, not the inguinal canal. Those are three different pages.
Mark lateral hip separately — gluteal tendinopathy coexists.
Mark buttock and posterior thigh — that opens the lumbar and deep gluteal questions.

BEHAVIOUR

	Fits FAI syndrome	Points elsewhere
Aggs	Deep flexion, prolonged sitting, squatting, pivoting	Cutting and kicking with adductor tenderness → adductor-related
Severity	VAS 0–10 at best / at worst / right now	—
Symptoms	Pinch, click, catch, stiffness, giving way	True locking → labral or loose body
Onset	Gradual, load-related	Weight-bearing pain, can't hop → bone stress
Age	Young, active	Older, morning stiffness, capsular restriction → hip OA
Night	Sore after load	Night or rest pain → screen

HISTORY

What positions? Get specific — car seat, squat depth, bike fit, dance position.
Training and load change.
Sport type — cutting, pivoting and deep-flexion sports carry the pattern.
What have they already been told, and have they had a scan? This matters more here than almost anywhere, because an imaging report has usually done the talking already.
Adolescent with a limp or hip pain? That is a slipped capital femoral epiphysis question.

SPECIAL / SCREENING QUESTIONS

Can they hop? Weight-bearing pain, night pain, RED-S profile → bone stress.
Night pain, rest pain, fever, weight loss?
True mechanical locking — the hip stuck, needing manipulation to free?
Any bowel, bladder, or bilateral leg symptoms?

Assessing this region? Download the Hip & Groin assessment template →

3 · HYPOTHESIS RANKING

Competing pattern	The one discriminating feature
Hip labral tear ± chondral lesion	Overlapping, and commonly coexists. True catching, locking or giving way points more to labral involvement.
Adductor-related groin pain	Tender adductor origin, positive squeeze. Tendon, not joint.
Iliopsoas-related pain	Tender deep to the inguinal ligament, pain on resisted hip flexion.
Hip osteoarthritis	Older, capsular restriction with a bony end-feel, morning stiffness. Same joint, not simply an earlier stage: in adults 55 and over, cam morphology was linked to new radiographic hip OA but not to new clinical hip OA [23].
Lumbar or deep gluteal referral	Buttock-dominant, neural behaviour, and the hip tests don't reproduce it.

The two that outrank the table

Femoral neck stress fracture. Same population, same location. Weight-bearing pain, inability to hop, night pain, or a RED-S risk profile means imaging before rehabilitation.

Slipped capital femoral epiphysis, in an adolescent. Limp, hip or knee pain, restricted internal rotation. Knee pain in a child can come from the hip — it belongs on this page too.

And the framing that decides how you use the scan

Hip-related pain in young and middle-aged active adults has its own consensus on classification and diagnostic criteria [1], which places FAI syndrome alongside acetabular dysplasia, labral pathology and other intra-articular causes rather than treating it as the default label for a sore young hip.

4 · RED FLAGS — DON'T MISS THIS

This section is free, on every pattern, forever. Safety is never gated.

Finding	What it suggests	What you do
Groin pain with inability to weight-bear or hop	Femoral neck stress fracture	Urgent imaging. Do not load. Radiographs are often normal, so a clear X-ray doesn't end it — MRI is the test (Bernstein et al. 2022) [21]
Night pain or rest pain	Bone stress, infection, tumour	Image
RED-S profile — low energy availability, menstrual disturbance, weight loss	Bone stress injury	Image and refer
Adolescent with a limp, hip or knee pain, restricted IR	Slipped capital femoral epiphysis	Urgent imaging and orthopaedic review
Fever, unwell, hot painful hip	Septic arthritis	Emergency
Young adult hip pain with IV drug use, alcohol excess or corticosteroid use in the history	Fracture, infection or ischaemic necrosis must be ruled out early	Image and refer early — they need treatment before the joint is damaged (Troum & Crues 2004) [22]
True mechanical locking	Labral tear, loose body	Orthopaedic review
Progressive night pain with a cancer history	Metastatic disease	Medical review
Sudden severe pain with functional loss	Fracture, avulsion	Image

The rule: position-related deep anterior hip pain in someone who can hop, with a clean systemic screen, is yours. Weight-bearing pain, night pain, an adolescent limp, systemic symptoms or true locking is not.

Cross-links: Hip labral tear · Adductor-related groin pain · Iliopsoas-related pain · Hip osteoarthritis

Members

The 4-minute lesson is for members

Twelve slides on this pattern: what you'll hear, what to examine, what to do. Free with an account.

Guideline anchor

No Australian guideline covers FAI syndrome.

Anchored to the Warwick Agreement (Griffin et al. 2016, PMID 27629403) for the definition — symptoms AND signs AND imaging findings; to the consensus on classification and diagnostic criteria for hip-related pain in young and middle-aged adults (Reiman et al. 2020, PMID 31959678) for where this sits among the other hip-related presentations; and to the two randomised trials of arthroscopy versus structured conservative care (Griffin et al. 2018, PMID 29893223; Palmer et al. 2019, PMID 30733197) for the surgical conversation.

PubMed Source

Both anchors are international consensus statements, not Australian documents and not clinical practice guidelines with graded recommendations. An Australian multi-centre randomised trial comparing arthroscopy with physiotherapy exists (Hunter et al. 2021) and a 2025 survey of contemporary practice includes Australian clinicians — but there is no Australian guideline.

Members

The evidence summary is for members

Verified diagnostic accuracy, where the evidence stands and what it doesn't settle. Free with an account.

Sources · 21

Show

Every source on this page resolves and title-verifies against PubMed. Newest first.

2020Reiman et al. (2020). Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018. British journal of sports medicine, 54(11), 631-641. https://doi.org/10.1136/bjsports-2019-101453
2020Pålsson et al. (2020). Combining results from hip impingement and range of motion tests can increase diagnostic accuracy in patients with FAI syndrome. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 28(10), 3382-3392. https://doi.org/10.1007/s00167-020-06005-5
2022Wong et al. (2022). Physical Examination of the Hip: Assessment of Femoroacetabular Impingement, Labral Pathology, and Microinstability. Current reviews in musculoskeletal medicine, 15(2), 38-52. https://doi.org/10.1007/s12178-022-09745-8
2025Zhang et al. (2025). Hip muscle changes in femoroacetabular impingement: a systematic review and meta-analysis. Journal of orthopaedic surgery and research, 20(1), 717. https://doi.org/10.1186/s13018-025-06135-x
2021Palmer (2021). Femoroacetabular Impingement (FAI): Counterpoint-Do Not Equate FAI Morphology With FAI Syndrome. AJR. American journal of roentgenology, 217(6), 1297-1298. https://doi.org/10.2214/AJR.21.26181
2020Mascarenhas et al. (2020). The Lisbon Agreement on Femoroacetabular Impingement Imaging-part 1: overview. European radiology, 30(10), 5281-5297. https://doi.org/10.1007/s00330-020-06822-9
2024Radha et al. (2024). Best practice guidelines for clinical and radiological assessment of patients with femoroacetabular impingement. Results from the ISHA International Delphi Consensus Project-Phase 2. Journal of hip preservation surgery, 11(1), 44-50. https://doi.org/10.1093/jhps/hnad028
2021Terrell et al. (2021). Therapeutic Exercise Approaches to Nonoperative and Postoperative Management of Femoroacetabular Impingement Syndrome. Journal of athletic training, 56(1), 31-45. https://doi.org/10.4085/1062-6050-0488.19
2020Hoit et al. (2020). Physiotherapy as an Initial Treatment Option for Femoroacetabular Impingement: A Systematic Review of the Literature and Meta-analysis of 5 Randomized Controlled Trials. The American journal of sports medicine, 48(8), 2042-2050. https://doi.org/10.1177/0363546519882668
2023Pasculli et al. (2023). Non-operative Management and Outcomes of Femoroacetabular Impingement Syndrome. Current reviews in musculoskeletal medicine, 16(11), 501-513. https://doi.org/10.1007/s12178-023-09863-x
2025Dancy et al. (2025). Femoroacetabular Impingement: Critical Analysis Review of Current Nonoperative Treatments. JBJS reviews, 13(4). https://doi.org/10.2106/JBJS.RVW.24.00211
2026Hibbert et al. (2026). Evaluating a 3-Month Physical Impairment and Functional Performance-Based Rehabilitation Program After Hip Arthroscopy for Femoroacetabular Impingement (FAI) Syndrome. The Journal of orthopaedic and sports physical therapy, 56(7), 456-464. https://doi.org/10.2519/jospt.2026.13775
2025Lawrenson et al. (2025). Diagnosis and management of femoroacetabular impingement syndrome (FAIS): a survey of contemporary physiotherapy practice. BMC musculoskeletal disorders, 26(1), 924. https://doi.org/10.1186/s12891-025-08708-7
2018Griffin et al. (2018). Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet (London, England), 391(10136), 2225-2235. https://doi.org/10.1016/S0140-6736(18)31202-9
2019Palmer et al. (2019). Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial. BMJ (Clinical research ed.), 364, l185. https://doi.org/10.1136/bmj.l185
2022Zhu et al. (2022). Conservative therapy versus arthroscopic surgery of femoroacetabular impingement syndrome (FAI): a systematic review and meta-analysis. Journal of orthopaedic surgery and research, 17(1), 296. https://doi.org/10.1186/s13018-022-03187-1
2021Hunter et al. (2021). Multi-centre randomised controlled trial comparing arthroscopic hip surgery to physiotherapist-led care for femoroacetabular impingement (FAI) syndrome on hip cartilage metabolism: the Australian FASHIoN trial. BMC musculoskeletal disorders, 22(1), 697. https://doi.org/10.1186/s12891-021-04576-z
2016Griffin et al. (2016). The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. British journal of sports medicine, 50(19), 1169-76. https://doi.org/10.1136/bjsports-2016-096743
2022Dijkstra et al. (2022). Oxford consensus on primary cam morphology and femoroacetabular impingement syndrome: part 1-definitions, terminology, taxonomy and imaging outcomes. British journal of sports medicine, 57(6), 325-41. https://doi.org/10.1136/bjsports-2022-106085
2022Dijkstra et al. (2022). Oxford consensus on primary cam morphology and femoroacetabular impingement syndrome: part 2-research priorities on conditions affecting the young person's hip. British journal of sports medicine, 57(6), 342-58. https://doi.org/10.1136/bjsports-2022-106092
2023Runhaar et al. (2023). Risk Factors and Population-Attributable Fractions for Incident Hip Osteoarthritis. HSS journal : the musculoskeletal journal of Hospital for Special Surgery, 19(4), 407-412. https://doi.org/10.1177/15563316231192461

Mapped to this pattern

Generic measures that also apply

Did this page do its job?

CliniStudy is in beta. One tap is enough — it decides what gets fixed first.