43-year-old male with CAM impingement like symptoms

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Pain and stiffness with sensation of instability for 9-10 months. 

Long- and short-axis fat- and water-weighted images were performed after contrast administration. 6cc of OptiMARK injected.

  • Bone/conformity:
    • Markedly abnormal. While cup depth is not inordinately deep or shallow dysplastic head-neck junction is identified. 
  • Marked asphericity is associated with a greater than 65-degree alpha ankle. 
  • Prominent bump cyst complex. 
  • Articular:
    • Diffuse class 3 and 4 chondromalacia emanating predominantly from the fovea capitis and spreading more anterior than posterior. Less conspicuous is the inside-out or outside-in abrasion of impingement syndrome anteriorly where the cartilage is relatively preserved although still chondromalacic. 
  • Large anterosuperior to posterosuperior impingement type labral tear noted. 
  • A near full thickness rent in the capsule at the capsulolabral interface is present with slight gapping at the tear site 3mm in length. 
  • Bone Marrow:
    • Bump cyst complex as describe. Reactive edema from chondromalacia. 
  • Entrapment Neuropathy:
    • None. 
  • Flexors extensors abductors and adductors normal. 
  • External rotators:
    • Normal.

FAI Cam type impingement with asphericity of the head-neck junction and abnormal alpha angle (65 degrees) as the primary contributory even though the acetabular development and cup depth is normal. Labral tear large and superior posterior to anterior. Capsular tear as described. Perifoveal anterior greater than posterior chondromalacia.

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