A 17-year-old female elite high school junior basketball athlete (1.73 m, 66 kg, body mass index = 22.1 kg/m2) was involved in a collision during a basketball game, landing on her right hip. Her primary complaints were as follows: right lower back and groin pain, feeling like her back "popped," burning pain in the right anterior-superior thigh, and occasional catching/clicking in her right hip/buttock region. There were also complaints of pain (8 on a scale of 10) as a result of jogging the day before initial examination, an antalgic gait pattern on the involved right side, and pain with range of motion (ROM) of the lumbo-pelvic-hip complex. Due to the patient's acute pain level, she did not practice for the next week.
The neurologic examination yielded negative results. The lumbar/pelvic girdle examination led to a focus on the hip joint (Figure 1).
Hip strength was 3 (out of 5) for abduction and 4 for extension, compared to 4 for strengths on the left hip. Internal rotation ROM was 15  on the right and 30  on the left. Clinical testing for FAI and most labral tear tests yielded positive results.
Right hip radiography, magnetic resonance imaging arthrogram (MRA), and 3-dimensional computed tomography suggested pincer impingement with cam lesion (Figure 2) and a tear of the superior labrum. Rehabilitation primarily addressed restricted hip internal rotation and hip/trunk weakness for 6 weeks, until surgical consultation.
Intra-articular injection of 3 mL of Marcaine (bupivacaine hydrochloride) and 80 mg of Depo-Medrol (methylprednisolone acetate) was performed to confirm the diagnosis of intra-articular hip joint pathology. Complete (albeit temporary) relief of symptoms led to surgical consultation. Surgical intervention was recommended due to the recalcitrant nature of the patient's complaints, temporary complete relief of symptoms with intra-articular injection, as well as lack of significant improvement with physical therapy. At operation, the acetabular labrum was intact without pathologic pincer impingement. Articular cartilage breakdown of the anterolateral acetabulum was seen (grade III; Figure 3) with cam-type impingement. Chondroplasty of anterior acetabulum and synovectomy of acetabular fossa were performed, followed by femoroplasty for cam impingement.
Initial rehabilitation consisted of controlled weightbearing with crutches (4 weeks), soft tissue mobilization, hip joint mobilizations (grades I and II), hip flexor and anterior/posterior hip joint stretching, progressive strengthening initiated with isometrics, and ROM in pain-free ranges. Once full weightbearing was well tolerated, exercises were slowly advanced to progressive resistive weightbearing, proprioceptive and balance exercises, and sport-related stretching and strengthening exercises. Hip mobilizations were progressed to grades III and IV for restricted ROM.
A slow return to competitive basketball was allowed approximately 4 months after hip surgery. At the last clinic visit, 6 months after surgery, the patient scored 96 on the modified Harris Hip Score, had normal ROM and strength, and passed all functional testing. The patient was consulted via phone 20 months after surgery and was continuing with competitive basketball without complaints.