Question
When treating impingement, what is your time frame for rehab? How long do you try rehab before you refer to the surgeon? What types of findings would you look for that would make you refer to the surgeon right away?
Answer
I always screen right away. If there is an aversion issue where there is obviously some anteversion or retroversion that is just glaring, my choice to refer for imaging is sooner than later. If someone has normal, symmetrical anteversion, it's not that big of a deal. If they are young, that's when we will go to the FABER and Quadrant test. In an older hip, you tend to see adduction and internal rotation, or internal rotation and abduction. That internal rotation is the first thing to go. If I have reproduction of symptoms, a patient that says that gives me my groin pain, or if I do not like the end feel side to side with a lack of rotation, even if it is subtle, those are the ones that I get to the doctor sooner. I like to get those folks worked up a little bit quicker to rule out any obvious osseous issues, but again just because they have that does not mean that that is the cause of their symptoms, but I think that it warrants good consideration. If they have a FABER where they lack distance, I do like the impingement sign, because it allows me to go from abduction to adduction and from internal to external rotation. That internal rotation is the last maneuver. It is like BANG, you save that until last, they got it, those are the ones to go. If they have bad core strength or puny gluteus medius in the absence of any bad end feel with passive internal rotation, we will rehab for three to four or four to six weeks before we will refer out. We get all of our bases covered and then kind of go from there.
