Presentation
Referred by ED post fall 2 weeks earlier with ongoing pubic symphysis pain since. No prior surgical or medical history. Normal range of movement of both hips on examination.
Patient Data
There is a synovial herniation pit, also known as Pitt pit, at the anterolateral aspect of the right femoral head neck junction which was not present on the prior radiograph from 5 years before (not shown).
In addition, there is abnormal bony spurring at the bilateral femoral head neck junctions, left greater than right, consistent with bilateral cam-type femoroacetabular impingement anatomy.
No significant hip joint space loss.
A synovial herniation pit also known as Pitt pit at the anterolateral aspect of the right femoral head-neck junction (white arrow).
Abnormal bony spurring at the bilateral femoral head neck junctions, left greater than right, concerning for bilateral cam-type femoroacetabular impingement (black arrows).
Case Discussion
Femoroacetabular impingement (FAI) syndrome is a group of morphological changes involving femoral head and/or neck combined with pain and/or range of movement which causes early degenerative disease.
There are three types of FAI:
- pincer
- cam (presented in this case)
- mixed
A "cam" is a part of camshaft a car's engine part. It looks like a bump on a stick - like a shaft, similarly to abnormality seen in the area of femoral neck in FAI.
Pitt pit is a synovial herniation cyst localized typically in antero superior aspect of the femoral neck. Its significance is debatable. In most of the cases Pitt pit has no clinical significance however in some cases it is associated with femoroacetabular impingement.
In this case, Pitt pit helped to reach a diagnosis. After spotting the synovial cyst, the reporter investigated in detail the femoral heads, which were abnormal.
The patient was referred to the Orthopedic clinic for review and treatment plan.
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