The initial treatment suggestions include working with a experience physical therapists who can work on hip capsule mobility, hip traction, gluteal stabilization. Would recommend modifying exercise program to avoid deep squats or repetitive hip flexion type activities as this will cause the impingement symptoms to worsen. Additional considerations include repeat hip corticosteroid injection but with less volume of injectate to avoid hip capsule distention, PRP intra-articular and labral injections under ultrasound guidance. If these treatments do not provide pain relief, may consider further consultation with an experienced hip arthroscopy surgeon.
FAI, a condition diagnosed by identifying excess bony growth on either the femur (known as a CAM impingement) or the pelvis (known as a pincer impingement) that results in an abnormal shape of either (or both) structures. Theoretically, this causes poor bone alignment as the bones move on each other and can cause pinching and tearing of the labrum (a ring of fibrocartilage that sits between ball and socket that promotes stability of the joint) and ultimately pain most notably in the groin. Even up 85% of asymptomatic soccer players have imaging findings of FAI (Yepez, et al 2017). A study in the Journal of Hip Preservation Surgery from 2016 found that only 64% of patients were satisfied after undergoing arthroscopic surgery for FAI.
The typical presentation of a patient with a spinoglenoid cyst compressing on the suprascapular nerve is vague shoulder pain along with infraspinatus muscle weakness. However, should the spinoglenoid cyst be large enough; supraspinatus muscle weakness may also be present [12]. Several approaches have been proposed for the management of a symptomatic spinoglenoid cyst including observation [5,8], needle aspiration under ultrasound (US) or computed tomography (CT) guidance, or surgical intervention [5,13]. The surgical intervention can range from open drainage of the cyst to arthroscopic procedure involving either/both the cyst or/and the labrum of the glenoid [5,8,14,15]. Currently, surgical intervention is the preferred approach by most surgeons not only due to the unresponsiveness in nonoperative management, but also due to worsening of the symptoms of the patient.