Hip pain

Pain in the hip is the experience of pain in the muscles or joints in the hip/ pelvic region, a condition commonly arising from any of a number of factors. Sometimes it is closely associated with lower back pain. Radiography in normal hipX-ray in pincer impingement type of hip dysplasiaX-ray of camHip in osteoarthritisSeptic arthritisFigure 2A. Normal hip.Figure 2B. Hip dysplasia.Figure 2C. AP view of a patient with left hip effusion secondary to trauma showing widening of the medial joint space.Figure 3A. Herring lateral pillar classificationFigure 4: (a) X-ray of a 10-year-old child with left hip pain. It was considered normal at emergency despite the widening of the left physis (arrow). Two weeks later epiphysiolysis was evident (b). Despite appropriate surgical reduction (c) osteonecrosis developed and femoral head collapsed 1 month later (d).Axial CT image of pigmented villonodular synovitis eroding the posterior cortex of the femoral neck.Sagittal T2* gradient echo image showing a posterior soft tissue mass with hypointense areas secondary to hemosiderin deposition.X-ray of synovial chondromatosis.CT of synovial chondromatosis.X-ray of a patient with transient osteoporosis of the left hip showing osteoporosis.Coronal stir imaging in transient osteoporosis, showing diffuse edema.Scintigraphy (A), sagittal T1 (B), and coronal PD fat sat of a patient with a subchondral fracture of the femoral head with convex shape to the articular surface.Coronal T1 of a patient with avascular necrosis of the femoral head.Sagittal T1 weighted image showing anterosuperior labral tear.Sagittal T1 weighted image showing chondral lesion.Sagittal CT-arthrography showing posteroinferior chondral injury.Coronal CT-arthrography (d) showing ligamentum teres tear.Stress femoral neck fracture in a young athlete barely visible in X-ray film as a sclerotic line (arrow)In this case, Tc 99 scintigraphy shows a band of uptakeFurthermore, T1 (left) and DP fat saturated (right) weighted MR images showed the fracture line and a pattern of edema.Useful ultrasound measures in neonatal hip sonography, alpha and beta angles.Measurement of femoral head coverage.Normal ultrasound appearance of the femoral head-neck junction.Joint effusion in transient synovitis of the hip.Flattening of the femoral head in a patient with Perthes disease.Step in the femoral head-neck junction in a patient with SCFE. Pain in the hip is the experience of pain in the muscles or joints in the hip/ pelvic region, a condition commonly arising from any of a number of factors. Sometimes it is closely associated with lower back pain. Causes of pain around the hip joint may be intra-articular, extra-articular, or referred pain from neighboring structures, such as sacroiliac joint, spine, symphysis pubis, or the inguinal canal. Common etiologies include: Pain in the groin, called anterior hip pain, is most often the result of osteoarthritis, osteonecrosis, occult fracture, acute synovitis, and septic arthritis; pain on the sides of the hip, called lateral hip pain, is usually caused by bursitis; pain in the buttock, called posterior or gluteal hip pain, which is the least common type of hip pain, is most often caused by sacroiliac joint dysfunction as well as sciatica (whether from a hemorrhaged spinal disk or a tense piriformis muscle). Herpes zoster (shingles) may also cause posterior hip pain. Clinical tests are adapted to identify the source of pain as intra-articular or extra-articular. The flexion-abduction-external rotation (FABER), internal range of motion with overpressure (IROP), and scour tests show sensitivity values in identifying individuals with intra-articular pathology ranging from 0.62 to 0.91. Projectional radiography ('X-ray') is the first imaging technique of choice in hip pain, not only in older people with suspected osteoarthritis but also in young people without any such suspicion. In this case plain radiography allows categorization as normal hip or dysplastic hip, or with impingement signs, pincer, cam, or a combination of both. Imaging of the hip needs to be complementary to the clinical history and physical examination because it is well known that imaging findings do not always correlate with the presence of pain and vice versa. Projectional radiography ('X-ray') is currently useful not only in older patients in whom osteoarthritis of the hip is suspected but also in younger patients without osteoarthritis, who are being evaluated for femoroacetabular impingement (FAI) or hip dysplasia. Plain radiography allows us to categorize the hip as normal or dysplastic or with impingement signs (pincer, cam, or a combination of both). Besides these, pathologic processes like osteoarthritis, inflammatory diseases, infection, or tumors can also be identified (Figure 1).