Imaging for hip pain

Many cases of mild hip pain without trauma respond to activity modification, stretching, and anti-inflammatories. Imaging is appropriate when:

• There is a history of trauma
• Pain is severe, persistent beyond four to six weeks, or wakes you from sleep
• There is a history of corticosteroid use, alcohol use disorder, or sickle cell disease (risk for avascular necrosis)
• There is concern for cancer, infection, or stress fracture in an athlete
• Pain limits weight-bearing

For older adults with a sudden inability to bear weight after even minor trauma, X-ray plus MRI may be needed because some hip fractures are not visible on X-ray alone — a missed occult femoral neck fracture is a recognized failure mode that MRI prevents.

Hip X-ray is the first study. AP pelvis and dedicated hip views show alignment, joint space, fractures, and femoral head shape.

Hip MRI evaluates cartilage, labrum, marrow, surrounding tendons (gluteus medius/minimus), and bursae. It's the test of choice for suspected avascular necrosis, stress fracture, labral tear, or unexplained pain after a normal X-ray.

Hip CT is used when MRI is contraindicated or when complex bony detail is needed for surgical planning.

MR arthrogram of the hip is the gold standard for evaluating labral tears, femoroacetabular impingement, and cartilage damage in young adults with hip pain.

Hip MRI evaluates:

• The femoral head and neck for avascular necrosis, fracture, or marrow lesions
• The acetabular cartilage and labrum (best with arthrography)
• Gluteus medius and minimus tendons (the 'rotator cuff of the hip')
• The greater and ischial trochanteric bursae
• The sacroiliac joints for sacroiliitis
• The iliopsoas and adductor muscles for strain or tear

Osteoarthritis — joint space narrowing and bone spurs. Common cause of groin pain in older adults.

Femoroacetabular impingement (FAI) — abnormal bony contact between femur and acetabulum, often associated with labral tear in young adults.

Labral tear — tear in the cartilage ring around the socket; may cause clicking, catching, or groin pain.

Avascular necrosis (osteonecrosis) — loss of blood supply to the femoral head; early diagnosis on MRI is critical because early-stage AVN can sometimes be saved.

Greater trochanteric pain syndrome — pain over the outside of the hip; usually gluteus medius/minimus tendinopathy with or without bursitis.

Occult or stress fracture — common in older adults after low-energy trauma and in athletes with sudden training increases.

Reports return within a day. Most hip problems are managed nonoperatively with physical therapy, activity modification, and selective injections. Surgical options range from hip arthroscopy (labral repair, FAI) to hip replacement for end-stage arthritis. Early avascular necrosis warrants prompt orthopedic referral.

Bring your physician's order and ID. Hip MRI takes about 30 minutes; arthrography adds 30 minutes. Call 800-558-2223 for a transparent self-pay quote.