Center for Hip Preservation

Diagnosis

"All images and imaging are not created equal."

The right diagnosis is essential when obtaining the right care. Specialization and unmatched experience are the hallmarks of the Center for Hip Preservationís medical staff. The advanced tests available at our center assist our specialists in making the right diagnosis and pursuing the right treatment. This involves both a physical examination as well as radiological examinations. Without an official reading by an experienced radiologist, subtle x-ray findings (e.g., tears, infections, systematic diseases, tumors, etc.) may remain undetected until such time as an abnormality has progressed to the point where a non-imaging specialist may identify it. Delays in diagnosis add to medical cost and may considerably effect treatment and ultimate patient outcome. The skilled staff members at the Center for Hip Preservation help patients and families understand conditions as well as all of the treatment options available.

The Physical Hip Exam

During the physical examination, performed by a Center physician, a patientís gait, or the way a patient walks, will be evaluated. Next, the range of motion of a patientís hip will be examined to learn whether the problem is coming from the spine, if there is bursitis in the great trochanter, or if iliotibial band tightness is present. The doctor will also check the internal and external rotation of the patientís hips, look for leg length discrepancies, test muscle strength in the hip, and test range of motion in the back. View a Physical Examination of the Hip to learn more.

"What is causing my hip to ache?"


Assessing Hip Abnormalities

Medical imaging, including x-rays and magnetic resonance imaging (MRI), is crucial in diagnosing hip pain. An x-ray can reveal an excess of bone on the femoral head or neck and the acetabular rim. An MRI can reveal fraying or tears of the cartilage and labrum.

Sometimes it is necessary to find a way to differentiate pain radiating from the hip joint and pain radiating from the lower abdomen. To accomplish this, the hip can be injected with a steroid analgesic. If the pain is coming from the hip joint, the injection provides the patient with pain relief and confirms the diagnosis of hip pain. Once this is established, proper imaging can be performed to better understand how to provide relief. If the pain is not relieved, then the pain is coming from outside the hip joint and further examination is necessary.

"I have recurring groin pain."


Testing

Although patients may have undergone tests prior to arriving at the Center, additional tests using the Centerís advanced equipment may reveal conditions or problems previously unseen. The HSS Radiology & Imaging group at the Center is nationally and internationally recognized as the premier center for leading-edge, musculoskeletal, orthopedic, rheumatologic, clinical, and research imaging. Approximately 200,000 musculoskeletal imaging examinations are performed annually (including Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Ultrasound, and Nuclear Medicine), of which approximately 132,500 are conventional radiography (x-ray) and interventional procedures.

"My hip makes a snapping sound."


Patients may undergo some of the following tests:

X-Rays

X-rays (radiographs) are the most universal and often used diagnostic imaging technique. An x-ray is similar to having a photograph taken in a portrait studio. A Radiologic Technologist (RT) uses non-visible x-rays (shorter wavelength) to create an image similar to a photographer using visible light. An x-ray machine emits electromagnetic waves (radiation) that go through the body and expose film to show the bodyís internal makeup. The level of radiation exposure from x-rays is not harmful, but the doctor will take special precautions when pregnancy is possible.

"Although patients may sometimes arrive at an appointment without x-rays, explaining that their doctor said, 'they were normal,' there is still a wealth of information to be learned from an x-ray."

Bones, tumors and other dense matter appear white or light because they absorb the radiation. Less dense soft tissues and breaks in bone let radiation pass through, making these parts look darker on the x-ray film. Sometimes, to make certain organs stand out in the picture, patients are given barium sulfate or a dye.

The image demonstrates the body structures and is called a radiograph or x-ray image. X-rays demonstrate body structures proportionally with their density. The denser the tissue, (bone versus fat) the fewer the x-rays that pass through it.

MRI

MRI is a diagnostic test that depicts both soft tissue and bone. MRI depicts soft tissue injury and abnormalities with greater sensitivity and specificity than conventional imaging techniques. Hospital for Special Surgery has expertise in high resolution MR imaging, demonstrating fine detail of articular cartilage, tendon pathology, peripheral nerve imaging, and other soft tissue structures, which are not always demonstrated on routine MR exams.

CT Scan

CT stands for Computer Tomography, a type of x-ray examination that obtains digital images of the body using a thin x-ray beam to produce a more detailed, cross-sectional image of the body.

For a more detailed explanation of various tests, visit the HSS Department of Radiology and Imaging.

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