This topic contains 3 replies, has 2 voices, and was last updated by 
Christopher Stepien July 24, 2018 at 2:57 pm.
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Matthew Buffan
I have a 14 year old female with bilateral hip symptoms. Plays travel lacrosse and has been doing theater and dance since was 6. Excessive clicking reported, poor response to treatment.
SHF is maxed out at 4 digits on the left (reflex change to 3 post treatment does not hold). Deep anterior pinch. Internal Rotation provokes deep anterior pinch. Right 2 digits. anterior pinch not as intense as the left.
I have referred her and she is scheduled to see an hip specialist orthopedist. I’m not sure which imaging would be best? The MRA will show the labrum, that is what i’m thinking, yet concerned if the dye will limit the view of the joint shape.
What is the best way to proceed with imaging this case?
Adam Holen D.C.
This is from an article on pubmed: “Imaging evaluation of developmental hip dysplasia in the young adult” 2013
Conclusion: Cross-sectional imaging, including CT and MRI, afford improved detection and characterization by providing morphologic information about acetabular deficiency. MRI also allows evaluation of potential associated injuries to the articular cartilage, the labrum, and the ligamentum teres. Familiarity with the radiographic and cross-sectional imaging findings of mild hip dysplasia in the young adult may allow a timely diagnosis and implementation of treatment strategies, which may prevent or delay the development of early osteoarthritis.
Seems like MRI would be your best bet to see both labrum and joint. I would just make sure to tee-up the radiologist on what you’re suspicious of with clinical data.
Paul Nottoli
I would call the radiology center an ask what you are expecting as the diagnosis. I have had to do this before in my area and they have always been extremely helpful.
A PD (proton density) MRI also would probably show enough of the joint space and labrum.
Christopher Stepien
What data suggests labrum vs. cartilage/displasia/morphology?
Doesn’t the answer lie there?
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