Imaging of the Hip in Athletes

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SUMMARYHip pain in the athlete may present with confusing clinical symptoms that do not reflect a specific soft tissue or osseous injury. While plain radiographs are recommended as the initial diagnostic imaging test, they are relatively insensitive to many of the more common injuries, including stress fracture. Bone scintigraphy may be helpful in disclosing multiple sites of osseous injury, but it is limited by poor soft tissue contrast and specificity. Magnetic resonance (MR) imaging has supplanted traditional imaging tests as the most comprehensive assessment of the cause of hip pain in the athlete, including stress fractures or reaction, muscle injuries, and subtle labral and cartilage injuries. In addition to traditional orthopedic causes for hip pain, certain nonorthopedic causes should be considered, including hernia formation and nerve entrapment syndromes. Musculoskeletal ultrasound, given its ability to actively load muscle–tendon units, may be efficacious in detecting dynamic tendinopathy and occult hernia formation.

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