The right hip pain diagnosis is essential to obtaining the right care. Specialization and unmatched experience are the hallmarks of the Hip Preservation Service medical staff. The advanced hip pain tests available at HSS assist our specialists in making the right diagnosis and pursuing the right treatment. Both a physical examination and radiological examinations are conducted to diagnose hip joint pain. 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 Hip Preservation Service help patients and families understand their hip pain and all of the treatment options available.
During the physical examination, performed by a Service physician, a patient’s gait, or the way a patient walks, will be evaluated. Next, the range of motion of a patient’s hip will be examined to learn whether the problem causing hip pain 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 patient’s hips, look for leg length discrepancies, test muscle strength in the hip, and test range of motion in the back.
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.
Although patients may have undergone tests prior to arriving at HSS, additional tests using the our advanced equipment may reveal conditions or problems previously unseen. The HSS Radiology & Imaging group 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 MRI, Computed Tomography (CT) and Ultrasound, of which approximately 132,500 are conventional radiography (X-ray) and interventional procedures.
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 body’s 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 Computed 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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