Skip to main content

Advertisement

Log in

Magnetic resonance imaging for acute hip pain in the emergency department

  • Review Article
  • Published:
Emergency Radiology Aims and scope Submit manuscript

Abstract

MRI is an excellent imaging modality for the evaluation of acute hip pain in the ED and provides accurate diagnosis; facilitating appropriate and timely management thereby can result in decreased cost and improved prognosis in these patients. In this article, we review the use of MRI for patients presenting with acute hip pain in the Emergency Department (ED), including MRI protocols, MRI features of common acute hip pathologies, pivotal differential diagnoses, and management options.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

Similar content being viewed by others

References

  1. Khurana B, Okanobo H, Ossiani M, Ledbetter S, Al Dulaimy K, Sodickson A (2012) Abbreviated MRI for patients presenting to the emergency department with hip pain. AJR Am J Roentgenol 198(6):W581–W588. doi:10.2214/AJR.11.7258

    Article  PubMed  Google Scholar 

  2. Maj L, Gombar Y 3rd, Morrison WB (2013) MR imaging of hip infection and inflammation. Magn Reson Imaging Clin N Am 21(1):127–139. doi:10.1016/j.mric.2012.09.009

    Article  PubMed  Google Scholar 

  3. Haramati N, Staron RB, Barax C, Feldman F (1994) Magnetic resonance imaging of occult fractures of the proximal femur. Skelet Radiol 23(1):19–22

    Article  CAS  Google Scholar 

  4. Oka M, Monu JU (2004) Prevalence and patterns of occult hip fractures and mimics revealed by MRI. AJR Am J Roentgenol 182(2):283–288

    Article  PubMed  Google Scholar 

  5. Khoury NJ, Birjawi GA, Chaaya M, Hourani MH (2003) Use of limited MR protocol (coronal STIR) in the evaluation of patients with hip pain. Skelet Radiol 32(10):567–574

    Article  CAS  Google Scholar 

  6. Guanche CA, Kozin SH, Levy AS, Brody LA (1994) The use of MRI in the diagnosis of occult hip fractures in the elderly: a preliminary review. Orthopedics 17(4):327–330

    CAS  PubMed  Google Scholar 

  7. Miyanishi K, Kaminomachi S, Hara T, Maeda H, Watanabe H, Shimizu A, Torisu T (2007) A subchondral fracture in transient osteoporosis of the hip. Skelet Radiol 36(7):677–680

    Article  Google Scholar 

  8. May DA, Purins JL, Smith DK (1996) MR imaging of occult traumatic fractures and muscular injuries of the hip and pelvis in elderly patients. AJR Am J Roentgenol 166(5):1075–1088

    Article  CAS  PubMed  Google Scholar 

  9. Verbeeten KM, Hermann KL, Hasselqvist M, Lausten GS, Joergensen P, Jensen CM, Thomsen HS (2005) The advantages of MRI in the detection of occult hip fractures. Eur Radiol 15(1):165–169

    Article  PubMed  Google Scholar 

  10. Deutsch AL, Mink JH, Waxman AD (1989) Occult fractures of the proximal femur: MR imaging. Radiology 170(1 Pt 1):113–116

    Article  CAS  PubMed  Google Scholar 

  11. Hakkarinen DK, Banh KV, Hendey GW (2012) Magnetic resonance imaging identifies occult hip fractures missed by 64-slice computed tomography. J Emerg Med 43(2):303–307. doi:10.1016/j.jemermed.2012.01.037

    Article  PubMed  Google Scholar 

  12. Geijer M, Dunker D, Collin D, Göthlin JH (2012) Bone bruise, lipohemarthrosis, and joint effusion in CT of non-displaced hip fracture. Acta Radiol 53(2):197–202. doi:10.1258/ar.2011.110466

    Article  PubMed  Google Scholar 

  13. Lakshmanan P, Sharma A, Lyons K, Peehal JP (2007) Are occult fractures of the hip and pelvic ring mutually exclusive? J Bone Joint Surg (Br) 89(10):1344–1346

    Article  CAS  Google Scholar 

  14. Nachtrab O, Cassar-Pullicino VN, Lalam R, Tins B, Tyrrell PN, Singh J (2012) Role of MRI in hip fractures, including stress fractures, occult fractures, avulsion fractures. Eur J Radiol 81(12):3813–3823. doi:10.1016/j.ejrad.2011.04.003

    Article  CAS  PubMed  Google Scholar 

  15. Bui-Mansfield LT, Chew FS, Lenchik L, Kline MJ, Boles CA (2002) Nontraumatic avulsions of the pelvis. AJR Am J Roentgenol 178(2):423–427

    Article  PubMed  Google Scholar 

  16. Bogost GA, Lizerbram EK, Crues JV 3rd (1995) MR imaging in evaluation of suspected hip fracture: frequency of unsuspected bone and soft-tissue injury. Radiology 197(1):263–267

    Article  CAS  PubMed  Google Scholar 

  17. Dominguez S, Liu P, Roberts C, Mandell M, Richman PB (2005) Prevalence of traumatic hip and pelvic fractures in patients with suspected hip fracture and negative initial standard radiographs—a study of emergency department patients. Acad Emerg Med 12(4):366–369

    PubMed  Google Scholar 

  18. Cabarrus MC, Ambekar A, Lu Y, Link TM (2008) MRI and CT of insufficiency fractures of the pelvis and the proximal femur. AJR Am J Roentgenol 191(4):995–1001. doi:10.2214/AJR.07.3714

    Article  PubMed  Google Scholar 

  19. Galloway HR, Meikle GR, Despois M (2004) Patterns of injury in patients with radiographic occult fracture of neck of femur as determined by magnetic resonance imaging. Australas Radiol 48(1):21–24

    Article  PubMed  Google Scholar 

  20. Chatha H, Ullah S, Cheema Z (2011) Review article: magnetic resonance imaging and computed tomography in the diagnosis of occult proximal femur fractures. J Orthop Surg (Hong Kong) 19(1):99–103

    Google Scholar 

  21. Ohishi T, Ito T, Suzuki D, Banno T, Honda Y (2012) Occult hip and pelvic fractures and accompanying muscle injuries around the hip. Arch Orthop Trauma Surg 132(1):105–112. doi:10.1007/s00402-011-1388-0

    Article  PubMed  Google Scholar 

  22. Quinn SF, McCarthy JL (1993) Prospective evaluation of patients with suspected hip racture and indeterminate radiographs: use of T1-weighted MR images. Radiology 187(2):469–471

    Article  CAS  PubMed  Google Scholar 

  23. Hossain M, Barwick C, Sinha AK, Andrew JG (2007) Is magnetic resonance imaging (MRI) necessary to exclude occult hip fracture? Injury 38(10):1204–1208

    Article  CAS  PubMed  Google Scholar 

  24. Sheikh A, Koujok K, Sampaio ML, Schweitzer ME (2013) MR imaging of osseous lesions of the hip. Magn Reson Imaging Clin N Am 21(1):111–125. doi:10.1016/j.mric.2012.09.001

    Article  PubMed  Google Scholar 

  25. Berger PE, Ofstein RA, Jackson DW, Morrison DS, Silvino N, Amador R (1989) MRI demonstration of radiographically occult fractures: what have we been missing? Radiographics 9(3):407–436

    Article  CAS  PubMed  Google Scholar 

  26. Petchprapa CN, Bencardino JT (2013) Tendon injuries of the hip. Magn Reson Imaging Clin N Am 21(1):75–96. doi:10.1016/j.mric.2012.09.004

    Article  PubMed  Google Scholar 

  27. Bui KL, Ilaslan H, Recht M, Sundaram M (2008) Iliopsoas injury: an MRI study of patterns and prevalence correlated with clinical findings. Skelet Radiol 37(3):245–249

    Article  Google Scholar 

  28. Marshall N, Koulouris G (2009) Traumatic injuries of the hip. Magn Reson Imaging Clin N Am 17(4):681–696. doi:10.1016/j.mric.2009.06.009, vi

    Article  PubMed  Google Scholar 

  29. Goodman BS, Smith MT, Mallempati S, Nuthakki P (2013) A comparison of ultrasound and magnetic resonance imaging findings of a Morel-Lavallée lesion of the knee. PM R 5(1):70–73. doi:10.1016/j.pmrj.2012.08.001

    Article  PubMed  Google Scholar 

  30. Puig J, Pelaez I, Baños J, Balliu E, Casas M, Maroto A, Pedraza S (2006) Long-standing Morel-Lavallée lesion in the proximal thigh: ultrasound and MR findings with surgical and histopathological correlation. Australas Radiol 50(6):594–597

    Article  CAS  PubMed  Google Scholar 

  31. Mukherjee K, Perrin SM, Hughes PM (2007) Morel-Lavallee lesion in an adolescent with ultrasound and MRI correlation. Skelet Radiol 36(Suppl 1):S43–S45

    Article  Google Scholar 

  32. Yu JS, Habib P (2009) MR imaging of urgent inflammatory and infectious conditions affecting the soft tissues of the musculoskeletal system. Emerg Radiol 16(4):267–276. doi:10.1007/s10140-008-0786-2

    Article  PubMed  Google Scholar 

  33. Soldatos T, Durand DJ, Subhawong TK, Carrino JA, Chhabra A (2012) Magnetic resonance imaging of musculoskeletal infections: systematic diagnostic assessment and key points. Acad Radiol 19(11):1434–1443. doi:10.1016/j.acra.2012.05.022

    Article  PubMed  Google Scholar 

  34. Christian S, Kraas J, Conway WF (2007) Musculoskeletal infections. Semin Roentgenol 42(2):92–101

    Article  PubMed  Google Scholar 

  35. Bierry G, Huang AJ, Chang CY, Torriani M, Bredella MA (2012) MRI findings of treated bacterial septic arthritis. Skelet Radiol 41(12):1509–1516. doi:10.1007/s00256

    Article  Google Scholar 

  36. Palestro CJ, Love C, Miller TT (2006) Infection and musculoskeletal conditions: imaging of musculoskeletal infections. Best Pract Res Clin Rheumatol 20(6):1197–1218

    Article  PubMed  Google Scholar 

  37. Boutry N, Paul C, Leroy X, Fredoux D, Migaud H, Cotten A (2002) Rapidly destructive osteoarthritis of the hip: MR imaging findings. AJR Am J Roentgenol 179(3):657–663

    Article  PubMed  Google Scholar 

  38. Blankenbaker DG, Tuite MJ (2011) MR imaging of early hip joint degeneration. Magn Reson Imaging Clin N Am 19(2):365–378. doi:10.1016/j.mric.2011.02.001

    Article  PubMed  Google Scholar 

  39. Baltzer AW, Ostapczuk MS, Stosch D, Seidel F, Granrath M (2013) A new treatment for hip osteoarthritis: clinical evidence for the efficacy of autologous conditioned serum. Orthop Rev (Pavia) 5(2):59–64. doi:10.4081/or.2013.e13

    Article  Google Scholar 

  40. Bennell K (2013) Physiotherapy management of hip osteoarthritis. J Physiother 59(3):145–157. doi:10.1016/S1836-9553(13)70179-6

    Article  PubMed  Google Scholar 

  41. Stürzenbecher A, Braun J, Paris S, Biedermann T, Hamm B, Bollow M (2000) MR imaging of septic sacroiliitis. Skelet Radiol 29(8):439–446

    Article  Google Scholar 

  42. Lacout A, Rousselin B, Pelage JP (2008) CT and MRI of spine and sacroiliac involvement in spondyloarthropathy. AJR Am J Roentgenol 191(4):1016–1023. doi:10.2214/AJR.07.3446

    Article  PubMed  Google Scholar 

  43. Hermet M, Minichiello E, Flipo RM, Dubost JJ, Allanore Y, Ziza JM et al (2012) Infectious sacroiliitis: a retrospective, multicentre study of 39 adults. BMC Infect Dis 12:305. doi:10.1186/1471-2334-12-305

    Article  PubMed Central  PubMed  Google Scholar 

  44. Ehrenfeld M (2012) Spondyloarthropathies. Best Pract Res Clin Rheumatol 26(1):135–145. doi:10.1016/j.berh.2012.01.002

    Article  CAS  PubMed  Google Scholar 

  45. Turecki MB, Taljanovic MS, Stubbs AY, Graham AR, Holden DA, Hunter TB, Rogers LF (2010) Imaging of musculoskeletal soft tissue infections. Skelet Radiol 39(10):957–971. doi:10.1007/s00256-009-0780-0

    Article  Google Scholar 

  46. File TM Jr, Tan JS, DiPersio JR (1998) Group A streptococcal necrotizing fasciitis. Diagnosing and treating the “flesh-eating bacteria syndrome”. Cleve Clin J Med 65(5):241–249

    Article  PubMed  Google Scholar 

  47. Mizutani H, Ohba S, Mizutani M, Otake S, Otsuka T, Nakamura T (1994) Calcific tendinitis of the gluteus maximus tendon with cortical bone erosion: CT findings. J Comput Assist Tomogr 18(2):310–312

    Article  CAS  PubMed  Google Scholar 

  48. Siegal DS, Wu JS, Newman JS, Del Cura JL, Hochman MG (2009) Calcific tendinitis: a pictorial review. Can Assoc Radiol J 60(5):263–272. doi:10.1016/j.carj.2009.06.008

    Article  PubMed  Google Scholar 

  49. Loew M, Daecke W, Kusnierczak D, Rahmanzadeh M, Ewerbeck V (1999) Shock-wave therapy is effective for chronic calcifying tendinitis of the shoulder. J Bone Joint Surg (Br) 81(5):863–867

    Article  CAS  Google Scholar 

  50. Ouellette H, Thomas BJ, Nelson E, Torriani M (2006) MR imaging of rectus femoris origin injuries. Skelet Radiol 35(9):665–672

    Article  Google Scholar 

  51. Torres GM, Cernigliaro JG, Abbitt PL, Mergo PJ, Hellein VF, Fernandez S, Ros PR (1995) Iliopsoas compartment: normal anatomy and pathologic processes. Radiographics 15(6):1285–1297

    Article  CAS  PubMed  Google Scholar 

  52. Malizos KN, Zibis AH, Dailiana Z, Hantes M, Karachalios T, Karantanas AH (2004) MR imaging findings in transient osteoporosis of the hip. Eur J Radiol 50(3):238–244

    Article  PubMed  Google Scholar 

  53. Van Wagenen K, Pritchard P, Taylor JA (2013) Transient osteoporosis of the hip: a case report. J Can Chiropr Assoc 57(2):116–122

    PubMed Central  PubMed  Google Scholar 

  54. Siva S, Roach V (1997) Transient osteoporosis of the hip in pregnancy. Aust N Z J Obstet Gynaecol 37(3):261–266

    Article  CAS  PubMed  Google Scholar 

  55. Bloem JL (1988) Transient osteoporosis of the hip: MR imaging. Radiology 167(3):753–755

    Article  CAS  PubMed  Google Scholar 

  56. Meyers MH (1988) Osteonecrosis of the femoral head. Pathogenesis and long-term results of treatment. Clin Orthop Relat Res 231:51–61

    PubMed  Google Scholar 

  57. Kamal D, Trăistaru R, Alexandru DO, Kamal CK, Pirici D, Pop OT, Mălăescu DG (2012) Morphometric findings in avascular necrosis of the femoral head. Rom J Morphol Embryol 53(3 Suppl):763–767

    PubMed  Google Scholar 

  58. Mitchell DG, Kressel HY, Arger PH, Dalinka M, Spritzer CE, Steinberg ME (1986) Avascular necrosis of the femoral head: morphologic assessment by MR imaging, with CT correlation. Radiology 161(3):739–742

    Article  CAS  PubMed  Google Scholar 

  59. Markisz JA, Knowles RJ, Altchek DW, Schneider R, Whalen JP, Cahill PT (1987) Segmental patterns of avascular necrosis of the femoral heads: early detection with MR imaging. Radiology 162(3):717–720

    Article  CAS  PubMed  Google Scholar 

  60. Koo KH, Ahn IO, Kim R, Song HR, Jeong ST, Na JB, Kim YS, Cho SH (1999) Bone marrow edema and associated pain in early stage osteonecrosis of the femoral head: prospective study with serial MR images. Radiology 213(3):715–722

    Article  CAS  PubMed  Google Scholar 

  61. Huang GS, Chan WP, Chang YC, Chang CY, Chen CY, Yu JS (2003) MR imaging of bone marrow edema and joint effusion in patients with osteonecrosis of the femoral head: relationship to pain. AJR Am J Roentgenol 181(2):545–549

    Article  PubMed  Google Scholar 

  62. Glickstein MF, Burk DL Jr, Schiebler ML, Cohen EK, Dalinka MK, Steinberg ME, Kressel HY (1988) Avascular necrosis versus other diseases of the hip: sensitivity of MR imaging. Radiology 169(1):213–215

    Article  CAS  PubMed  Google Scholar 

  63. Vande Berg BE, Malghem JJ, Labaisse MA, Noel HM, Maldague BE (1993) MR imaging of avascular necrosis and transient marrow edema of the femoral head. Radiographics 13(3):501–520

    Article  CAS  PubMed  Google Scholar 

  64. Beltran J, Herman LJ, Burk JM, Zuelzer WA, Clark RN, Lucas JG et al (1988) Femoral head avascular necrosis: MR imaging with clinical-pathologic and radionuclide correlation. Radiology 166(1 Pt 1):215–220

    Article  CAS  PubMed  Google Scholar 

  65. Amanatullah DF, Strauss EJ, Di Cesare PE (2011) Current management options for osteonecrosis of the femoral head: part 1, diagnosis and nonoperative management. Am J Orthop (Belle Mead NJ) 40(9):E186–E192

    Google Scholar 

  66. Amanatullah DF, Strauss EJ, Di Cesare PE (2011) Current management options for osteonecrosis of the femoral head: part II, operative management. Am J Orthop (Belle Mead NJ) 40(10):E216–E225

    Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Disclosures

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sachin S Saboo.

Additional information

Sachin S Saboo, MD, FRCR and Yu-Ching Lin, MD contributed equally to this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Saboo, S.S., Lin, YC., Juan, YH. et al. Magnetic resonance imaging for acute hip pain in the emergency department. Emerg Radiol 22, 409–422 (2015). https://doi.org/10.1007/s10140-014-1293-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10140-014-1293-2

Keywords

Navigation