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I-test: a 34-year-old female with hip pain and remote trauma
  1. S B S Wong1,
  2. C Yong-Hing2,
  3. T L C Lee2,
  4. J E Taunton3,
  5. G T Andrews2,
  6. B B Forster2
  1. 1Singapore General Hospital, Singapore
  2. 2The University of British Columbia Hospital, Vancouver, British Columbia, Canada
  3. 3Allan McGavin Sports Medicine Centre, The University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to B B Forster, Department of Radiology, Vancouver General and The University of British Columbia Hospitals, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada; bruce.forster{at}vch.ca

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Case

A 34-year-old former national gymnast presented to the regional Sports Medicine Centre with a chronic history of intermittent right low back pain, quiescent after physiotherapy. During the appointment, she revealed an ongoing history of right hip discomfort, with clicking and popping, worse during cycling. She had a cycling accident a month earlier, falling onto her right side, with extensive bruising on her right thigh laterally still present during the appointment. She denied any sensory changes and had self-medicated with Naprosyn.

On examination, no pelvic tilt or limb length discrepancy was seen. She had mild soft tissue swelling over the lateral aspect of the right hip joint but no bruising. Lumbar spine range of motion was good, with no slump or pain on straight leg raises and negative bowstring and femoral stretch signs. No sensory abnormality was elicited.

She had weak right hip joint abduction, normal hip flexion power and pain during forced flexion–abduction and internal rotation of the hip. Her right hip was more internally rotated than the left side.

A set of exercises to strengthen her right hip abduction and to maintain her core strength, low back strength and flexibility was prescribed. An MR hip arthrography, to rule out a labral tear, was performed (figures 1–3).

Figure 1

Coronal T1W fat saturation images from the MR hip arthrography. Note the homogeneous hypointense signal fluid collection in-between the subdermal fat layer and the iliotibial band aponeurosis. Hip joint intra-articular contrast medium is from the arthrography.

Figure 2

Coronal T2W fat saturation images from the MR hip arthrography show a heterogeneous hyperintense fluid collection with multiple internal septations and a hypointense capsule of variable thickness.

Figure 3

Coronal T2W fat saturation images from the MR hip arthrography, at a more …

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