Hip pain is a common complaint. Healthcare providers often use medical imaging to identify its cause, and an X-ray is frequently among the first diagnostic tools. This non-invasive procedure creates images of the hip joints and pelvic bones using small beams of radiation. X-rays provide insights into bone structures, aiding in the diagnosis of many conditions.
What an X-ray Reveals
A hip X-ray provides a clear view of bones and joint spaces, identifying many bone-related issues causing hip pain. Fractures, such as those from trauma or osteoporosis, are visible as breaks or cracks. X-rays can also show dislocated hip joints, where the thigh bone is displaced from its socket.
Arthritis, particularly osteoarthritis, is a frequent finding on hip X-rays. Signs include narrowing of the joint space, which indicates cartilage wear, and bone spurs (osteophytes) forming around the joint. Other indicators are subchondral sclerosis (hardening of bone beneath cartilage) and subchondral cysts (fluid-filled sacs within bone). These changes help determine the severity of the condition.
X-rays can also detect structural abnormalities that contribute to hip pain. Femoroacetabular impingement (FAI), a condition where abnormal contact between the femoral head and the acetabulum causes damage, can be identified by unusual bone shapes or excess bone growth. Hip dysplasia, a developmental condition where the hip socket is abnormally shallow, can be assessed through skeletal alignment.
X-rays are useful in the initial detection of bone tumors and infections, such as osteomyelitis. While these images may show abnormal bone growth, bone destruction, or changes in bone density, further imaging like MRI or CT scans often become necessary for a definitive diagnosis and to assess the full extent of the condition. X-rays serve as a screening tool, guiding more detailed investigations when needed.
What an X-ray Does Not Show
While X-rays excel at imaging bone structures, they have limitations in visualizing soft tissues. Conditions involving muscles, ligaments, tendons, and bursae are generally not directly visible on standard X-ray images. For instance, muscle strains or tears, such as those affecting the hip flexors or groin, cannot be diagnosed by an X-ray alone.
Ligament injuries and labral tears, which involve the cartilage rim around the hip socket, are not typically seen on X-rays. Although X-rays might show underlying bone abnormalities that predispose to labral tears, the tears themselves require more advanced imaging like an MRI for clear visualization.
Tendonitis or tendinopathy, characterized by inflammation or degeneration of tendons around the hip, also fall outside the scope of X-ray detection. Conditions like gluteal tendinopathy or iliopsoas tendinopathy, which cause pain due to tendon issues, do not manifest as changes on X-ray images. Bursitis, such as trochanteric bursitis (hip bursitis) or iliopsoas bursitis, involves inflammation of fluid-filled sacs cushioning joints, and while an X-ray can rule out bone issues that mimic bursitis, it does not directly show the inflamed bursa.
Nerve impingement, like sciatica or meralgia paresthetica, which involve compressed nerves, cannot be diagnosed via X-ray, as these images do not show nerve tissue. For these soft tissue and nerve-related conditions, healthcare providers often rely on a physical examination, patient history, and other imaging modalities such as MRI or ultrasound, which are specifically designed to capture detailed images of non-bony structures.
The X-ray Process and Next Steps
A hip X-ray is a relatively quick and straightforward procedure, typically performed by a radiologic technologist. During the examination, you will be positioned on an X-ray table, and the technologist will adjust your hip to capture images from different angles. It is important to remain still during the brief moments the images are taken to ensure clarity.
After the images are acquired, a radiologist, who is a medical doctor with specialized training in interpreting medical images, will analyze them. The radiologist examines the X-ray for any abnormalities, fractures, or signs of disease, then compiles a report of their findings. This report is then sent to your referring healthcare provider.
Your healthcare provider will discuss the X-ray results with you, explaining the findings in the context of your symptoms and medical history. This discussion is crucial for understanding the diagnosis and planning the next steps in your care. Depending on the findings, these next steps might include further diagnostic tests, such as an MRI for soft tissue assessment, or a referral to a specialist.
Treatment recommendations will be tailored to the diagnosis, potentially involving physical therapy, medication, or in some cases, surgical consultation. The X-ray serves as an initial step in diagnosing hip pain, providing information that guides subsequent management.