0:00

So here is a 38-year-old gal with repetitive

0:04

microtrauma because she's a personal

0:06

trainer who's complaining of lateral

0:08

pain, rule out iliofemoral ligament tear.

0:12

And we've got the strong, powerful

0:16

iliofemoral ligament laterally.

0:18

It's also anterior, preventing

0:21

anterior hip dislocation.

0:22

It's one of the reasons why we

0:24

almost always dislocate out the back.

0:27

And it has a firm, tight attachment

0:31

to the acetabular cortex.

0:32

There's no fluid separating

0:35

the ligament from the underlying acetabulum.

0:38

So that isn't her problem.

0:40

What is masquerading as an iliofemoral

0:43

ligament tear as we move posterior is this

0:47

mass-like, proteinaceous, water single intensity

0:51

mass that is essentially a pseudocyst.

0:55

Mucoid material surrounded by

0:57

fibrous tissue, but not lined by

0:59

synovium or cuboidal epithelium.

1:03

Now a pseudocyst can occur as a result

1:07

of a ganglion from mucoid degeneration

1:10

or degeneration of a capsule.

1:12

It can come through a labrum

1:14

as in a paralabral cyst.

1:16

It can come out of the sheath of a tendon.

1:19

When you're around a ball and socket joint and

1:23

you see proteinaceous water signal intensity

1:26

under pressure, it is almost always associated

1:30

with a labral tear, whether you see it or not.

1:35

So there's a labral tear present here.

1:36

You can bet on it.

1:39

And here it is.1 00:00:00,500 --> 00:00:04,700 So here is a 38-year-old gal with repetitive

0:04

microtrauma because she's a personal

0:06

trainer who's complaining of lateral

0:08

pain, rule out iliofemoral ligament tear.

0:12

And we've got the strong, powerful

0:16

iliofemoral ligament laterally.

0:18

It's also anterior, preventing

0:21

anterior hip dislocation.

0:22

It's one of the reasons why we

0:24

almost always dislocate out the back.

0:27

And it has a firm, tight attachment

0:31

to the acetabular cortex.

0:32

There's no fluid separating

0:35

the ligament from the underlying acetabulum.

0:38

So that isn't her problem.

0:40

What is masquerading as an iliofemoral

0:43

ligament tear as we move posterior is this

0:47

mass-like, proteinaceous, water single intensity

0:51

mass that is essentially a pseudocyst.

0:55

Mucoid material surrounded by

0:57

fibrous tissue, but not lined by

0:59

synovium or cuboidal epithelium.

1:03

Now a pseudocyst can occur as a result

1:07

of a ganglion from mucoid degeneration

1:10

or degeneration of a capsule.

1:12

It can come through a labrum

1:14

as in a paralabral cyst.

1:16

It can come out of the sheath of a tendon.

1:19

When you're around a ball and socket joint and

1:23

you see proteinaceous water signal intensity

1:26

under pressure, it is almost always associated

1:30

with a labral tear, whether you see it or not.

1:35

So there's a labral tear present here.

1:36

You can bet on it.

1:39

And here it is.

1:40

Let's go to our water-weighted image and scroll.

1:44

And when we do, we see a hyperintense

1:47

signal running vertically, way too deep,

1:51

and longitudinally, and one on the opposite

1:54

side that happens to be asymptomatic.

1:57

Which, by the way, is not an uncommon event.

1:59

In an overuse athlete.

2:01

The reason the one on the right is

2:03

symptomatic is because of the large

2:05

paralabral cyst associated with it.

2:08

Now she'll probably develop a cyst on the

2:10

opposite side because you can see a little

2:13

bit of inflammation and a little bit of

2:15

synovial fluid that has extended outside

2:18

the labrum and is running along the side.

2:20

It's just not under pressure yet.

2:24

If you look at the image.

2:27

It's very hard to identify a nice dark

2:30

labrum, but this wouldn't be the sequence

2:33

that you would search for a labral tear on.

2:36

You would be more interested in the overall

2:38

morphology of the head and the neck,

2:40

which, by the way, is over-tapered, and the

2:42

configuration of the acetabulum and the roof.

2:46

Relative to the head.

2:47

So, this is an individual with bilateral labral

2:51

tears, symptomatic on the right, masquerading

2:54

clinically as an iliofemoral ligament injury,

2:58

and in the axial projection, we do see not

3:01

just one cyst, but actually another smaller

3:04

cyst anteriorly on the right, and maybe even

3:06

a little tiny one starting to brew on the left

3:10

as a manifestation of this patient's bilateral

3:13

labral tears, but the labral tears themselves

3:15

were only seen in the coronal projection.

3:18

Let's take on another case, shall we?