Patient History
56-year-old female with snapping right hip syndrome and right hip pain
Findings
SKELETAL: Diffuse edema throughout the acetabulum and femoral head consistent with stress reaction surrounding innumerable erosions from chronic osteoarthritis although, at this time, paucity of spurs. Acetabular under coverage as an adult presentation of developmental dysplasia of the hip with labral detachment is the likely culprit. Shallow acetabular cup. Small areas of pitting at the femoral head-neck junction, right greater than left, suggests a component of pincer morphology exacerbated by a short femoral neck.
PELVIS: Remainder of the pelvic ring is uninvolved including sacroiliac joints, pubis, and contralateral hip. No pelvic mass.
JOINTS: Capsulosynovial inflammation, moderate-sized effusion, and diffuse capsular distension. Innumerable penetrating erosions with osteoedema. Cystic and non-cystic foci. Weightbearing portion of the articulation most severely affected. No collapse. Other than labral detachment, no intraarticular bodies or signs of metaplasia.
ACETABULUM/LABRUM: The entirety of the anterior superior and superior labrum are detached with the upper portion of the labrum freely floating. Tear extends at least from the anterior mid equator of the joint to the posterosuperior quadrant.
MUSCLES/TENDONS/LIGAMENTS: Ligamentum teres present. Iliofemoral ligament stretched. Transverse acetabular ligament present. Mild swelling tendinopathy and peritendinitis of the abductor mechanism. Adductors normal. Hamstrings normal. Hip flexors normal.
OTHER/SOFT TISSUE: No soft tissue masses other than swelling around the hip.
Conclusion
Class 4 chondromalacia of the weightbearing hip joint with innumerable edematous erosions and a detached labrum. Short femoral neck and shallow acetabular cup is consistent with adult presentation of developmental dysplasia of the hip and a pincer component of such.
