0:00

Okay, we're transitioning in our hip vignettes.

0:02

From sequences, which we will continue

0:06

drumming upon, to pathology and analysis.

0:10

This is a 38-year-old woman, who is a

0:14

personal trainer, who complains of pain,

0:17

and the history said, rule out any pain.

0:20

Iliofemoral ligament injury.

0:22

We are using bilateral standard

0:26

conventional sequences to start.

0:29

And in fact, this entire case uses bilateral

0:32

imaging, which affords us the ability

0:34

to compare the two sides for symmetry.

0:37

And we'll do that.

0:38

We've got an axi we have

0:39

a coronal T1 on the left.

0:41

And on the right, we've got a,

0:44

T2 with fat suppression.

0:47

Which, by the way, isn't one of

0:48

my favorite labral sequences.

0:50

Bye.

0:51

But it's adequate in this particular,

0:53

case, as you'll see in a moment.

0:57

We have previously reviewed some key areas of

1:00

terminology, and I'd like to translate these

1:03

onto an MRI in terms of the overall lines that

1:07

you might use in a conventional radiograph.

1:09

For instance, this line that comes down

1:13

would be analogous to the ilio issue

1:16

line on a conventional radiograph.

1:20

And if the head, at any point, protruded

1:23

medial to this line from back to front, then

1:26

the patient would have the condition known as

1:28

coxa profunda, and that might lead you in the

1:32

direction, not pathognomonic, but lead you

1:34

in the direction of pincer-type impingement.

1:37

On the other hand, if we come a little bit more

1:41

forward, This line right here that comes off

1:45

the acetabulum and proceeds towards the pubis

1:49

is the ileopectinial line of lesser importance.

1:55

This central area representing the center of

1:58

the acetabular cup, if you've got protrusion of

2:01

the femoral head medial to this point, in the

2:04

back or in the front or right in the center, you

2:08

might have the scenario of protrusioacetabuli.

2:13

Which might also lead you towards the diagnosis

2:17

of pincer type impingement, or too deep a cup.

2:21

We also have the acetabular roof,

2:24

which if it is too vertical, would

2:27

produce the scenario of undercoverage.

2:30

For in this case, we do have good coverage.

2:33

The roof is horizontal.

2:35

It ends right at the drop-off of the head neck

2:39

junction, for this right hip, as a demonstrator.

2:43

And so there is adequate coverage

2:45

of the acetabulum over the femur.

2:49

Despite the fact that you're going

2:50

to learn that this patient has

2:52

bilateral labral tears in a moment.

2:55

Another interesting and important descriptor

3:00

that we have not yet vignetted for you is

3:03

the phenomenon of sphericity or asphericity.

3:08

Let's take out our rudimentary drawing tools.

3:13

I'll use the color yellow

3:14

to show you a femoral head.

3:18

And then at the head neck junction, we

3:20

like to see some nice symmetric tapering.

3:25

If there is not tapering and the head

3:27

is just simply too fat, we say there

3:30

is the condition of asphericity,

3:32

or lack of a transition

3:34

between the head neck junction.

3:36

This can be rather symmetric and diffuse,

3:39

as I've drawn, or it can be rather focal,

3:43

associated with an anteriorly oriented bump.

3:47

And sometimes that bump may be accompanied

3:50

by a friction-related cyst, or an

3:52

intraosseous ganglion, which has been

3:55

misnamed in the past as a herniation pit.

3:58

This pit is nothing more than

4:00

a friction-induced ganglion.

4:02

Intraosseous ganglion.

4:05

Oh, but we're not done yet.

4:07

If we draw on one side of the screen, why

4:10

not draw on the other side of the screen?

4:14

Let's show you the complete opposite.

4:19

A head that tapers way too much.

4:23

In other words, the neck is hypoplastic.

4:27

Does that happen?

4:28

You bet it does.

4:30

In fact, it's happening right here.

4:32

Let's look at our personal trainer.

4:35

Let's go back and scroll her images.

4:37

Look at how thin her neck is.

4:40

On both sides.

4:42

Now this is extremely uncommon in men.

4:45

Far more common in women.

4:48

And the converse is absolutely true.

4:52

Diffuse, broad, thick necks

4:54

are more common in men.

4:56

And we know that diffuse, broad,

4:59

thick, symmetric necks or lack

5:01

of sphericity without a bump

5:04

is extremely common in

5:06

high-performance athletes.

5:08

And this has been analyzed in National

5:10

Football League professional quarterbacks.

5:13

They have broader necks and greater degrees

5:16

of asphericity than the average man.

5:20

So this may be a sign of an

5:22

athletic or powerful individual.

5:25

So broad necks more common in men,

5:27

especially athletic men, and very narrow,

5:30

delicate necks more common in women.

5:36

So, we're going to move on now to the next

5:39

portion of this vignette, and if you want to

5:41

forward to the next vignette, we're going to

5:43

show you bilateral labral tears in this case.