Patient History
Chronic right hip pain
Findings
SKELETAL: Generalized marrow pallor in keeping with bone demineralization, osteopenia or osteoporosis.
Multifocal patchy areas of moderate confluent reactive osteoedema surrounding microtrabecular insufficiency fractures involving the right femoral head weight-bearing surface, the femoral neck and the anterior acetabular column.
PELVIS: Unremarkable pelvic basin contents.
JOINTS: Mild right hip joint osteoarthrosis.
Full-thickness chondral plate delamination involving the weight-bearing surfaces of the femoral head and acetabulum; nondisplaced multifocal areas of penetrating chondral fissures and erosions.
Moderate joint effusion with reactive synovitis and internal debris.
ACETABULUM/LABRUM: Penetrating chondromalacia and subchondral arthropathic cyst formation at the anterior acetabular column.
Saucerized, chronically torn and mildly displaced carpet-like tear of the superior labrum extending posterior to anterior. No paralabral cysts.
MUSCLES/TENDONS/LIGAMENTS: Mildly inflamed ligamentum teres.
The ischiofemoral, iliofemoral and transverse ligaments are intact.
The iliopsoas, pectineus, adductor longus, adductor brevis, adductor magnus, quadratus femoris, obturator internus and externus, superior and inferior gemellus, hamstrings, gluteus, sartorius, tensor fascia lata and rectus femoris are intact.
OTHER/SOFT TISSUE: Normal sciatic nerves and neurovascular bundles. No space-occupying lesions or nerve compression. No secondary signs of denervation.
Impressions
1. Advanced generalized chondromalacia of the right hip with multifocal areas of penetrating chondral erosions and fissures with subchondral microtrabecular insufficiency fractures surrounded by moderate confluent osteoedema located at the femoral head weight-bearing surface, the femoral neck and the anterior aspect of the acetabular column with formation of subchondral arthropathic cysts.
2. Generalized marrow pallor in keeping with bone demineralization, osteopenia or osteoporosis.
3. Carpet-like, saucerized, mildly displaced tear of the superior labrum extending posterior to anterior; no paralabral cysts.
4. Moderate reactive joint effusion with synovitis, internal debris and periarticular soft tissue swelling.
5. Low-grade sprain of the ligamentum teres.
6. Femoral neck shape suggests prior femoroplasty.
