From the Guidelines
The presence of a focal tear in the anterosuperior labrum is likely the source of hip symptoms, while the bone island in the proximal left ischium is a benign finding that requires no treatment. The MRI of your left hip shows two findings. First, there is a focal tear in the anterosuperior labrum, which means there's damage to the ring of cartilage (labrum) that surrounds the socket part of your hip joint, specifically in the front and upper portion. This type of tear can cause pain, catching sensations, or clicking in the hip, particularly with certain movements. According to the American College of Radiology Appropriateness Criteria 1, MRI hip without IV contrast is appropriate in patients with chronic hip pain when radiographs are negative, equivocal, or nondiagnostic and a labral tear is suspected. Second, there is a bone island in the proximal left ischium, which is a benign (non-cancerous) area of compact bone within normal bone. Bone islands are typically incidental findings that require no treatment and cause no symptoms. They're considered normal variants. Some key points to consider in the management of chronic hip pain include:
- Radiographs of the pelvis and hip should be the first test ordered for the evaluation of patients with chronic hip pain 1.
- MRI hip without IV contrast is appropriate in patients with chronic hip pain when radiographs are negative, equivocal, or nondiagnostic and there is a suspicion for an extra-articular noninfectious soft tissue abnormality such as tendonitis 1.
- Treatment for the labral tear might include rest, physical therapy, anti-inflammatory medications, or in some cases, surgical repair, depending on your symptoms and functional limitations. You should discuss these findings with your doctor to determine the appropriate next steps based on your specific situation and symptoms.
From the Research
Significance of MRI Findings
The MRI of the left hip without contrast revealing a focal tear of the anterosuperior labrum and a bone island of the proximal left ischium is significant because it indicates a potential injury to the hip joint.
- A focal tear of the anterosuperior labrum may be similar to a SLAP (Superior Labrum, Anterior and Posterior) lesion in the shoulder, as described in 2.
- The anterosuperior labrum is a critical structure in the hip joint, and a tear in this area can cause hip pain and impaired function, as noted in 2.
- A bone island of the proximal left ischium is a benign lesion, but it can be associated with other hip injuries or conditions, as described in various orthopedic studies.
Comparison to SLAP Lesions
The findings of the MRI can be compared to SLAP lesions in the shoulder, which are well-studied in the medical literature.
- SLAP lesions are characterized by tears of the superior labrum, and can be classified into different types based on the extent of the tear, as described in 3.
- The diagnosis and treatment of SLAP lesions have been evolving, and non-operative rehabilitation programs have been shown to be effective in some cases, as noted in 4.
- The use of MRI and MR arthrography has been studied for the diagnosis of SLAP lesions, and direct MR arthrography has been shown to be more accurate than non-enhanced MR imaging, as described in 5.
Clinical Implications
The clinical implications of the MRI findings are important to consider.
- A focal tear of the anterosuperior labrum may require further diagnostic work-up, such as arthroscopy, to confirm the diagnosis and assess the extent of the injury, as recommended in 2.
- The presence of a bone island of the proximal left ischium may not require treatment, but it should be monitored for any changes or associated symptoms, as described in various orthopedic studies.
- The patient's symptoms and medical history should be taken into account when interpreting the MRI findings and developing a treatment plan, as noted in 6.