Diagnostic Approach for Left Hip Pain

Standard Radiographic Protocol

The American College of Radiology recommends radiography as the initial imaging modality for left hip pain, including an anteroposterior (AP) view of the pelvis and a cross-table lateral view of the affected hip 1, 2, 3, 4
The initial imaging should include an AP view of the pelvis with approximately 15 degrees of internal hip rotation, and a cross-table lateral view of the symptomatic left hip, which is preferred over frog-leg lateral due to lower risk of fracture displacement in trauma cases 3, 4
The pelvis view allows comparison with the contralateral asymptomatic side, which is crucial for accurate diagnosis 5, 6

For acute traumatic hip pain, radiography is the initial imaging modality of choice and can be performed portably in the trauma bay, reducing morbidity associated with acute hip fracture and/or dislocation by enabling prompt treatment 3, 4
Delays in diagnosis are associated with increased costs, complication rates, hospital length-of-stay, and mortality 3, 6
For chronic hip pain, radiographs should be obtained first in most, if not all, cases and provide specific information for common disorders such as arthritis or less common disorders such as primary bone tumors 1, 2, 7

Radiography serves as an excellent screening tool that guides selection of additional imaging techniques when needed, and is fast to obtain and provides essential baseline information regardless of whether they are normal or abnormal 1, 2, 3, 4, 7
The American College of Radiology emphasizes the importance of radiographs in the initial evaluation of hip pain 1, 2, 3, 4

If fracture is still suspected after negative or equivocal radiographs, MRI without IV contrast is the recommended next imaging study, with near 100% sensitivity for proximal femoral fracture detection 5, 6
If chronic pain with negative radiographs, MRI without IV contrast should generally be the first imaging technique used after radiographs for detecting osseous and soft tissue abnormalities 1, 2, 7

Imaging should never be used in isolation, but must be combined with the patient's symptoms and clinical signs 8, 9
Never rely solely on hip radiographs without including pelvis views, as this may miss associated pelvic fractures that can alter treatment decisions 5, 6
Never make a diagnosis based on imaging alone—diagnosis requires integration of symptoms, clinical signs, and imaging findings 8, 9