Diagnostic Approach to Right Anterior Hip Pain with Locking

Initial Diagnostic Workup

The American College of Radiology recommends starting with plain radiographs, including AP pelvis and frog-leg lateral views, to identify cam or pincer morphology, loose bodies, osteoarthritis, or acetabular dysplasia in patients with hip pain and mechanical symptoms like locking 1, 2
Look specifically for cam deformity at the femoral head-neck junction, pincer lesions with acetabular overcoverage, joint space narrowing, and any calcified loose bodies on plain radiographs 1, 3

The American College of Radiology suggests proceeding directly to MR arthrography if radiographs are negative or equivocal, as it is superior for detecting labral tears and has a high appropriateness rating of 9/9 2, 4
MR arthrography uses intra-articular dilute gadolinium and is the established gold standard for diagnosing acetabular labral tears, with a higher sensitivity than standard MRI 2, 3

The American Academy of Orthopaedic Surgeons recommends beginning physical therapy and oral NSAIDs while awaiting imaging results, as these have strong evidence for symptomatic hip pathology 6, 3
Oral NSAIDs should be used when not contraindicated, with high quality evidence and a strong recommendation from the American Academy of Orthopaedic Surgeons 6

Consider image-guided intra-articular corticosteroid injection if the pain source is unclear or if concurrent low back/pelvic pathology exists, with a moderate recommendation and high quality evidence from the American Academy of Orthopaedic Surgeons 5, 7, 6
Intra-articular corticosteroids could be considered for symptomatic relief, with high quality evidence and a moderate recommendation from the American Academy of Orthopaedic Surgeons 5, 7, 6

The American College of Radiology advises against skipping plain radiographs and proceeding directly to MRI, as this may miss important bony pathology 1, 2, 3
Always include AP pelvis view to assess bilateral hip morphology and pelvic alignment, and screen for lumbar spine and sacroiliac pathology with directed examination 1, 2, 3