It is more often performed on shoulders and knees. The physiotherapist advised Karp to see yet another orthopaedist, Andrew Wolff, who specialises in arthroscopic hip surgery, in which miniature instruments reach damaged areas through small incisions. The head of the femur becomes abnormally shaped and no longer fits seamlessly in the acetabulum, or socket, putting the hip at risk of future injury. (Right) This X-ray of an arthritic hip shows severe. Impingement occurs in adolescence, in part from repeated stress, common in ballet. (Left) In this X-ray of a normal hip, the space between the ball and socket indicates healthy cartilage. She told Karp she was probably suffering from a form of hip impingement – the failure of the ball-and-socket hip joint to move smoothly. “She used a lot of terms I didn’t understand at the time,” Karp says. When Karp replied that she had studied ballet for years and still loved dancing, she said the therapist’s response was unequivocal: “I know exactly what’s wrong with you – and our doctors can’t help you.” Inspect the soft tissues that surround the hip joint for abnormalities such as effusion, periosteal reaction, calcification or foreign bodies. The therapist asked Karp a question: Are you a dancer? Moreover, nonorthopaedic causes may also present as chronic hip pain. Chronic hip pain is difficult to diagnose as patients often present with associated chronic lumbar spine and/or knee joint pain. He saw a physician and had an x-ray of the hip area performed. Chronic hip pain is distressing to the patient as it not only impairs the daily activities of life but also affects the quality of life. The receptionist suggested that Karp see an in-house physiotherapist instead. A fifty-year-old gentleman had severe pain in the outside of his hip. This paper looks at the arthroscopic findings of patients who have had hip pain and a positive response to an intra-articular anaesthetic but have non-contributory imaging. On the day her first shot was scheduled, Karp was unable to obtain it because of a paperwork glitch. Patients with groin, hip and pelvic pain but normal findings on MRI and minimal changes on x-ray can be a diagnostic problem.

Hip pain with normal xray