Hip Pain in Ajax: What a Hip X-Ray Can Show

Point to where your hip hurts. If your hand went to the front of your groin, the outside of your upper thigh, or the back of your pelvis just above the buttock, you are in good company, because people mean all three when they say “my hip.” Only one of those spots sits directly over the hip joint itself. The other two can be the hip, but they can just as easily be a tendon, a fluid-filled sac, the lower back or something else entirely.

That is why a hip X-ray is often one of the first tests a health-care provider orders, and also why it does not always give a complete answer. It is very good at some questions and quiet on others. This article walks through what the images can and cannot show, how the views are usually taken, and what patients from Ajax, Pickering, Whitby and nearby communities can expect when they come in.

Where hip pain tends to come from

Before thinking about any test, it helps to understand how the area is built. The hip is a ball-and-socket joint. The ball is the rounded head at the top of the thigh bone (the femur), and the socket is a cup in the pelvis called the acetabulum. Cartilage lines both surfaces, and a rim of tougher tissue called the labrum deepens the socket. Around all of this are strong ligaments, large muscles and their tendons, and several bursae, which are small cushions of fluid that help tissues glide.

Pain in different places often points a provider toward different structures:

• Front of the hip and groin. This is the classic location for problems inside the joint, such as wear of the cartilage or irritation of the labrum. Groin pain can also come from a hernia or from muscles that attach near the pubic bone.
• Outer hip, over the bony bump at the side of the thigh. Pain here is frequently related to the tendons of the buttock muscles or to an irritated bursa, rather than to the joint itself.
• Back of the pelvis and buttock. This area often reflects the lower spine or the sacroiliac joints where the spine meets the pelvis. Pain can travel from the back into the buttock and down the leg.

None of this is a rule, and a provider will combine where you hurt with how it started, what makes it worse, and what they find on examination. But it explains why an X-ray of the hip is sometimes requested alongside, or instead of, an X-ray of the lower back. If back pain is part of your picture, our post on back pain and X-ray covers that side.

How a hip X-ray is usually taken

A hip X-ray is a short exam. Most people are in and out of the X-ray room within a few minutes, although positioning can take a little longer if moving is painful.

You will usually lie on your back on the X-ray table. The first view is often a front-to-back picture of the whole pelvis, which shows both hips side by side. Seeing both is useful because the radiologist can compare the painful side with the other one, and because some problems that feel like hip pain show up elsewhere in the pelvis.

A second view of the painful hip is commonly added. One frequently used position has you bend the knee and let it fall gently outward, a bit like a frog’s leg, which shows the top of the femur from a different angle. Other side views are possible depending on what your provider is asking. In some cases, a standing view may be requested so the joint can be seen while carrying your weight.

The technologist will guide you through each position and may use foam pads to support you. If a position hurts, say so. There is often another way to get a useful picture.

What the images can show

X-ray is at its best when the question is about bone: its shape, its outline, its density and how two bones sit in relation to one another. For the hip, that covers a fair amount of ground.

Wear-and-tear changes in the joint

Osteoarthritis is one of the most common reasons adults have a hip X-ray. Because cartilage does not show on X-ray, the radiologist looks for indirect signs, such as narrowing of the gap between ball and socket and small spurs at the joint edges. We explain those features in detail in our article on arthritis imaging, so we will not repeat them here. The short version for the hip is that these changes help your provider understand how the joint has been affected over time, and a baseline image is useful for comparison later.

Fractures

A fall onto the side, especially in an older adult, raises the question of a broken hip. Most of these fractures happen at the top of the femur, just below the ball. Many are clearly visible on X-ray. A small number are subtle at first and may not show on the first images, which is why a provider may arrange further imaging if pain continues and suspicion remains.

Stress fractures, which build up from repeated load rather than one injury, can also affect the hip and pelvis, particularly in runners. Early stress fractures are often invisible on plain X-ray. Our post on running injuries and stress fractures explains why.

The shape of the ball and socket

In younger and middle-aged adults, especially active ones, a provider may be interested in the shape of the joint rather than signs of wear. Some people have a socket that is shallower than usual, a pattern called hip dysplasia. Others have extra bone on the ball or on the rim of the socket that can cause the two to pinch together at the end of movement, a pattern often referred to as femoroacetabular impingement. X-ray can show these shapes and allow certain angles to be measured, which is helpful when deciding whether more detailed imaging or a specialist opinion is worthwhile.

Changes in the bone itself

Occasionally an X-ray shows changes in the texture or outline of the femoral head, areas of unusual density, or calcium deposits in tissues near the joint. These findings are described in the report, and your provider will decide what they mean in the context of your symptoms and health history.

After a hip replacement

If you have had a hip replacement or another hip operation, X-ray is the usual way to check the position of the implant and the bone around it. Follow-up images are often compared with earlier ones, so it helps if previous images are available. Let the technologist know about any surgery when you check in.

What a hip X-ray will not answer

The flip side of being so good at bone is that X-ray shows soft tissue poorly. Several common causes of hip pain leave little or no trace on a plain film.

• Tendon problems and bursitis on the outside of the hip. These are among the most common reasons for pain at the side of the hip, and the X-ray is frequently normal. Ultrasound can look at these tendons and bursae directly, and our page on ultrasound services describes the musculoskeletal scans offered.
• Labral tears. The labrum does not show on X-ray. If a tear is suspected, a provider may consider other imaging, often after reviewing the X-ray for joint shape.
• Early inflammation. Some inflammatory conditions affect the joint lining for a while before they change the bone.
• Hernias and other groin causes. These are usually assessed with examination and, when needed, ultrasound.

A report that says the hip looks normal is therefore genuinely useful information. It may rule out a fracture or significant arthritis and steer your provider toward the soft tissues instead. It does not mean your pain is imagined.

Red flags that should not wait for an appointment

A community imaging clinic is not the right place for an emergency. Call 911 or go to the nearest emergency department if:

• you have fallen and cannot stand, cannot put weight on the leg, or the leg looks shorter or turned outward
• an older person has fallen and is in severe pain, even if they managed to get up
• the hip is hot, swollen and very painful, especially with fever or feeling unwell
• you have new weakness or numbness in the leg, or loss of bladder or bowel control

For a fall that is less dramatic but still worrying, our article on what to do in the minutes after a fall offers some practical guidance.

Getting ready for your visit

A hip X-ray needs very little preparation, but a few small things make it smoother.

1. Dress for it. Track pants or leggings without zippers, studs or metal buttons near the hips are ideal. Belts, phones and keys in pockets will need to come out. You may be offered a gown.
2. Tell the technologist if you might be pregnant. The pelvis sits close to the uterus, so this matters more for hip and pelvic images than for, say, a hand. The technologist will talk with you about how to proceed.
3. Mention metal and surgery. Implants, screws or a previous hip replacement are not a problem, but knowing about them helps.
4. Bring your health card and any paperwork from your provider. If you are not sure whether you need a requisition, call the clinic to confirm before you come.
5. Plan for comfort. If getting on and off a table is hard, let the front desk know. The clinic is on the ground floor and has free parking close to the entrance.

Questions to take back to your provider

When the report comes back, these questions can help you make sense of it together:

• Does the X-ray explain the pain I am having, or does it point somewhere else?
• Is what the report describes typical for someone my age?
• Is there anything about the shape of my hip joint that matters for the activities I enjoy?
• Would ultrasound or another test add useful information?
• Will repeat images be helpful in the future, and when?

Decisions about exercise, physiotherapy, medication or referral to a specialist are medical choices that depend on your whole picture. Your provider is the right person to guide them.

Hip X-ray at our Ajax clinic

Rossland Diagnostic Clinic offers walk-in digital X-ray at Unit 102, 300 Rossland Road East in Ajax, Monday to Friday from 9:00am to 5:00pm and Saturday from 8:00am to 3:30pm. Walk-in X-ray can close early when the day’s capacity is reached, so calling ahead for live availability saves a wasted trip. A report is sent to your provider, the ordering physician is alerted to any urgent finding, and images can be provided on CD when needed. More details are on our X-ray service page.

If you have questions about your hip X-ray or want to check whether today is a good day to come in, call us at 905-426-3111. For booked exams such as ultrasound, you can also request an appointment online.