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Pediatric hip pain may be caused by a variety of pathology, many of which are uniquely related to the anatomy of the immature skeletal system. Diagnosis of a specific etiology can sometimes be difficult given overlapping clinical presentation and potential barriers in communication in young children. Imaging is usually required in conjunction with clinical findings for diagnosis. In this article, we review imaging features of common sources of pediatric hip pain with a focus on ultrasound and radiography. • Pediatric hip pathology can be a diagnostic challenge. • Clinical features in tandem with imaging are integral in diagnosis. • Pediatric hip pathology can be identified with specific features on imaging. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to determine whether physical examinations (flexion–abduction–external rotation [FABER], impingement, range-of-motion profiles) could be used to detect the bony abnormalities of femoroacetabular impingement (FAI) in an athletic population. Methods: We performed a prospective study of 65 male collegiate football players. Both hips were evaluated by 2 orthopaedic surgeons for radiographic signs of FAI. The alpha angle and head-neck offset were measured on frog-leg lateral films. The center-edge angle, acetabular index, crossover sign, and alpha angle were measured on anteroposterior films. Measurements were averaged for both observers. Maximum hip range of motion in flexion (supine) and internal/external rotation (supine, sitting, and prone) was measured with a goniometer. Pain provoked by the impingement and FABER tests was also recorded. Examinations were completed at 2 of 4 stations (2 duplicates), each staffed by 2 clinicians (1 examined and 1 measured). The relation between each range-of-motion and radiographic measure was determined. Data from each station were assessed separately. Only those regressions significant (P < .05) for paired stations were considered clinically significant. Results: The alpha angle and head-neck offset measured on the frog-leg lateral films were significantly correlated (all P < .01) to supine, sitting, and prone internal rotation for all stations. Correlation coefficients ranged from −0.59 to −0.35 for alpha angle and 0.42 to 0.57 for head-neck offset. Although 95% of the hips had at least 1 radiographic sign of FAI, pain was reported in only 8.5% and 2.3% during the impingement and FABER tests, respectively. Conclusions: Internal rotation correlates to radiographic measures of cam FAI in this cohort of collegiate football players. Football players with diminished internal rotation in whom hip pain develops should be evaluated for underlying cam FAI abnormalities. Level of Evidence: Level IV, therapeutic case series. [Copyright &y& Elsevier]

Abstract: Objective: The purpose of this study is to examine the inter- and intraexaminer reliability of determining the prevalence of vertebral artery hypoplasia on magnetic resonance imaging (MRI) as well as the reliability of assigning a severity grading of mild, moderate, or marked hypoplasia. Methods: Two chiropractic radiologists independently evaluated the MR images of 131 adult patients retrospectively for visual vertebral artery hypoplasia. Severity of hypoplastic was graded. The side of hypoplasia and sex of the patient were recorded. The process was repeated after 1 month. Descriptive statistics were calculated for prevalence, severity, and sex distribution of hypoplasia. The κ statistic was calculated for the reliability of detecting and grading the hypoplasia. Results: Interexaminer reliability was substantial for both readings (κ = 0.68, 83% agreement for the first reading; κ = 0.75, 86% agreement for the second reading). Interexaminer reliability for grading the severity of asymmetry was substantial (κ = 0.73, 83% agreement for the first read; κ = 0.69, 81% agreement for the second reading). Intraexaminer reliability readings provided a κ of 0.71 (substantial) and 83% agreement for examiner 1. Examiner 2 had a κ of 0.85 (almost perfect) with 92% agreement. Overall, 57 (43.5%) of the 131 patients demonstrated hypoplasia. Hypoplasia was more common in women (49%) than men (35.8%). Seven arteries demonstrated severe hypoplasia. Six of these 7 patients were women. Conclusions: Vertebral artery hypoplasia is common and can be reliably diagnosed and categorized on cervical MRI scans. Vertebral artery hypoplasia was more common in women than men in this group of patients. [Copyright &y& Elsevier]

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