It allows analyzing the most anterior and posterior aspects of the joint space that are not depicted on the AP and the other lateral radiographs, at the expense of a decrease in the overall quality of the image. The off-lateral view (also called false profile of Lequesne) is a unique radiograph that provides an evaluation of the hip joint in a near sagittal plane, with the femur in an anatomic position ( Fig. 4 ). Most of the lateral radiographs are obtained with different degrees of hip abduction and flexion providing a lateral view of the proximal femur. Several different lateral views of the hip can be obtained, the choice of which may depend on the clinical situation ( Fig. 3, Table 1 ). In the authors’ institution, an AP hip radiograph usually is obtained because of the high quality of the bony details secondary to beam collimation. The added value of an AP hip radiograph to complement pelvic radiograph is open to debate except after total hip replacement. Standing hip radiograph does not provide additional information on the joint space except in severe hip dysplasias, opposite to the knee joint, for which proper assessment of the joint space width requires weight-bearing radiographs. When obtained in a standing position, it enables detecting leg length discrepancy but provides a less satisfactory analysis of the bone structure. The AP pelvic radiograph should be obtained with the patient lying supine, the lower limbs medially rotated (20 degrees). Moreover, by allowing the comparative analysis of both hips, it enhances the detection of subtle bone and joint abnormalities. The pelvic radiograph allows the assessment of the entire pelvic girdle, providing an overview of the entire region. doi:10.1148/rg.Radiological work-up of the hip includes an anteroposterior (AP) radiograph of the pelvis and a lateral radiograph of the symptomatic hip. Imaging of the Pubic Symphysis: Anatomy and Pathologic Conditions. MRI Diagnosis of Subpubic Cartilaginous Cyst. Athletic Pubalgia and 'Sports Hernia': Optimal MR Imaging Technique and Findings.

Atlas of Normal Roentgen Variants That May Simulate Disease E-Book. The Adult Human Pubic Symphysis: A Systematic Review. Diseases of the Pubis and Pubic Symphysis: MR Imaging Appearances. Supplied by branches of the pudendal and/or genitofemoral and/or iliohypogastric/ ilioinguinal nerves 2Ĭongenital widening of the pubic symphysis (rare) 5ĭue to anteriorly-situated secondary ossification centers may appear 'V-shaped' in adolescents on axial slices but will normally be parallel in adults 1 Mainly supplied by branches of obturator and inferior epigastric arteries 2 Normally very little movement: up to 2 mm shift and 1° rotation 2. Proximal ends of the penile/clitoral shaftsīladder (separated from the pubic symphysis by the retropubic fat pad) Remaining thigh adductor muscles (adductor magnus, pectineus, gracilis) 7 Remaining anterior abdominal wall muscles (internal oblique, transversus abdominis) 7 Other ligaments which attach to the pubic symphysis include:Īdductor longus, adductor brevis and rectus abdominis muscles attach to the anterior pubic ligament and interpubic disc 2Įxternal oblique aponeurosis also reinforces the pubic symphysis anteriorly 3 Posterior pubic ligament: blends with periosteum of both pubic bodies posteriorly Inferior pubic (or subpubic or arcuate) ligament: runs from right to left inferior pubic ramusĪnterior pubic ligament: blends with periosteum laterally as well as the interpubic disc Superior pubic ligament: runs from pubic crest to pubic crest The pubic symphysis is reinforced by four strong ligaments 2,3: The width of the joint space differs at different ages:įor physiological reasons, women have a greater thickness of the fibrocartilaginous disc, allowing more mobility of the pelvic bones and thereby providing a larger pelvic diameter needed for childbirth. The pubic symphysis is a secondary cartilaginous joint, which means there is a wedge-shaped fibrocartilaginous interpubic disc situated between two layers of hyaline cartilage, which line the oval-shaped medial articular surfaces of the pubic bones 1,2.

Normal femail hip xray