this is part 2 of the hip imaging in athletes series if you haven't watched part 1 make sure to click this link here and come back to this afterwards this is a nice example of a cam deformity secondary to a slipped capital femoral epiphysis as you can see that epiphysis is tilted medially and a little bit downwards and as a result you have this flattening here of the femoral head neck junction and this is one of the theologies for cam deformities actually although it doesn't really matter if you have an adult patient we've come to form a deal what the reason actually was but it's nice to have that in mind anyways because in the end the treatment is the same they also they get the surgery here and then it's done this is a nice example of a patient with a issue of femoral impingement which is one of the extra-articular hip impingement as opposed to the femoral acetabular impingement and you can see here on the right hand side that there is this edema in the quadratus femoris muscle as a result of a chronic contact or force here between the femoral bone and the facial bone here you can do some measurements if you want and there was a meta-analysis i also referenced that in the article so if it's less than 15 millimeters here then you have like a sensitivity of 77% or something like that and but I wouldn't bother measuring just make sure that you have this Dima here and/or you can also have a fatty atrophy of the muscle if it's not an acute finding and don't rely on these measurements here because they don't help you sometimes you have a very narrow space without any edema here and it's also depending on the position of the leg as well so again I'm not a really big fan of measurements anyways another form of extra-articular hip impingement is the so called slop spine impingement where you have a very prominent anterior inferior iliac spine here as in this case you can see here this is the spine here and you have this defect corresponding here on the femoral head neck junction and you can imagine this is a sagittal view if this patient is flexing the hip this one is going up and it's impinging here on the anterior inferior iliac spine what they sometimes do is then resect this and tear inferior iliac spine is in this case as for labral tears it's very easy basically in the hip they most often occur at anterior superior position as in this case and if you go a little bit more cuddly or distally you often have these super great label recesses here not going through short margins and stuff like that this is a recess this is a tear and also the labrum here it's quite changed in signal intensity so look for these tears at the entrance to position of the hip sometimes they are located anteriorly just below the absorbed in which is here this one is just a little bit bit further down and this is third up of the episodes tendon here and there is one theory that interrupts or tendon actually can cause labral tears if there is like a chronic friction and stuff like that so if you want to know more about it also go and have a look at the article I just wanted to show you here an example of a tear versus a tube labor recess and that location is key there's not much to say about this image here we have the cam deformity as you can see here that there is an abnormality in the head next Junction we have this label tear here at the control control label junction here and also associated control defect here and some elimination also going on and - labrum is signal change and this is a core alleged elimination a central defect of the cartilage in the femoral hat near the phobia and this is sometimes not so easy to see because you don't typically look there for cartilage defects so make sure to have a look there specifically for cartilage defects and you also benefit if you do a traction em or a jog Rafi because you're riding in the joint space and give the defect enough space to have fluid or contrast entering the defect and therefore presenting it here like in this case now this is a nice example because it's the same patient with a follow-up eight month after the first image so this was at the initial presentation and you can see here this variant it's a so-called supra acetabular fossa and this is the same for the same location just eight months later so it's a very young patient I think 18 years old woman and you can see here it was filled with contrast and here it was filled with cartilage and if you go in the literature you can see that there is a distinction between a type 1 if it's fluid field and a type 2 if it's cartilage field and basically this proves that it's probably a continuum and you just have a type 1 and eventually it fills up with cartilage and we have a type 2 so keep that in mind and don't please don't mistake this as a osteo contribution that was part 2 part 3 in coming next week [Applause] [Applause] [Music]