Stress fractures are classified as fatigue, resulting from normal bone being subjected to abnormal repetitive forces, and insufficiency, due to normal stress placed on abnormal bone. Stress injuries are most commonly seen in endurance athletes, such as runners and military recruits, as well as recreational athletes with sudden increase in activity. However, because stress injuries may progress to complete fracture and result in prolonged recovery or career-ending complications, it is imperative to identify these injuries early. Stress injuries are due to a mismatch between native bone strength and chronic mechanical load applied on bone over time. Recently, high-resolution conventional MR imaging is replacing MR arthrography at many centers. If symptoms or clinical exam findings suggest intra-articular pathology, dedicated small field-of-view (FOV) MR arthrography of the hip is considered the imaging method of choice. For symptoms of generalized pain or nonspecific physical exam findings, imaging is best performed with conventional MRI of the pelvis and hip. According to the American College of Radiology Musculoskeletal Imaging Criteria, MRI is the next appropriate imaging method in those individuals with negative radiographs. Anteroposterior view of the pelvis is standard, and dedicated views of the symptomatic hip are often performed in the athletic hip which include cross-table lateral, frog-leg lateral, or Dunn lateral. The radiographic examination is a critical component in the diagnostic evaluation and treatment decision-making process and considered the first-line imaging technique in the evaluation of hip pain.
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