MRI Scan for Hip Pain

Hip pain affects around 10-15% of adults over 60 in the UK, and it is increasingly common in younger, active people too — particularly runners, footballers, and dancers. The hip is a deep ball-and-socket joint surrounded by thick muscle, making clinical examination alone unreliable for pinpointing the problem. MRI shows the hip joint, labrum, cartilage, tendons, bursae, and bone in detail that X-ray and ultrasound cannot match, often revealing the cause of hip pain when other tests have been inconclusive.

Whether your hip has been aching for months, suddenly seized up, or causes a catching sensation with certain movements, an MRI can identify the structural problem and guide you towards the right treatment.

Common Causes of Hip Pain

• Osteoarthritis — the most common cause of hip pain in people over 50. Affects around 5-10% of adults. MRI shows cartilage loss, bone marrow oedema, osteophytes, and synovitis — often before X-ray changes are visible.
• Femoroacetabular impingement (FAI) — bony abnormalities of the femoral head (cam morphology) or acetabulum (pincer morphology) cause mechanical impingement during hip flexion, damaging the labrum and cartilage. Common in young, active adults. Two types:
  • Cam impingement — a bony bump on the femoral head/neck junction. More common in young men.
  • Pincer impingement — over-coverage of the femoral head by the acetabulum. More common in women.
  • Mixed — most patients have both.
• Labral tears — tears of the fibrocartilage ring around the hip socket. Often caused by FAI or trauma. Symptoms include clicking, catching, and groin pain with hip flexion. MRI with arthrography (contrast injected into the joint) improves detection.
• Avascular necrosis (AVN) — loss of blood supply to the femoral head, causing bone death. See our dedicated avascular necrosis MRI guide.
• Greater trochanteric pain syndrome (GTPS) — previously called trochanteric bursitis. Pain on the outer hip. MRI often shows gluteus medius and/or minimus tendinopathy or tearing, with or without bursitis. Affects around 10-25% of the general population.
• Stress fractures — femoral neck stress fractures are an urgent diagnosis in runners. MRI detects the bone marrow oedema weeks before X-ray changes appear. Left untreated, a femoral neck stress fracture can displace — a surgical emergency.
• Iliopsoas tendinopathy/bursitis — causes anterior hip/groin pain, often with snapping during hip flexion.
• Hamstring origin tendinopathy/tear — causes deep buttock pain, often confused with sciatica. MRI shows the hamstring origin attachment at the ischial tuberosity.
• Referred pain — hip pain can come from the lumbar spine (L2-L4 nerve root irritation), sacroiliac joint, or even the knee (in children, a slipped capital femoral epiphysis presenting as knee pain). If hip MRI is normal, spinal assessment may be needed.

What a Hip MRI Shows

• Labrum — assessed for tears, degeneration, and paralabral cysts. Standard MRI detects most labral tears, but MR arthrography is more sensitive (particularly for partial tears).
• Articular cartilage — thickness and integrity of cartilage on both the femoral head and acetabulum. Cartilage loss indicates arthritis.
• Bone — femoral head and neck shape (cam morphology), acetabular morphology (pincer), subchondral bone marrow oedema, AVN changes, stress fractures.
• Tendons — gluteus medius and minimus (lateral), iliopsoas (anterior), hamstring origin (posterior). Assessed for tendinopathy, partial tears, and complete tears.
• Bursae — trochanteric, iliopsoas, and ischiogluteal bursae. Fluid in bursae indicates bursitis.
• Joint — effusion, synovitis, loose bodies.

What MRI Cannot Show

• Dynamic impingement — FAI symptoms occur during movement, but MRI is static. Bony morphology (cam/pincer) is visible, but the actual impingement is inferred, not seen directly.
• All labral tears — standard MRI misses some labral tears, particularly small partial tears. MR arthrography improves sensitivity.
• Pain source in complex cases — hip pain can have multiple contributing factors (labral tear + FAI + tendinopathy + referred spinal pain). MRI shows all the structural findings but cannot determine which is causing the most symptoms. Diagnostic injections can help.

What to Expect

A hip MRI takes 25-35 minutes. You lie on your back with a coil over your pelvis/hip. The scan covers the entire hip joint and surrounding structures. If MR arthrography is planned, there is a separate appointment first to inject contrast into the hip joint under X-ray or ultrasound guidance.

Alternative Diagnostic Approaches

• X-ray — first-line for hip pain, especially if arthritis is suspected. Standing AP pelvis and lateral hip views. Good for joint space, bony morphology, and advanced disease. Misses early cartilage loss and soft tissue problems.
• Ultrasound — good for trochanteric tendons and bursae, iliopsoas tendon, joint effusion, and guided injections. Cannot see labrum, deep cartilage, or bone marrow.
• CT — better bony detail than MRI. Useful for assessing cam/pincer morphology for surgical planning (3D reconstruction).
• Diagnostic injection — local anaesthetic injected into the hip joint under ultrasound or X-ray guidance. If it relieves your pain temporarily, it confirms the hip joint itself is the pain source.

Treatment Pathways

• Hip osteoarthritis — weight management, physiotherapy, exercise (swimming, cycling), NSAIDs. Joint injection (steroid or hyaluronic acid). Total hip replacement for end-stage disease — around 90,000 performed annually in the UK, with 95%+ 10-year implant survival.
• FAI and labral tears — physiotherapy first (hip strengthening, activity modification). Hip arthroscopy for persistent symptoms — reshaping the bone (osteoplasty) and repairing or debriding the labrum. Results are best in younger patients with minimal arthritis.
• Greater trochanteric pain syndrome — physiotherapy (gluteal strengthening is the key treatment), activity modification, corticosteroid injection, shockwave therapy. Surgery is rarely needed.
• Stress fracture — tension-side femoral neck fractures: strict non-weight-bearing and orthopaedic monitoring. Compression-side fractures: modified weight-bearing. Complete fractures need urgent surgical fixation.
• AVN — see our avascular necrosis MRI guide for detailed treatment pathways.

UK Statistics

• Hip osteoarthritis affects approximately 5-10% of adults in the UK
• Around 90,000 hip replacements are performed annually in England and Wales
• Greater trochanteric pain syndrome affects 10-25% of the general population
• FAI affects an estimated 10-15% of young, active adults
• Femoral neck stress fractures account for up to 11% of running injuries

Frequently Asked Questions

Related Articles

• Avascular Necrosis MRI
• MRI Scan for Arthritis
• MRI Scan for Back Pain
• MRI Scan for Sports Injuries