OpenHealth Q&A

MRI Report Analysis: Pelvic and Hip Issues Postpartum

Subject: 44-year-old female, 19 months postpartum, height 5'5", body mass index (BMI) 37, with an athletic background in competitive swimming from Canada. During her pregnancy, she was diagnosed with Symphysis Pubis Diastasis, a condition that became acute and persisted post-delivery, leading to a scheduled cesarean section. Following the birth, she has been experiencing ongoing pain, particularly in the hips. With a significant wait time to see her physician—over a month—she is in considerable discomfort. The MRI results have just returned. Post-delivery, she has received cortisone injections monthly in the pelvic and hip areas, providing temporary relief. Any guidance on the MRI findings would be greatly appreciated. **CLINICAL REASON FOR IMAGING:** Examination initiated due to persistent symphysis pubis discomfort after childbirth; previous x-ray findings suggest sacroiliac joint instability, with pronounced lateral hip pain as a primary symptom. **IMAGING PROCESS:** An unenhanced multi-directional MRI of the pelvis and hip regions was conducted. **COMPARATIVE ANALYSIS:** Previous pelvis and hip x-rays taken in July 2024 were referenced. **IMAGING RESULTS:** **RIGHT HIP:** The anterosuperior labrum appears irregular and frayed, evidenced by a complete chondrolabral separation from the 1 to 2 o'clock position, alongside a 5 mm paralabral cyst. Early signs of cartilage degeneration in the anterosuperior region are noted, but there is no high-grade cartilage loss or cam deformity present. The acetabular coverage and version remain normal, and femoroacetabular marrow signals are stable. The ligamentum teres shows no anomalies, with minor effusion detected, but no loose bodies are observed. **LEFT HIP:** The anterosuperior labrum is also frayed but smaller in size, without any defined tear. Partial-thickness cartilage loss has occurred in the anterosuperior section, and significant loss of cartilage is seen posteriorly. No cam deformity is evident; acetabular positioning and coverage are normal, with femoroacetabular marrow signals within the expected range. The ligamentum teres appears intact. No effusion or loose bodies found. **PELVIC FINDINGS:** Mild degenerative alterations at the symphysis pubis. Notably high-grade tearing of the right adductor longus-rectus abdominis aponeurosis is present, alongside pronounced tendinosis at the origin of the adductor longus. Mild tendinosis is also evident at the left adductor longus site. The tendons of gluteus minimus and medius remain intact, with minimal thickening of the greater trochanteric bursa. Sciatic nerves appear normal, with mild tendinosis noted in the right and minimal in the left common hamstrings. The intervals around the ischiofemoral joint are adequate. The femoral neurovascular structure is normal, and the origins of rectus femoris and insertions of iliopsoas are intact. No significant arthropathies in the sacroiliac joints. Limited evaluation of the pelvic viscera returns normal results. **CONCLUSIONS:** 1. The high-grade tear of the right adductor longus-rectus abdominis aponeurosis, in the context of marked tendinosis at the adductor longus origin, likely explains the patient's abdominal and groin pain. Mild degenerative changes at the symphysis pubis are noted alongside some left adductor longus tendinosis. 2. Observations indicate bilateral degeneration of the anterosuperior hip labra and early cartilage degenerative changes, specifically noting a full-thickness tear on the right with an associated 5 mm cyst. 3. There is slight thickening of the greater trochanteric bursa, which may suggest minimal bursitis, correlating with lateral hip pain. 4. No significant issues found in the sacroiliac joints. 5. Tendinosis is minimal in the right and slight in the left common hamstrings.

Answers (1)

6/19/2025, 1:40:52 AM

OpenHealth AI

The MRI results indicate a combination of issues that are likely contributing to your ongoing hip and pelvic pain after childbirth. Here’s a breakdown of the findings and practical next steps for managing your discomfort:

Key Findings from MRI:

1. Labral Tears and Cartilage Changes:

   • Right hip: A complete tear of the labrum with a cyst and early cartilage degeneration.
   • Left hip: A smaller frayed labrum and partial thickness cartilage loss.

2. Tendinosis:

   • High-grade tearing of the right adductor longus aponeurosis, which is likely causing pain in your groin and abdomen.
   • Mild to moderate tendinosis at the tendons of the adductor longus.

3. Bursitis:

   • Some thickening of the greater trochanteric bursa, which may correlate with the lateral hip pain you're experiencing.

4. Mild Degenerative Changes:

   • Notable mild changes at the symphysis pubis.

Practical Next Steps:

1. Pain Management:

   • Continue with the cortisone injections as these provide temporary relief. Discuss the possibility of alternative treatments (e.g., physical therapy, corticosteroid injections) with your physician when you see them.
   • Over-the-counter pain relief, such as ibuprofen or acetaminophen, may help manage acute pain. Be sure to follow dosing recommendations and consult if you have any underlying health concerns.

2. Physical Therapy:

   • Engage in physical therapy focused on the pelvic region and hips. A physical therapist can design a program to strengthen the surrounding muscles and stabilize the pelvis, potentially alleviating pain and improving mobility.

3. Activity Modification:

   • Avoid activities that strain the hips or pelvis, especially those involving significant twisting or impact (e.g., running, jumping, or heavy lifting).
   • Opt for low-impact exercises such as swimming or cycling, which you might enjoy due to your swimming background.

4. Strengthening and Stretching:

   • Gentle stretching and strengthening exercises, particularly for the hip flexors and adductor muscles, may help. Ensure these exercises are recommended by a healthcare professional familiar with your condition.

5. Monitor Symptoms:

   • Keep a log of your symptoms, noting what activities exacerbate or improve your pain, to better discuss this with your physician when you get the opportunity.

6. Consider Second Opinion:

   • If you feel your symptoms are severe and not improving, consider seeking a second opinion from a specialist, such as an orthopedic surgeon or a sports medicine physician, who may provide additional insights into managing your condition.

It's understandable to feel discouraged with ongoing pain, especially after previously being active. Focus on these steps, and while waiting for your physician’s appointment, ensure to communicate any changes in your symptoms or pain levels. You're taking proactive steps in managing your health, which is commendable! Let me know if you have further questions or need additional guidance.