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What views should be ordered?

TIA-I know this is presumptuous but I would like to suggest to my pcp what xray views to order. I sustained a high speed flight/fall/bounce/thud a year ago in a bus accident. I am in my 60's. I am having increasing disability. Pain in groin when pivoting, side-stepping, and with single leg wt bearing/flexing (getting out of shower.) Extremely tense tendon at times nearby. After accident I had small hematoma top front of thigh on the outer edge (so not the groin) of a line drawn straight up from the patella. I still feel a bulge at that location though no visual clues, and have deeper subtle pain there.   I don't have snapping or clicking but I hear 'internally' a dull thump from the socket when I shift off the leg. Prior to accident I could hold the raised legs position bilaterally for quite a while (always surprised the gyn drs when they would pull out the table extension.) Now I can only raise this leg 1 inch at best-opposite leg is as good as ever. It feels like the muscle in the upper leg gives out but the muscle closer to the knee kicks in so I don't fall when I first begin walking. I can no longer stand up from low toilets or chairs. (You cannot believe what you have to do to get out of such a predicament.) I purchased one of those walkers that fits over the toilet seat which works great but I don't exactly want to travel with it... When sitting in a chair I can also only raise that leg up 1 inch at best. I am aware the groin pain most likely relates to the labrum but I am not interested in MRI-just want to rule out fracture. I am terrified of the physical exam the pcp will feel compelled to do to 'elicit' the pain.
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Avatar universal
Well, I googled my way to Standing AP Pelvis and Frogleg Lateral Hip views. I practiced the frogleg position at home on the bed and it was excruciating and I could not get my leg flat to the mattress.  

I told the PCP I did not want 'vanilla' views and asked for those views instead and was surprised by the PCP googling the frogleg view while in the room with me and then commenting it seems to mostly be for children. So I commented that one website said don't do that frogleg view if you suspect fracture.  

So her supervisor switched the Frogleg view to Hip Dunn view.  Basically, results were mild hip djd, osteopenia, djd si/sp, linear calcification lateral gr. trochanter, loss of head neck offset junction,  and possibly femoroacetabular impingement syndrome.  

I will probably need a hip replacement years from now lol. Meanwhile I still have intermittant left hip pain and more cautiously move. My muscle function has improved and I can do a brief straight leg raise higher than before, and stand up with the support of my left hand.
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Avatar universal
I realize you have already found an answer to your question but I am posting this in case others have similar questions:

The American College of Radiology (ACR) has published evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. The relevant section for acute trauma to the hip can be accessed at: https://acsearch.acr.org/docs/3082587/Narrative/

Initial workup should include X-rays of the hip: frontal and lateral. Please note that X-rays are more of a screening test for ruling out obvious bony findings, such as fracture, dislocation, and degenerative changes, but are not so good for soft tissues. X-rays do not evaluate the labrum, cartilage, tendons, and/or muscles, which can only be evaluated with MRI.

Your clinical scenario is somewhat complex and may benefit from referral to a specialist (e.g., orthopedics) who can perform a tailored physical exam. Do not be afraid of the different tests to elicit pain! The whole point is to figure out the root of your problem and hopefully alleviate the pain. If persistent concern for labral injury or other hip pathology, consider MRI.
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