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. 2017 Dec 16;101(Suppl 2):6.
doi: 10.5334/jbr-btr.1371.

Ultrasound Diagnostic and Therapeutic Injections of the Hip and Groin

Phey Ming Yeap  1 , Philip Robinson  1   2
Affiliations

Ultrasound Diagnostic and Therapeutic Injections of the Hip and Groin

Phey Ming Yeap et al. J Belg Soc Radiol. .

Abstract

Hip and groin pain often presents a diagnostic and therapeutic challenge. The differential diagnosis is extensive, comprising intra-articular and extra-articular pathology and referred pain from lumbar spine, knee and elsewhere in the pelvis. Various ultrasound-guided techniques have been described in the hip and groin region for diagnostic and therapeutic purposes. Ultrasound has many advantages over other imaging modalities, including portability, lack of ionising radiation and real-time visualisation of soft tissues and neurovascular structures. Many studies have demonstrated the safety, accuracy and efficacy of ultrasound-guided techniques, although there is lack of standardisation regarding the injectates used and long-term benefit remains uncertain.

Keywords: Diagnostic; Groin; Hip; Injection; Therapeutic; Ultrasound.

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Figures

Figure 1
Figure 1
Anterior longitudinal approach for an in-plane hip joint injection. An arrow parallel to the long axis of the transducer is drawn on the skin adjacent to the end of transducer where the needle will be introduced.
Figure 2
Figure 2
Anterior longitudinal view of the hip joint. The needle is introduced from an inferior and anterior approach, lateral to the femoral neurovascular bundle (arrow). A, acetabulum; H, femoral head; N, femoral neck; double arrow – anterior joint recess.
Figure 3
Figure 3
Transverse image of the hip joint. The needle is introduced from a lateral and anterior approach, to rest on the femoral head (arrow). A, acetabulum; H, femoral head; N, femoral neck; LAT, lateral; MED, medial.
Figure 4
Figure 4
Transverse oblique ultrasound image superior to the femoral head, demonstrating the iliopsoas tendon. The needle is directed between the deep surface of the iliopsoas tendon and the superficial surface of the ilium (I) from a lateral approach (arrow) at the level of iliopectineal eminence. FA, femoral artery; ILP, iliopsoas muscle; LAT, lateral; MED, medial.
Figure 5
Figure 5
Transverse image over the greater trochanter showing the bony apex (asterisk) between the gluteus minimus tendon (double arrow) insertion onto the anterior facet (A) and the gluteus medius tendon (double arrow) insertion onto the lateral facet (L). GL MAX, gluteus maximus muscle; GL MED, gluteus medius muscle.
Figure 6
Figure 6
Transverse plane over the greater trochanter. The needle is advanced into the tissue plane between the gluteal maximus-iliotibial band and gluteus medius tendon from a posterior approach (arrow). GL MED, gluteus medius tendon; GL MAX, gluteus maximus muscle; ANT, anterior; POST, posterior.
Figure 7
Figure 7
Sagittal image shows merging of the anterior capsular tissues (arrows), pyrimidalis, rectus abdominis (RA), adductor longus muscle (AL) and its tendon (asterisk). P, pubis; DIS, distal PROX; proximal.
Figure 8
Figure 8
(A, image above) Transverse image of the symphysis pubis. P, pubis. (B, image below) Sagittal ultrasound image for symphyseal injection. The needle is introduced from a superior approach (arrow). Asterisk indicates the joint. DIS, distal; PROX, proximal.
Figure 9
Figure 9
Tranverse oblique image shows LFCN (arrow) at the level of anterior superior iliac spine (ASIS). LAT, lateral; MED, medial.
Figure 10
Figure 10
The needle is introduced from a lateral approach (arrow) for LFCN perineural injection. SM, sartorius muscle; LAT, lateral; MED, medial.
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