Methods of ultrasound of the hip joints
Last reviewed: 23.04.2024
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Front access.
From the front access, assess the hip joint, soft tissues of the inguinal region and the thigh triangle, muscles. Ultrasound of the hip joints is lying on the back with straight legs. The sensor is installed longitudinally along the long axis of the thigh. Obtain an image of the wing of the ileum and semicircle of the head of the femur, which are bony landmarks.
Between the iliac and the femoral head, a hyperechoic linear triangular structure, the acetabulum, is distinguished. From this access, hypoechoic hyaline cartilage is well visible, as well as the synovial articular capsule of the hip joint, represented by the fibers of several ligaments: iliac-femoral, pubic-femoral and ischial-femoral. Considering the large size of the hip joint, it is recommended to use the panoramic scanning capabilities. Visualization of the synovial capsule is enhanced by the presence of effusion in the joint cavity. The distance from the surface of the femoral neck to the joint capsule varies depending on the constitution from 4 to 9 mm (average 6.4 mm).
Periarticular region (anterior part).
In the mode of panoramic scanning in the transverse plane from the pubic bone to the wing of the ilium, the neurovascular bundle located in the femoral triangle is evaluated. Medially lies the femoral vein, behind it - lateral artery and nerve. In this projection, soft tissues are also examined. On the contour of the wing of the ilium, the tendons of the quadriceps muscle of the thigh are attached, they are distal to the muscle fibers of the corresponding groups. Lateral from the rectus muscle are bundles of muscle, stretching the wide fascia of the thigh. The sartorius muscle is superficial and superficial; deeper lie the fibers of the ilio-lumbar muscle, the tendon of which attaches to the small trochanter of the femur.
The ileo-lumbar sac is normally present in 98% of cases and communicates with the joint cavity at 15-20%. Normally, it is not visible with ultrasound.
Also in this area, the deep and superficial inguinal lymph nodes are examined. Normally, the lymph nodes are oval in shape. The ridge should be more than 2 times the anteroposterior size. The cortical substance of the node is hypoechoic, it surrounds the brain substance of increased echogenicity. The ratio of cortical and cerebral matter is equivalent or in favor of the brain. Unchanged lymph nodes are weakly vascularized, but sometimes distinguish feeding vessels entering the gates of the node and small vessels in the central part.
Lateral hypodermic nerve of hip.
In the presence of indications, the lateral subcutaneous nerve of the thigh is examined, which is formed from the posterior roots of L2-L3. The nerve follows the lumbar muscle, partially the iliac muscle, before reaching the lateral section of the inguinal ligament next to the anterior superior arch of the ileal wing.
Medial access.
For examination of the medial part of the hip region, the limb is bent at the knee joint and is withdrawn outward. From this access, the group of adductor muscles of the femur and the tendon part of the ilio-lumbar muscle are examined. Muscle bundles are arranged along a long axis, so their pinnate structure is clearly visible. Bone orientations are a small spit and part of the head of the femur.
Lateral access.
The patient is examined lying on his side or with internal rotation of the limb. The most prominent bone fragment is a large spit. Immediately above it, superficially, the sciatic bag is placed subcutaneously. The dimensions of the bag along the length about 4-6 cm, in the width of 2-4 cm.
Rear access.
The study is carried out on the side, the limb being examined is bent and brought to the stomach. This access is assessed by the gluteal muscles, sciatic tubercle, sciatic nerve. The sciatic is the main bone guide in this area. It is palpable in the lower part of the gluteal region, proximal to the gluteal fold. If the sensor is installed along the fold, the sciatic tubercle looks like an uneven curved line. Above, the general tendon of the hamstrings of the hip is visualized, attached to the ischial tubercle. The sciatic-gluteus is located between the tubercle and the gluteus majorus. Normally, the bag is not visible.
The sciatic nerve.
The sciatic nerve emerges from the small pelvis and follows longitudinally down the posterior surface of the thigh. It is located 2-3 cm lateral to the sciatic mound. The diameter of the sciatic nerve is about 5-9 mm. In longitudinal scanning, the fibers of the nerve are surrounded by a hyperechoic membrane, in the transverse section the nerve is oval in shape.
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