Hip ultrasound techniques

Anterior approach.

The hip joint, soft tissues of the inguinal region and the femoral triangle area, and muscles are assessed from the anterior approach. Ultrasound of the hip joints is performed lying on the back with straight legs. The sensor is installed longitudinally along the long axis of the thigh. An image of the iliac wing and the semicircle of the femoral head, which are bone landmarks, is obtained.

Between the ilium and the femoral head, a hyperechoic linear triangular structure is distinguished - the acetabular labrum. From this approach, the hypoechoic hyaline cartilage is clearly visible, as well as the synovial joint capsule of the hip joint, represented by fibers of several ligaments: iliofemoral, pubofemoral and ischiofemoral. Given the large size of the hip joint, it is recommended to use the capabilities of panoramic scanning. 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 (on average 6.4 mm).

Periarticular region (anterior section).

In the panoramic scanning mode in the transverse plane from the pubic bone to the iliac wing, the vascular-nerve bundle located in the femoral triangle is assessed. The femoral vein lies medially, with the artery and nerve located laterally behind it. Soft tissues are also examined in this projection. The tendons of the quadriceps femoris are attached along the contour of the iliac wing, and distally they pass into the muscle fibers of the corresponding groups. Lateral to the rectus muscle are the bundles of the muscle that tenses the broad fascia of the thigh. The sartorius muscle lies medially and superficially; deeper lie the fibers of the iliopsoas muscle, the tendon of which is attached to the lesser trochanter of the femur.

The iliopsoas bursa is normally present in 98% of cases and communicates with the joint cavity in 15-20%. It is normally not visible during ultrasound examination.

Also in this area, deep and superficial inguinal lymph nodes are examined. Normally, lymph nodes have an oval shape. The length should be more than 2 times greater than the anterior-posterior size. The cortex of the node is hypoechoic, surrounded by a medulla of increased echogenicity. The ratio of the cortex and medulla is equal or in favor of the medulla. Unchanged lymph nodes are poorly vascularized, but sometimes feeding vessels entering the gate of the node and small vessels in the central part are distinguished.

Lateral saphenous nerve of the thigh.

If indicated, 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, partly the iliac muscle, until it exits under the lateral part of the inguinal ligament near the anterior superior arch of the iliac wing.

Medial approach.

To examine the medial part of the hip region, the limb is bent at the knee joint and abducted outward. From this approach, the adductor group of the thigh and the tendinous part of the iliopsoas muscle are examined. The muscle bundles are located along the long axis, so their feathery structure is clearly visible. The lesser trochanter and part of the femoral head serve as bone landmarks.

Lateral approach.

The patient is examined lying on his side or with the limb internally rotated. The most prominent bone fragment is the greater trochanter. The trochanteric bursa is located superficially and subcutaneously just above it. The bursa measures approximately 4-6 cm in length and 2-4 cm in diameter.

Rear access.

The examination is performed on the side, the examined limb is bent and brought to the stomach. From this approach, the gluteal muscles, ischial tuberosity, and sciatic nerve are assessed. The ischial tuberosity is the main bony landmark in this area. It is palpated in the lower part of the gluteal region, proximal to the gluteal fold. If the sensor is placed along the fold, the ischial tuberosity looks like an uneven curved line. Above, the common tendon of the muscles of the back of the thigh is visualized, attached to the ischial tuberosity. The ischiogluteal bursa is located between the tuberosity and the gluteus maximus muscle. Normally, the bursa is not visible.

Sciatic nerve.

The sciatic nerve emerges from the pelvis and runs longitudinally down the back of the thigh. It is located 2-3 cm lateral to the ischial tuberosity. The diameter of the sciatic nerve is about 5-9 mm. When scanning longitudinally, the nerve fibers are surrounded by a hyperechoic membrane; in cross-section, the nerve has an oval shape.

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