Ultrasound of hip joints in adults
Last reviewed: 18.10.2021
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Pathological changes occurring in the hip joint and in surrounding soft tissues are not so numerous as in the knee and shoulder joints. MRI is the leading method for detecting the pathology of this area. Ultrasound of the hip joints may be an additional method for clinical or X-ray examinations. It should be noted that ultrasound is superior in informative MRI in detecting small effusions in the hip joint, even less than 1 ml. The hip region is the place of passage of large neurovascular bundles, the area of tumor metastasis and the spread of inflammatory processes from the abdominal cavity and small pelvis, and also from the lower limbs. To study this joint and surrounding soft tissues, depending on the constitution, use a sensor in the range 3.5-7 MHz with a linear or convective working surface.
Anatomy of the hip joint
The hip joint is formed by the articular surfaces of the head of the femur and the acetabulum of the hip bone. On the edge of the acetabulum, increasing its depth, the acetabulum is attached. The joint capsule is attached to the edge of the acetabulum, covering the head of the femur, and is attached to the front on the intervertebral line, and behind it covers two thirds of the femoral neck.
For the convenience of the study, the condition of the hip region is divided into articular and periarticular. In turn periarticular - on anterior, lateral, medial and posterior. Each of the above areas is evaluated in two mutually perpendicular planes.
Method of ultrasound of hip joints in adults
Front access.
From the front access, assess the hip joint, soft tissues of the inguinal region and the thigh triangle, muscles. The examination is carried out 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).
Methods of ultrasound of the hip joints
Ultrasonic diagnosis of diseases of the hip area
The main task of a doctor of ultrasound is to conduct differential diagnostics between intraarticular and extraarticular pathologies. Intraarticular pathological conditions include: effusion into the joint cavity, synovitis, deforming arthrosis, aseptic necrosis of the head of the femur.
Exudation in the joint cavity, synovitis.
The presence of effusion in the hip joint is diagnosed with ultrasound if the distance between the surface of the femoral neck and the joint capsule exceeds 9-10 mm. When synovitis, as a rule, a thickening of the joint capsule is observed. Therefore, it is important to evaluate the symmetry of the thickness of the joint capsule with a healthy side. A difference of more than 1-2 mm indicates a pathology of the synovial articular bag. Ultrasonic examination is also used to detect fluid around the prosthetic hip joint or after osteosynthesis. With CT or MRI, often metal prostheses cause artifacts that interfere with the correct assessment of the presence of fluid in the cavity or around the joint.
Ultrasound signs of diseases of the hip area
Ultrasound diagnosis of periarticular pathology
Muscle ruptures, muscle injuries, ruptures of tendons and ligaments.
Traumatic injuries in the hip are less common than in the knee and shoulder joints. In the case of an automobile accident, the rectus muscle of the thigh is more often damaged. Athletes often have microtraumas of the rectus thigh muscles. Pain in the symphysis area in soccer players is often associated with stretching or rupturing of adductor muscles that attach to the pubic bones.
Hematomas of the hip and gluteal region.
The subcutaneous fat layer on the thigh and buttocks is usually well pronounced. The fiber of this region contains few connective tissue membranes and is relatively loosely associated with the fascia, so thigh and buttock blows relatively easily cause hematomas both in the thickness of the cellulose and in the subfascial space.