So one of the cool application of point of care ultrasound is the use of hip ultrasound to diagnose hip effusion. Every pediatric care providers know that it is really hard to diagnose children who present to the emergency department with a limp and fever. Hip ultrasound can actually be helpful to identify the presence of a hip effusion for those patients. In conjunction with the rest of the physical exam findings, lab investigations, I believe hip ultrasound can be one of the useful tools to guide management of these patients. So in order to achieve proper imaging of the hip, the patient needs to be lying supine with the leg in slight flexion and abduction as much as its tolerated by the patients who are often having some hip pain. So proper pain medication should be offered to the patients.
The probe that should be selected to do hip ultrasound is the linear probe for younger and smaller patients, and a curving linear probe can actually be used for adolescent or heavier patients who need a depth of more than four to five centimetres. When the patient is positioned supine with the hip and abduction, you look at the inguinal crease and the ultrasound probe actually has to be perpendicular to that hip crease. This actually follows the femoral neck of the patient. When the ultrasound beam is perpendicular to the inguinal crease, and parallel to the femoral neck you can actually visualize the femoral neck, the femoral head and the ..
In the long axis. In order to see whether the patient has a hip effusion or not, what you need to look at is to look at the femoral neck and the ... Muscle next to it.
And what you're looking for is, you're looking for a hypoechoic fluid collection in this area. The measurement needs to be done at the level of the femoral neck, and if the fluid collection is more than five millimeters on the effected side, or if there's a two millimeter difference when you compare to the uneffected side, then it's considered a pathologic hip effusion. The trick is to always compare to the other side in order to see if there's a difference. The hypoechogenicity of this hip can actually be tricky because in cases where there's a ... Hip effusion, the fluid collection can be not a hundred percent black so you should still take it into consideration. Identifying a hip effusion can be quite helpful for a primary care provider or also seeing that there's no hip effusion can be reassuring, but unfortunately it doesn't help us differentiate between two very different diagnosis: septic arthritis and transient synovitis which have very different prognosis for the patient. So I think the use of hip ultrasound to diagnose hip effusion is a useful tool when its used in addition to other clinical factors and lab investigations. Remember to Like and Subscribe!.
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