ST - How to: Hip Ultrasound Exam
- We're gonna examine the hip today, this is her right hip and we'll look anteriorly at the femoral acetabular joint, and then we'll also look laterally at the greater trochanter. Positioning is important, she is lying on her back with her leg extended and slightly externally rotated. This is the best position to see this joint. I've chosen a C60 transducer. There is a line here which corresponds to the turquoise dot on the screen, and this we usually, by tradition, keep proximally or medially, and that's the way I'll orient this image. I'm trying to align the transducer approximately parallel with the femoral neck, and the left side of the screen, the hyperechoic line is the acetabulum. The curved structure, or circular structure, is the femoral head. It then drops down to the femoral neck, and we can see the femur itself extending parallel to the top part of the image, out toward the right.
You can even see the joint capsule and the cartilage on the femoral head, and in the corner where the neck joins the ball of the femur you can see the femoral joint space. And that area right there at the base is where you aim when you want to do an injection. Before you do anything, you want to identify the great vessels, and I will turn the transducer transversely, and look medially, and we can see the anechoic structures that are pulsating. I'll turn on the color. Should be able to confirm that those are the vessels. We want to, obviously, avoid those. When I turn back longitudinally, I see that those vessels are medial to where I was looking before, and now that area that I have examined does not have blood vessels. Sometimes it's a good idea to look in this area, because that's the direction the needle is gonna be coming, to make sure there are no branches of the femoral artery or vein going in that direction.
If an effusion is present, you'll usually see it right at that junction point between the femoral head and the neck. You'll see a bulge in the joint capsule, it will be coming up and to the right, and we'll usually move the iliopsoas muscle and tendon dorsally, or superficially. I'm gonna examine the lateral aspect of her hip, the greater trochanter especially. This would be an area that you can examine with ultrasound in a symptomatic patient. She's lying on her left side with her hip extended. Just slight flexion position. I'm using a linear transducer now. Sometimes in a person who has a much deeper area to traverse, I might use a C60.
This transducer has a linear mark here, which corresponds to the turquoise dot on the screen, and we keep that proximal, or we keep that medial. The hyperechoic curved line is the superior edge of the greater trochanter. There are muscles and tendons, then, just beneath the skin. Going distally, we see the rest of the greater trochanter with tendinous insertions of the gluteus muscles.
If we turn this transversely, we can again see the bony outline deep as a hyperechoic structure, and above it, a series of tendinous structures, the gluteus muscles come in and attach to the greater trochanter. Anteriorly and posteriorly we can see these images around the greater trochanter, and there are a series of bursae present there, with fluid-filled sacs visible in a person who would have bursitis.
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