SONOGRAPHY OF HIP JOINT final for presentation.pptx

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1. SONOGRAPHIC ANATOMY AND SCANNING PROTOCOL FOR HIP MUSCULOSKELETAL ULTRASOUND (MSK) PRESENTER: RICHARD ADOMEYON MDU STUDENT.

2. Normal sonographic appearance of Muscles,tendon and ligament Hypoechoic interspersed with bright foci Muscle bundles are surrounded by hyperechoic structures Fibro adipose septa. TENDON Hyperechoic ,Striated and More compact in comparison to tendons LIGAMENT Hyperechoic,Striated and more compact in comparison to tendons

3. APPEARANCE OF SOFT TISSUE AND OTHER OSSEOUS STRUCTURES OF THE HIP

4. Sonographic anatomy and scanning protocol Anterior hip Anterior hip joint - Effusion. - synovitis . -capsular Thickenning . -cortical irregularities. -Hip joint loose bodies-synovial chondromatosis - Anterior labrum Ilipsoas muscle –short and long axis, distal to proximal -bursitis -snapping -anterior, posterior& lat.

5. Rectus femoris Satorius Dynamic examination if patient complains of internal snapping.

6. Protocol and position With the patient supine, place the transducer in an oblique longitudinal plane over the femoral neck to examine the anterior synovial recess using the femoral head as a landmark

7. Suggital oblique

8. As you move your probe cranially Cranial to the anterior recess, the fibrocartilaginous anterior glenoid labrum of the acetabulum can be detected as a homogeneously hyperechoic triangular structure (same appearance as the knee meniscus)

9. Moving the probe cranially

10. FH –FEMORAL HEAD *Acetabula labrum Arrows – iliopsoas tendon .

11. IPT SHORT AXIS-Probe placed in transverse plane over the femoral head

12. Rectus femoris muscle

13. SCANNING TECHNIQUE RFM Place the transducer over the anterior inferior iliac spine to examine the direct tendon of the rectus femoris . On long-axis planes, note the posterior acoustic shadowing that underlies the direct tendon related to changes in orientation of tendon fibres at the union of the direct and indirect tendons.

14. Calcification within the tendon

15. Rectus femoris in short axis Scan distally in transverse plane in the middle of the muscle. You can start from the middle of the thigh and trace the muscle superiorly.

16. Rectus femoris in short axis

17. Sartorius tendon and TENSOR FASCIA LATAE

18. Neurovascular bundle Place the probe at the acetabula rim in transverse orientation, then move it medially along the pubic ramus. Structures visualized : Femoral artery Femoral vein Femoral nerve Empty space and lymphatics

19. Medial Hip Adductors muscles gracilis , obturator externus , adductor brevis , adductor longus adductor magnus

20. For examination of the medial hip, place the patient with the thigh abducted and externally rotated and the knee bent. Examine the insertion of the iliopsoas tendon on the lesser trochanter using long-axis planes. Placing the probe over the bulk of the adductors, three muscle layers are recognized on longitudinal planes: the superficial refers to the adductor longus (lateral) and the gracilis (medial), the intermediate to the adductor brevis and the deep to the adductor magnus . To image the adductor insertion, sweep the probe over the long axis of these muscles up to reach the pubis. The insertion of the adductor longus tendon is seen with its triangular hypoechoic shape.

21. LATERAL HIP: abductors The US examination of the lateral hip is performed by asking the patient to lie on the opposite hip assuming an oblique lateral or true lateral position Transverse and longitudinal US planes obtained cranial to the greater trochanter show the gluteus medius (superficial) and gluteus minimus (deep) muscles. To recognize them, the tensor fasciae latae can be used as a landmark:

22. POSTERIOR HIP hamstrings For examination of the posterior hip, the patient lies prone with the feet hanging hanging down from the bed. Lower US frequencies may be required to image thick thighs or obese patients. The gluteus maximus muscle is first evaluated by means of transverse and coronal oblique planes orientated according to its long andshort axis.

23. Long head of bicep Femoris SEMITENDINOSUS SEMIMEBRANOSUS

24. HAMSTRING AND SCIATIC NERVE. Posterior axial planes are the most useful to recognize the proximal origin of the ischiocrural (semimembranosus, semitendinosus, long head of the biceps femoris ) muscles. The ischial tuberosity is the main landmark: once detected, the most cranial portion of the ischiocrural tendons can be demonstrated as they insert on its lateral aspect

25. Shifting the probe downward on axial planes, the conjoined tendon of semitendinosus and biceps femoris can be distinguished from the tendon of semimembranosus due to its more superficial and lateral position

26. PATHOLOGY

27. PARA LABRAL CYST

28. TROCHANTERIC BURSITIS

29. PROXIMAL THIGH BONE OSTEOMYELITIS

30. Developmental hip dysplasia in paediatric Developmental dysplasia of the hip (DDH) is a condition where the "ball and socket" joint of the hip does not properly form in babies and young children. It can be congenital or acquired. There are children who are born with normal hips who develop dysplasia due to neuromascular disorders On the other hand there are children who are born with dysplasia of the hip that resolves spontaneously or after relatively simple treatment.

31. Examination technique A linear, high frequency probe is used. The focus is set at the acetabular edge. It is important to display an image in the coronal plane at the level of the triradiate cartilage, which is the synchondrosis between the iliac, ischial and pubic bones which form the acetabulum.

32. first three points of interest need to be indentified in the image: Centre of labrum Lower limb of the iliac bone (=Undersurface of the medial border of the acetabulum where the iliac bone meets the triradiate cartilage) Bony rim of acetabulum. When the bony rim is angular this point is easily recognized. When rounded this point is defined as the point where the concavity of the bony acetabular roof changes into the convexity of the ilium

33. The cartilaginous roof is compressed between the femoral head and the bony acetabular rim .

34. Graf classification The alpha-angle, which is a measurement of the bony roof of the acetabulum, mainly determines the hip type. Actually, for classification purposes the beta angle is only used to differentiate between type Ia and Ib (both normal hips) and between type IIc and type D)

35. REPORT Hospital name. Patient name age sex date Clinical history: anterior hip joint pain x 1/12 Findings The hip joint recess appear normal, without effusion or synovial hypertrophy. No femoral or acetabula cortical irregularity seen. The anterior labrum appear normal No evidence of iliopsoas bursal ditension or tendinosis The direct tendon insertion of rectus femoris appear normal, no free fluid collection seen.

36. The indirect tendon of rectus femoris is visualized, appear normal The attachment of Sartorius at the AIIS appear normal. The adductor longus,adductor brevis and adductor magnus muscle appear normal, the conjoined tendons of semitendinosus and long head of bicep appear normal.no fluid collection seen. The neurovascular bundle is unremarkable, no masses appreciated. Impression Normal hip ultrasound. Richard Adomeyon- MDU resident.

37. References Diagnostic Ultrasound Musculoskeletal,Grifin et.al. second edition. WEBINA@https ://youtu.be/Uv7ILAlUNIY?t=2695 . European Society of MusculoSkeletal RadiologyMusculoskeletal UltrasoundTechnical Guidelines IV. Hip

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