Musculoskeletal ultrasound of the hip
- Mederic M Hall, MD
Mederic M Hall, MD
- Assistant Professor of Orthopedics and Rehabilitation
- UI Sports Medicine, University of Iowa
- Sathish Rajasekaran, MD
Sathish Rajasekaran, MD
- Assistant Clinical Professor of Physical Medicine and Rehabilitation
- University of Alberta
- Section Editor
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
Diagnosis of hip region disorders can prove challenging based on history and physical examination alone. Ultrasound has proven to be a useful clinical tool, especially when patient complaints are dynamic in nature (ie, snapping hip), as static imaging is typically unrevealing. Although the relatively deep location of many hip structures creates challenges, appropriate transducer selection and image optimization allows for adequate imaging of many structures.
This topic will describe a systematic approach to complete sonographic evaluation of each hip quadrant. Topics devoted to hip pain and specific hip conditions are found separately. (See "Approach to hip and groin pain in the athlete and active adult" and "Evaluation of the adult with hip pain" and "Overview of hip pain in childhood" and "Musculoskeletal examination of the hip and groin" and "Greater trochanteric pain syndrome (formerly Trochanteric bursitis)" and "Hip fractures in adults" and "Evaluation and management of slipped capital femoral epiphysis (SCFE)" and "Osteitis pubis".)
USES, ADVANTAGES, AND LIMITATIONS OF HIP ULTRASOUND
Physical principles and technology of ultrasound are reviewed separately. (See "Basic principles and safety of diagnostic ultrasound in obstetrics and gynecology".)
Below, the advantages and limitations of the ultrasound examination of the hip are reviewed; the general advantages and limitations of musculoskeletal ultrasound are discussed separately. (See "Musculoskeletal ultrasound of the shoulder".)
Ultrasound offers many advantages about the hip. Its superior spatial resolution allows for detailed evaluation of muscle, tendon, and nerve disorders that may not be apparent on other imaging modalities. Mechanical complaints of snapping or clicking can be assessed in real time, and the location of pain can be correlated with precise anatomic structures by palpation with the ultrasound transducer (ie, sonopalpation). Another advantage of ultrasound is the lack of artifact associated with orthopedic hardware, allowing for evaluation of surrounding structures for impingement or irritation.
- American College of Radiology (ACR), Society for Pediatric Radiology (SPR), Society of Radiologists in Ultrasound (SRU). AIUM practice guideline for the performance of a musculoskeletal ultrasound examination. J Ultrasound Med 2012; 31:1473.
- Finnoff JT, Berkoff D, Brennan F, et al. American Medical Society for Sports Medicine (AMSSM) recommended sports ultrasound curriculum for sports medicine fellowships. PM R 2015; 7:e1.
- www.essr.org/html/img/pool/hip.pdf (Accessed on February 16, 2016).
- Klauser AS, Tagliafico A, Allen GM, et al. Clinical indications for musculoskeletal ultrasound: a Delphi-based consensus paper of the European Society of Musculoskeletal Radiology. Eur Radiol 2012; 22:1140.
- Jacobson JA. Fundamentals of musculoskeletal ultrasound, 2nd ed, Saunders, Philadelphia 2007.
- Robben SG, Lequin MH, Diepstraten AF, et al. Anterior joint capsule of the normal hip and in children with transient synovitis: US study with anatomic and histologic correlation. Radiology 1999; 210:499.
- Melamed A, Bauer CA, Johnson JH. Iliopsoas bursal extension of arthritic disease of the hip. Radiology 1967; 89:54.
- Pritchard RS, Shah HR, Nelson CL, FitzRandolph RL. MR and CT appearance of iliopsoas bursal distention secondary to diseased hips. J Comput Assist Tomogr 1990; 14:797.
- Tormenta S, Sconfienza LM, Iannessi F, et al. Prevalence study of iliopsoas bursitis in a cohort of 860 patients affected by symptomatic hip osteoarthritis. Ultrasound Med Biol 2012; 38:1352.
- Jacobson JA, Khoury V, Brandon CJ. Ultrasound of the Groin: Techniques, Pathology, and Pitfalls. AJR Am J Roentgenol 2015; 205:513.
- Balius R, Pedret C, Blasi M, et al. Sonographic evaluation of the distal iliopsoas tendon using a new approach. J Ultrasound Med 2014; 33:2021.
- USES, ADVANTAGES, AND LIMITATIONS OF HIP ULTRASOUND
- HIP ANATOMY
- ULTRASOUND EXAMINATION OF THE HIP
- Guidelines, structures to image, and positioning
- Anterior hip region
- - Sagittal oblique (parallel to long-axis of femoral neck)
- - Transverse oblique
- - Transverse
- - Dynamic scanning of snapping hip
- Lateral hip region
- - General examination
- - Dynamic scanning of snapping hip
- Medial region
- - Abducted-externally rotated (frog leg)
- - Flexion-abduction-external rotation (FABER)
- Posterior region (prone with or without pillow under hips)
- ADDITIONAL ULTRASOUND RESOURCES
- SUMMARY AND RECOMMENDATIONS