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High-resolution ultrasound in the evaluation of the adult hip

Linda Probyn
Linda Probyn
, 
Dyan Flores
Dyan Flores
, 
Emma Rowbotham
Emma Rowbotham
, 
Mark Cresswell
Mark Cresswell
 und 
Angela Atinga
Angela Atinga
   | 23. Nov. 2023
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Article Category: Review paper
Online veröffentlicht: 23. Nov. 2023
Seitenbereich: e223 - e238
Eingereicht: 30. Juni 2023
Akzeptiert: 27. Juli 2023
DOI: https://doi.org/10.15557/jou.2023.0031
Schlüsselwörter
© 2023 Linda Probyn et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1.

Normal anterior joint recess. Graphic illustrations (A, B) showing the transducer position (A) and equivalent anatomy (B) for long-axis scanning of the anterior hip joint recess. Long-axis US image (C) is depicted. Double-headed arrows in B and C demonstrate measurement of the recess (US image shows a recess measuring 5 mm)
Normal anterior joint recess. Graphic illustrations (A, B) showing the transducer position (A) and equivalent anatomy (B) for long-axis scanning of the anterior hip joint recess. Long-axis US image (C) is depicted. Double-headed arrows in B and C demonstrate measurement of the recess (US image shows a recess measuring 5 mm)

Fig. 2.

Normal iliopsoas myotendinous junction (MTJ) complex on US. Graphic illustration (A) showing normal transducer positions and equivalent short-axis oblique (B) and short-axis (C) US images (LFI – lateral iliacus muscle; MFI – medial iliacus muscle; PMT – psoas tendon; PMM – psoas major muscle; FA – femoral artery). Fig. 2 A is modified with permission from Flores et al.(3)
Normal iliopsoas myotendinous junction (MTJ) complex on US. Graphic illustration (A) showing normal transducer positions and equivalent short-axis oblique (B) and short-axis (C) US images (LFI – lateral iliacus muscle; MFI – medial iliacus muscle; PMT – psoas tendon; PMM – psoas major muscle; FA – femoral artery). Fig. 2 A is modified with permission from Flores et al.(3)

Fig. 3.

Normal iliopsoas tendon on US. Graphic illustration (A) and long-axis US image (B) show normal iliopsoas tendon (arrowheads) (LT – lesser trochanter with contour outlined in light blue). Fig. 3 A is modified with permission from Flores et al.(3)
Normal iliopsoas tendon on US. Graphic illustration (A) and long-axis US image (B) show normal iliopsoas tendon (arrowheads) (LT – lesser trochanter with contour outlined in light blue). Fig. 3 A is modified with permission from Flores et al.(3)

Fig. 4.

Normal rectus femoris anatomy. Graphic illustration (A) showing normal transducer positions and equivalent long-axis US images of the direct head (arrowheads) (B) and indirect head (arrows) (C) origins (blue outline – direct head origin at the ASIS; yellow outline – indirect head origin at the acetabular ridge)
Normal rectus femoris anatomy. Graphic illustration (A) showing normal transducer positions and equivalent long-axis US images of the direct head (arrowheads) (B) and indirect head (arrows) (C) origins (blue outline – direct head origin at the ASIS; yellow outline – indirect head origin at the acetabular ridge)

Fig. 5.

Normal US and MRI of the LFCN. Short-axis US image (A) and axial PD-weighted fat-suppressed MR image (B) at the level of the iliacus muscle show a normal LFCN (yellow dotted outline in A and arrow in B) medial to the innominate bone and superficial to the iliacus muscle (Gmin – gluteus minimus; SAR – sartorius, TFL – tensor fascia lata)
Normal US and MRI of the LFCN. Short-axis US image (A) and axial PD-weighted fat-suppressed MR image (B) at the level of the iliacus muscle show a normal LFCN (yellow dotted outline in A and arrow in B) medial to the innominate bone and superficial to the iliacus muscle (Gmin – gluteus minimus; SAR – sartorius, TFL – tensor fascia lata)

Fig. 6.

Joint effusion on US. Long-axis US image in an adult patient, with clinical concern for joint effusion, demonstrates joint fluid pooling in the anterior joint recess (arrows). The presence o fluid outlines the cartilage (arrowhead), making it more conspicuous (cartilage conspicuity sign)
Joint effusion on US. Long-axis US image in an adult patient, with clinical concern for joint effusion, demonstrates joint fluid pooling in the anterior joint recess (arrows). The presence o fluid outlines the cartilage (arrowhead), making it more conspicuous (cartilage conspicuity sign)

Fig. 7.

THA pseudotumor in a 60-year-old female with left hip swelling. Screening US was requested and long-axis US image of the left hip (A) shows large fluid collection (*) with hyperemia on color Doppler interrogation at the anterior aspect of the left hip. Transverse CT image of the pelvis (B) was requested the next day, confirming the pseudotumor (*). Note the streak artifacts emanating from the hardware on the CT image, though the large size of the pseudotumor enabled easy visualization
THA pseudotumor in a 60-year-old female with left hip swelling. Screening US was requested and long-axis US image of the left hip (A) shows large fluid collection (*) with hyperemia on color Doppler interrogation at the anterior aspect of the left hip. Transverse CT image of the pelvis (B) was requested the next day, confirming the pseudotumor (*). Note the streak artifacts emanating from the hardware on the CT image, though the large size of the pseudotumor enabled easy visualization

Fig. 8.

Anterosuperior paralabral cyst in a 70-year-old female with left hip pain of 4 months’ duration. Long-axis US image at the level of the hip (A) shows a complex lesion (arrows) arising from the joint space. This was noncompressible on transducer pressure, raising the possibility of a paralabral cyst. Axial PD-weighted fat-suppressed MR image (B) confirms a paralabral cyst (arrows) associated with an underlying labral tear (arrowhead)
Anterosuperior paralabral cyst in a 70-year-old female with left hip pain of 4 months’ duration. Long-axis US image at the level of the hip (A) shows a complex lesion (arrows) arising from the joint space. This was noncompressible on transducer pressure, raising the possibility of a paralabral cyst. Axial PD-weighted fat-suppressed MR image (B) confirms a paralabral cyst (arrows) associated with an underlying labral tear (arrowhead)

Fig. 9.

Iliopsoas avulsion in a 90-year-old female with suspected joint effusion. Long-axis US at the level of the femoral head (A) shows a curvilinear echogenic lesion with marked shadowing (arrowheads) at the level of the femoral head, raising the possibility of an avulsed fracture fragment likely related to the iliopsoas. Radiographs were requested. AP radiograph (B) confirmed an avulsed bony fragment (arrowhead) along with a frank pathologic fracture of the proximal femoral diaphysis
Iliopsoas avulsion in a 90-year-old female with suspected joint effusion. Long-axis US at the level of the femoral head (A) shows a curvilinear echogenic lesion with marked shadowing (arrowheads) at the level of the femoral head, raising the possibility of an avulsed fracture fragment likely related to the iliopsoas. Radiographs were requested. AP radiograph (B) confirmed an avulsed bony fragment (arrowhead) along with a frank pathologic fracture of the proximal femoral diaphysis

Fig. 10.

Iliopsoas bursal fluid in a 68-year-old female with right hip and groin pain, query labral tear. Long-axis (A) and short-axis (B) US images show a large fluid collection (*) deep to the femoral vessels. It appears to be compartmentalized on short-axis image related to a prominent band of tissue suspected to be either a septation, a bifid or slip of the psoas tendon (arrowheads in B). Axial PD-weighted fat-suppressed MR image (C) confirms the bursal fluid and the band of tissue (arrowhead in C), which was confirmed to be a bifid tendon on the rest of the axial MR images. A hip joint effusion is also noted
Iliopsoas bursal fluid in a 68-year-old female with right hip and groin pain, query labral tear. Long-axis (A) and short-axis (B) US images show a large fluid collection (*) deep to the femoral vessels. It appears to be compartmentalized on short-axis image related to a prominent band of tissue suspected to be either a septation, a bifid or slip of the psoas tendon (arrowheads in B). Axial PD-weighted fat-suppressed MR image (C) confirms the bursal fluid and the band of tissue (arrowhead in C), which was confirmed to be a bifid tendon on the rest of the axial MR images. A hip joint effusion is also noted

Fig. 11.

Graphic illustration showing normal transducer position for assessing the lateral hip. For evaluation of the gluteus tendons at the facets, the transducer can be swept anterior to posterior and vice-versa (doubleheaded curved arrow)
Graphic illustration showing normal transducer position for assessing the lateral hip. For evaluation of the gluteus tendons at the facets, the transducer can be swept anterior to posterior and vice-versa (doubleheaded curved arrow)

Fig. 12.

Normal facets. Graphic illustration (A), short-axis US image (B) and axial T1-weighted MR image (C) show normal facets. The anterior (yellow dotted outline) and lateral (light blue dotted outline) facets are demarcated by a sharp bony angulation (*) while the contour between the lateral and posterior (red dotted outline in B and C) curves more gently. The gluteus minimus tendon (arrowheads in B and C) attaches to the anterior facet, while the gluteus medius tendon (arrows in B and C) to the lateral and superoposterior facets. Intervening bursae are also shown (Gmed-t – gluteus medius tendon; Gmed- m – gluteus medius muscle; Gmin-t – gluteus minimus tendon; Gmin-m – gluteus minimus muscle; Gmax – gluteus maximus muscle; TB – trochanteric bursa; Gmed-b – subgluteus medius bursa; Gmin-b – subgluteus minimus bursa; Gmax – gluteus maximus muscle)
Normal facets. Graphic illustration (A), short-axis US image (B) and axial T1-weighted MR image (C) show normal facets. The anterior (yellow dotted outline) and lateral (light blue dotted outline) facets are demarcated by a sharp bony angulation (*) while the contour between the lateral and posterior (red dotted outline in B and C) curves more gently. The gluteus minimus tendon (arrowheads in B and C) attaches to the anterior facet, while the gluteus medius tendon (arrows in B and C) to the lateral and superoposterior facets. Intervening bursae are also shown (Gmed-t – gluteus medius tendon; Gmed- m – gluteus medius muscle; Gmin-t – gluteus minimus tendon; Gmin-m – gluteus minimus muscle; Gmax – gluteus maximus muscle; TB – trochanteric bursa; Gmed-b – subgluteus medius bursa; Gmin-b – subgluteus minimus bursa; Gmax – gluteus maximus muscle)

Fig. 13.

Small amount of trochanteric bursal fluid in a 84-year-old female with THA and concern for a pseudotumor. Long-axis US image of the greater trochanter shows trace fluid in the overlying trochanteric bursa (arrowheads). There is a small enthesophyte (arrow) adjacent to the greater trochanter
Small amount of trochanteric bursal fluid in a 84-year-old female with THA and concern for a pseudotumor. Long-axis US image of the greater trochanter shows trace fluid in the overlying trochanteric bursa (arrowheads). There is a small enthesophyte (arrow) adjacent to the greater trochanter

Fig. 14.

Calcific tendinosis in a 57-year-old female with severe left hip pain when lying on side. Long-axis US image (A) shows faint echogenic lesion adjacent to the greater trochanter (arrowhead). There is no significant hyperemia on color Doppler interrogation. AP radiograph of the pelvis (B) confirms calcification consistent with calcific tendinosis by the left greater trochanter
Calcific tendinosis in a 57-year-old female with severe left hip pain when lying on side. Long-axis US image (A) shows faint echogenic lesion adjacent to the greater trochanter (arrowhead). There is no significant hyperemia on color Doppler interrogation. AP radiograph of the pelvis (B) confirms calcification consistent with calcific tendinosis by the left greater trochanter

Fig. 15.

Complete gluteus minimus tendon tear and partial width gluteus medius tendon tear in an 82-year-old female with symptoms of abductor insufficiency. Short-axis US image shows bare appearance of the anterior facet (yellow dotted outline) and part of the lateral facet (light blue dotted outline), consistent with complete gluteus minimus and partial width gluteus medius tendon tears. The rest of the gluteus medius tendon fibers (arrows) are thickened but intact (border between anterior and lateral facets demarcated by *)
Complete gluteus minimus tendon tear and partial width gluteus medius tendon tear in an 82-year-old female with symptoms of abductor insufficiency. Short-axis US image shows bare appearance of the anterior facet (yellow dotted outline) and part of the lateral facet (light blue dotted outline), consistent with complete gluteus minimus and partial width gluteus medius tendon tears. The rest of the gluteus medius tendon fibers (arrows) are thickened but intact (border between anterior and lateral facets demarcated by *)

Fig. 16.

Partial intrasubstance tears and tendinosis of the gluteus medius in a 57-year-old female with lateral hip pain after THA, US ordered to evaluate for pseudotumor. AP radiograph of the pelvis (A) shows the right THA with a cerclage cable along the proximal femoral metaphysis. Long-axis US images (B) demonstrate thickening, irregularity, and small anechoic clefts within the gluteus medius tendon (arrowheads), consistent with partial intrasubstance tears and tendinosis. A few of the proximal fibers (arrows) appear intact
Partial intrasubstance tears and tendinosis of the gluteus medius in a 57-year-old female with lateral hip pain after THA, US ordered to evaluate for pseudotumor. AP radiograph of the pelvis (A) shows the right THA with a cerclage cable along the proximal femoral metaphysis. Long-axis US images (B) demonstrate thickening, irregularity, and small anechoic clefts within the gluteus medius tendon (arrowheads), consistent with partial intrasubstance tears and tendinosis. A few of the proximal fibers (arrows) appear intact

Fig. 17.

Gluteus medius tendon repair dehiscence in a 70-year-old woman with lateral hip pain after THA and abductor tendon repair. Short-axis US images of the left hip (A, B) and axial PD-weighted fat-suppressed MR image of the pelvis (C) show a bare lateral facet (light blue dotted outline), consistent with a high-grade dehiscence of the anterior gluteus medius tendon fibers. The more posterior fibers attaching to the superoposterior facet are tendinotic but intact arrowheads in A and C). Note the associated trochanteric bursal fluid (* in B and C)
Gluteus medius tendon repair dehiscence in a 70-year-old woman with lateral hip pain after THA and abductor tendon repair. Short-axis US images of the left hip (A, B) and axial PD-weighted fat-suppressed MR image of the pelvis (C) show a bare lateral facet (light blue dotted outline), consistent with a high-grade dehiscence of the anterior gluteus medius tendon fibers. The more posterior fibers attaching to the superoposterior facet are tendinotic but intact arrowheads in A and C). Note the associated trochanteric bursal fluid (* in B and C)

Fig. 18.

Clinical photograph of a Morel-Lavallée lesion in a ski cross athlete after a crash. Note the marked swelling over the lateral hip (arrowheads) centered on the greater trochanter (*)
Clinical photograph of a Morel-Lavallée lesion in a ski cross athlete after a crash. Note the marked swelling over the lateral hip (arrowheads) centered on the greater trochanter (*)

Fig. 19.

Morel-Lavallée lesion in a 32-year-old male who fell to his side during cycling. Long-axis US images (A, B) demonstrate a large, spindle-shaped complex fluid collection (arrowheads) adjacent to the greater trochanter (GT) extending to the anterior superior iliac spine (ASIS)
Morel-Lavallée lesion in a 32-year-old male who fell to his side during cycling. Long-axis US images (A, B) demonstrate a large, spindle-shaped complex fluid collection (arrowheads) adjacent to the greater trochanter (GT) extending to the anterior superior iliac spine (ASIS)

Fig. 20.

Normal proximal hamstring tendons on US. Graphic illustration (A) showing normal transducer positions and equivalent short-axis US images at the level of the ischial tuberosity (IT) (B) and proximal thigh (C) (arrowheads – conjoint tendon; arrows – sciatic nerve; curved arrows – semimembranosus tendon; st-m – semitendinosus muscle; am – adductor magnus muscle; bf – biceps femoris tendon). Fig. 20 A is modified with permission from Flores et al.(3)
Normal proximal hamstring tendons on US. Graphic illustration (A) showing normal transducer positions and equivalent short-axis US images at the level of the ischial tuberosity (IT) (B) and proximal thigh (C) (arrowheads – conjoint tendon; arrows – sciatic nerve; curved arrows – semimembranosus tendon; st-m – semitendinosus muscle; am – adductor magnus muscle; bf – biceps femoris tendon). Fig. 20 A is modified with permission from Flores et al.(3)

Fig. 21.

Normal ischiofemoral space. Graphic illustration (A) demonstrates normal transducer position for assessing the ischiofemoral space. Short-axis US image (B) shows the normal sonographic appearance of the space (qf – quadratus femoris; arrowhead – sciatic nerve) Fig. 21 A is modified with permission from Flores et al.(3)
Normal ischiofemoral space. Graphic illustration (A) demonstrates normal transducer position for assessing the ischiofemoral space. Short-axis US image (B) shows the normal sonographic appearance of the space (qf – quadratus femoris; arrowhead – sciatic nerve) Fig. 21 A is modified with permission from Flores et al.(3)

Fig. 22.

Complete hamstring tendon tear in a 55-year-old soccer player who felt a pop after a kick. Long-axis US image shows a complex tear of the proximal hamstrings with distal retraction of torn tendon fibers to the level of the proximal thigh (arrowheads) IT – ischial tuberosity). Sagittal PD-weighted fat-suppressed MR image confirms the tear (arrowheads)
Complete hamstring tendon tear in a 55-year-old soccer player who felt a pop after a kick. Long-axis US image shows a complex tear of the proximal hamstrings with distal retraction of torn tendon fibers to the level of the proximal thigh (arrowheads) IT – ischial tuberosity). Sagittal PD-weighted fat-suppressed MR image confirms the tear (arrowheads)

Fig. 23.

Ischiogluteal bursitis in a 52-year-old female with persistent pain during sitting. Short-axis US image (A) and sagittal CT (B) show a fluid collection (arrowheads) superficial to the ischial tuberosity (IT), consistent with ischiogluteal bursal fluid
Ischiogluteal bursitis in a 52-year-old female with persistent pain during sitting. Short-axis US image (A) and sagittal CT (B) show a fluid collection (arrowheads) superficial to the ischial tuberosity (IT), consistent with ischiogluteal bursal fluid

Fig. 24.

Graphic illustration (A) demonstrates the osseous footprints and normal transducer position for assessing the adductor tendons (AB – adductor brevis, footprint highlighted in red; AL – adductor longus, footprint highlighted in blue; AM – adductor magnus, footprint highlighted in green). Long-axis US image (B) shows the normal sonographic appearance of the same muscles
Graphic illustration (A) demonstrates the osseous footprints and normal transducer position for assessing the adductor tendons (AB – adductor brevis, footprint highlighted in red; AL – adductor longus, footprint highlighted in blue; AM – adductor magnus, footprint highlighted in green). Long-axis US image (B) shows the normal sonographic appearance of the same muscles
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