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Ultrasound-guided musculoskeletal interventional procedures around the hip: a practical guide

Domenico Albano
Domenico Albano
, 
Salvatore Gitto
Salvatore Gitto
, 
Francesca Serpi
Francesca Serpi
, 
Alberto Aliprandi
Alberto Aliprandi
, 
Luca Maria Sconfienza
Luca Maria Sconfienza
 e 
Carmelo Messina
Carmelo Messina
   | 28 feb 2023
Journal of Ultrasonography's Cover Image
INFORMAZIONI SU QUESTO ARTICOLO
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Article Category: Review paper
Pubblicato online: 28 feb 2023
Pagine: 15 - 22
Ricevuto: 27 ago 2022
Accettato: 17 nov 2022
DOI: https://doi.org/10.15557/JoU.2023.0003
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© 2023 Domenico Albano, Salvatore Gitto, Francesca Serpi, Alberto Aliprandi, Luca Maria Sconfienza, Carmelo Messina, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1

Ultrasound-guided hip joint injection. A. The patient is supine, and a convex transducer is positioned parallel to the femoral neck. B. The corresponding ultrasound image shows the needle inserted into the hip joint at the head-neck junction with in-plane technique. H– femoral head; N– femoral neck
Ultrasound-guided hip joint injection. A. The patient is supine, and a convex transducer is positioned parallel to the femoral neck. B. The corresponding ultrasound image shows the needle inserted into the hip joint at the head-neck junction with in-plane technique. H– femoral head; N– femoral neck

Fig. 2

Ultrasound-guided iliopsoas injection. A. The patient is supine, and a linear transducer is positioned in transverse position at the level of the acetabulum to scan the iliopsoas tendon in the short axis. B. The corresponding ultrasound image shows how to insert the needle with in-plane lateral-to-medial approach to reach the deep aspect of the tendon (asterisk). With this approach, the femoral neurovascular bundle (arrow), in the medial aspect of the image, cannot be injured. IP – iliopsoas muscle
Ultrasound-guided iliopsoas injection. A. The patient is supine, and a linear transducer is positioned in transverse position at the level of the acetabulum to scan the iliopsoas tendon in the short axis. B. The corresponding ultrasound image shows how to insert the needle with in-plane lateral-to-medial approach to reach the deep aspect of the tendon (asterisk). With this approach, the femoral neurovascular bundle (arrow), in the medial aspect of the image, cannot be injured. IP – iliopsoas muscle

Fig. 3

Ultrasound-guided greater trochanter injection. A. The patient is in lateral position on the unaffected side, with a linear probe placed in longitudinal position on the greater trochanter. B. The ultrasound image shows the middle facet of the greater trochanter (T), the insertion of the gluteus medius tendon (asterisk) and the needle that is advanced with in-plane caudal-to-cranial approach to reach the tendon beneath the fascia lata (arrow). GMa – gluteus maximus muscle; GMe – gluteus medius muscle
Ultrasound-guided greater trochanter injection. A. The patient is in lateral position on the unaffected side, with a linear probe placed in longitudinal position on the greater trochanter. B. The ultrasound image shows the middle facet of the greater trochanter (T), the insertion of the gluteus medius tendon (asterisk) and the needle that is advanced with in-plane caudal-to-cranial approach to reach the tendon beneath the fascia lata (arrow). GMa – gluteus maximus muscle; GMe – gluteus medius muscle

Fig. 4

Ultrasound-guided hamstrings injection. A. The patient is prone, with the probe being placed in longitudinal position on the ischial tuberosity. B. The needle in inserted with in-plane caudal-to-cranial approach to reach the ischial insertion of hamstring tendons (asterisk). I – ischial tuberosity
Ultrasound-guided hamstrings injection. A. The patient is prone, with the probe being placed in longitudinal position on the ischial tuberosity. B. The needle in inserted with in-plane caudal-to-cranial approach to reach the ischial insertion of hamstring tendons (asterisk). I – ischial tuberosity

Fig. 5

Ultrasound-guided sciatic nerve injection. A. The patient is prone, and the probe is placed in transverse position to scan the sciatic nerve on the posterior aspect of the buttock. B. The sciatic nerve is identified in the ischiofemoral space between the gluteus maximus (superficially) and pelvitrochanteric muscles (deeply and medially), with the needle being advanced with in-plane lateral-to-medial approach. I – ischium; F– femur
Ultrasound-guided sciatic nerve injection. A. The patient is prone, and the probe is placed in transverse position to scan the sciatic nerve on the posterior aspect of the buttock. B. The sciatic nerve is identified in the ischiofemoral space between the gluteus maximus (superficially) and pelvitrochanteric muscles (deeply and medially), with the needle being advanced with in-plane lateral-to-medial approach. I – ischium; F– femur

Fig. 6

Ultrasound-guided injection of the lateral femoral cutaneous nerve. A. The patient is supine, and the linear probe is in transverse position at the level of the anterior superior iliac spine. B. The needle is advanced with in-plane lateral-to-medial approach to reach the lateral femoral cutaneous nerve (arrow) beneath the inguinal ligament and superficial to the sartorius muscle (S). IP – iliopsoas muscle
Ultrasound-guided injection of the lateral femoral cutaneous nerve. A. The patient is supine, and the linear probe is in transverse position at the level of the anterior superior iliac spine. B. The needle is advanced with in-plane lateral-to-medial approach to reach the lateral femoral cutaneous nerve (arrow) beneath the inguinal ligament and superficial to the sartorius muscle (S). IP – iliopsoas muscle

Fig. 7

Ultrasound-guided injection of the pudendal nerve. A. The patient is prone, and the linear transducer is placed in oblique position at the level of the ischiatic spine. B. The pudendal nerve (arrow) is identified medial to the pudendal artery (within the circle) between the gluteus maximus muscle (GMa) and the obturator internus muscle (OI). Once identified, the needle can be advanced with in-plane lateral-to-medial approach. I – ischial bone; IS – ischial spine
Ultrasound-guided injection of the pudendal nerve. A. The patient is prone, and the linear transducer is placed in oblique position at the level of the ischiatic spine. B. The pudendal nerve (arrow) is identified medial to the pudendal artery (within the circle) between the gluteus maximus muscle (GMa) and the obturator internus muscle (OI). Once identified, the needle can be advanced with in-plane lateral-to-medial approach. I – ischial bone; IS – ischial spine
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