Download - Ultrasound Basics of the Hip
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Ultrasound Basics of the Hip
ByMohamed H Youssef MD
Arthritis/Rehab & Pain ClinicBoard certified of ABPM&R
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Hip Anatomy
• The hip joint is a “ball-and-socket” type joint that allows a good stability at the expense of a limited range of motion.
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Hip Anatomy
• The hip composed of the following structures:1-Bone structures (femoral head and acetabulum),
2-Fibrocartilaginous structures (acetabular labrum),3-Cartilage layers covering the hip joint,4-Capsular-ligamentous structures,
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Hip Anatomy
5-Synovial joint
6-Muscles and tendons
7-Synovial bursae
8-Neurovascular structures.
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Hip Joint
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Bone structures The acetabulumIt is a cup-shaped cavity .The ball-shaped head of the femur fits in.
The acetabular edge : circular bone flap surrounded itThe lunate-surface: the most peripheral portionof the inner surface, it is used in the articulationThe acetabular pit: the central portion, , accommodates the round ligament extended between the acetabulum and the femoral head surrounded by adipose tissue and vascular structures.
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Acetabulum
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Bone Structures The femoral head
. It is rounded in shape.• supported by the anatomical neck which is situated at an angle
of about 130° to the axis of the femoral shaft in the coronal plane.
• The trochanters: at the base of the neck two trochanters (the greater trochanter and the lesser trochanter) where the periarticular muscles are inserted
• fovea capitis femoris :in the center of the head there is a small depression to which the round ligament is attached.
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Femoral Head
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Fibrocartilaginous structures
• The acetabular labrum: it is an axial section of the triangular fibrocartilage whose base is inserted on to the acetabular edge.
• The Labrum has three main functions: 1- it inserts the capsular-ligamentous structures of the joint. 2-it increases the concavity of the acetabular fossa 3- it increases the contact area with the femoral head.
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Hip Joint Labrum
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Cartilage layer covering the hip joint
• The layers of articular cartilage cover the entire joint surface with the exception of the acetabular fossa and the fovea capitis femoris.
• The femoral head is covered by cartilage tissue up to the passage between the femoral head and neck.
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Cartilaginous layer
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Capsular-ligamentous structures
• The articular capsule is a fibrous sheath.• Proximally it inserts on to the edge of the acetabulum and on to the acetabular labrum• distally on to the intertrochanteric line (in front) • between the third medium and distal third of the femoral neck (behind). Three peripheral thickenings of the capsule form the most important ligaments : • The iliofemoral ligament •The pubofemoral ligament •The ischiofemoral ligament
• The round ligament is located centrally between the acetabular fossa and the fovea capitis of the femoral head.
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Hip Joint Ligaments
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Hip Joint Ligaments
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Synovial Joint
The synovial joint lines the inner surface of the joint capsule and forms a complete sheath by surrounding the round ligament.
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Synovial joint
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MUSCLES& TENDONS
• 1-ANTERIOR GROUP• 2-MEDIAL GROUP• 3-LATERAL GROUP• 4-POSTERIOR GROUP
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Anterior muscles
• RECTUS FEMORIS
• ILIOPSOAS
• ILIACUS
• PECTINEUS
• SARTORIUS
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Medial muscles
• Adductor longus
• Adductor brevis
• Adductor magnus
• Gracilis
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Lateral muscles
• Gluteus minimus
• Gluteus medius
• Gluteus maximus
• Tensor fasciae latae
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Posterior muscles
• Semimembranosus
• Semitendinosus
• Long head of Biceps Femoris
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Synovial bursae
• Iliopsoas bursa
• Peritrochantric bursadivided into: large,midium,small bursae
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What probe to use?
• Curved linear probe
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Where to put the probe?
• 30-35 degree with the vertical
• The meeting point of two imaginary lines vertical from ASIS and horizontal from ANT pubic edge.
• Two fingers breadth away from femoral pulse
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Position of the thigh
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Positioning the probe
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US of the Hip
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US of the GTB
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Injection of hip joint
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References
• Hip: Anatomy and US technique• L. Molini,a M. Precerutti,b A. Gervasio,c
F. Draghi,d and S. Bianchie,• Tom Clark ultrasound course