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Standardizedscanhipandbasic pathology INGRIDMÖLLER EULARWORKINGGROUPANATOMYFORTHE IMAGE AnatomicalImagesobtainedattheUniversityof Barcelona. InsLtutoPoaldeReumatologia [email protected] Ins$tutoPoalde ANTERIORHIPANATOMY ANTERIORHIP S Labrum IP RF VL Ilio-femoralLigamen FH POSITION-PLACEMENT-LANDMARKS Position : Supinedecubitus,hipinneutralpositionorslight externalrotation Probeplacement : Longitudinalandtransverseplains alignedwiththeaxisofthefemoralneck BonyLandmarks : Femoralhead,acetabulum,femoralneck ANTERIORHIPSONOANATOMY S IP RF VL Sartorius IliofemoralLigament Rectus Femoris The anterior joint capsule extends down to reach the intertrochanteric line superficial fibers Æ in continuity with the periosteum deep fibers Æ reflect and travel upward to insert into the junction between the femoral head and neck, at the distal edge of the articular cartilage ANTERIORHIPPATHOLOGY HIP-JOINTPATHOLOGY ANTERIORHIP-SYNOVITIS §Cannot bepalpated §US imagesobtainedlongitudinallyovertheanteriorfemoralneck §Anterior andposteriorlayersofcapsuleshouldnotbeconfusedwithsynovitis §Erosions aremoreaccuratelyseenbyMRIorCTimaging MRI CT §US cannotinvestigatetheoverallarticularsurfaceduetotheposterioracousticshadowingproduced bytheacetabularcover HIPSYNOVITIS HIP-GUIDEDINJECTION ANTERIORHIP-LABRUM ANTERIORHIP-LABRUM Pathologymostcommonanteriorly LABRALCYST CHONDROCALCINOSIS HIP-ARTICULARCARTILAGE. HIPOSTEOARTHRITIS HIPOSTEOARTHRITIS MOREANTERIORHIPANATOMY ANTERIOR PROXIMAL Pubis ASIS FN FA Ilio-Psoas POSTERIOR FEMORALTRIANGLE:LACUNA VASORUM/MUSCULORUM IL Thespacecomprisedbetweenthe inguinalligamentandtheunderlying bones(iliaclaterallyandpubismedially) isdividedintotwocompartmentsbythe iliopectinealligament iliopectineal arch IL iliopsoas femoral nerve Vein artery LACUNAVASORUM/MUSCULORUM Inguinalligament ASIS FA FN ilio-Psoas LACUNAVASORUM/MUSCULORUM ilio-PectinealLigament MOREANTERIORHIP PATHOLOGY ILIOPSOASBURSITIS • Closetothefemoralneurovascularbundle • Canproducecompression Pellman1986,Yoon2000,Bianchi2002 HIPSYNOVITIS/BURSITIS LATERALFEMORALCUTANEOUS NERVE USÆvisualizedin70%of cases(13-5MHz) 70% 13-5MHz LATERALFEMORALCUTANEOUS NERVE LATERALHIPANATOMY ANTERIOR LAT POSTERIOR MEDIAL POSITION,PLACEMENT,LANDMARKS Position : Lateraldecubitus Probeplacement : Transversallytothefemoraldiaphysis.Theprobeis movedfromanteriortoposterior BonyLandmarks : “TRIANGLE”ofGreatertrochanter FACETS SUPERIORPOSTERIOR POSTERIOR LATERAL ANTERIOR GluteusMinimus GluteusMedius TrochantericBursa MUSCLES-DEEPLAYER POST GMIN ANTFACET GMIN GMED “ ‘’ROTATORCUFF” GLUTEUSMINIMUS ANTERIOR POSTERIOR Gmin Gmed MUSCLES-DEEPLAYER GMED POST GMED “ROTATOR CUFF” GLUTEUSMEDIUS MUSCLES-DEEPLAYER CRANIAL Piriformis ANTERIOR Gluteusmedius Sciatic GT MUSCLES-DEEPLAYER CRANIAL POSTERIOR GluteusMedius ANTERIOR Posterior-SuperiorFacet LateralFacet MUSCLES-SUPERFICIALLAYER GM FL TFL GMAX TFL FL “DELTOIDOFFARABEUF” PERITROCHANTERICBURSAE • Trochanteric(Trb) Trb – Largest;PostFacet,LatGmedTendon,AntVastus LateralisInsertion;underGmax&Itb Itb • SubgluteusMedius – DeeptoLatGmedTendon;coveringSuperiorAspect oftheLatFacet • SubgluteusMinimus – DeeptoMinimusTendon;CoveringAntFacetGoing MediallytoAntHipCapsule • 20Bursae – AroundHipJt;upto6ormoreinTrochanteric Region;#IncreasewithAge 6 DUNN:CLINANAT2003;WOODLEY:JORTHO&SPORTS PT2008;PFIRRMAN201 POSITION,PLACEMENT,LANDMARKS Position : Lateraldecubitus Probeplacement : Transversallytothefemoraldiaphysis.Theprobeis movedfromanteriortoposterior BonyLandmarks : “TRIANGLE”ofGreatertrochanter LANDMARK:THETRIANGLE POSTERIOR ANTERIOR GLUTEUSMINIMUS GLUTEUSMINIMUS GLUTEUSFLMEDIUS FL Gmed GLUTEUSMEDIUS-rior POSTERIORSUPERIORFACET FL Gmed P-SFACET LATERALHIPPATHOLOGY GREATERTROCHANTERICTPAIN SYNDROME Tendinosisismorecommonthantendontear TendonoftheGmedcanbeinvolvedalone(mostfrequent)orinassociationwiththeGmin. Tearsoccurattendinousattachment TROCHANTERICBURSITIS • Bursaappearsasawell-circumscribedcrescent-shaped hypoanechoiccollection • Locatedsuperficiallytotheposteriorinsertionofthegluteus mediusandthegreater trochanteranddeeptothegluteusmaximus • Isolated bursitis is virtually nonexistent • Usuallyassociatedwithunderlyingtendinopathy KarpinskiMRK1985,BirdPA2001 SUBGLUTEUSMEDIUSBURSITIS
