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Ultrasound Basics of the Hip

Ultrasound Basics of the Hip. By Mohamed H Youssef MD Arthritis/Rehab & Pain Clinic Board certified of ABPM&R. 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. Hip Anatomy.

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Ultrasound Basics of the Hip

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  1. Ultrasound Basics of the Hip By Mohamed H Youssef MD Arthritis/Rehab & Pain Clinic Board certified of ABPM&R

  2. 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.

  3. 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,

  4. Hip Anatomy 5-Synovial joint 6-Muscles and tendons 7-Synovial bursae 8-Neurovascular structures.

  5. Hip Joint

  6. Bone structures The acetabulum It is a cup-shaped cavity . The ball-shaped head of the femur fits in. The acetabularedge : circular bone flap surrounded it The lunate-surface: the most peripheral portionof the inner surface, it is used in the articulation The acetabularpit: the central portion, , accommodates the round ligament extended between the acetabulum and the femoral head surrounded by adipose tissue and vascular structures.

  7. Acetabulum

  8. 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 capitisfemoris:in the center of the head there is a small depression to which the round ligament is attached.

  9. Femoral Head

  10. Fibrocartilaginous structures • The acetabularlabrum: 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.

  11. Hip Joint Labrum

  12. 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 capitisfemoris. • The femoral head is covered by cartilage tissue up to the passage between the femoral head and neck.

  13. Cartilaginous layer

  14. 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 iliofemoralligament  •The pubofemoral ligament  •The ischiofemoral ligament  • The round ligament is located centrally between the acetabular fossa and the fovea capitis of the femoral head.

  15. Hip Joint Ligaments

  16. Hip Joint Ligaments

  17. Synovial Joint The synovial joint lines the inner surface of the joint capsule and forms a complete sheath by surrounding the round ligament.

  18. Synovial joint

  19. MUSCLES& TENDONS • 1-ANTERIOR GROUP • 2-MEDIAL GROUP • 3-LATERAL GROUP • 4-POSTERIOR GROUP

  20. Anterior muscles • RECTUS FEMORIS • ILIOPSOAS • ILIACUS • PECTINEUS • SARTORIUS

  21. Medial muscles • Adductor longus • Adductor brevis • Adductor magnus • Gracilis

  22. Lateral muscles • Gluteus minimus • Gluteus medius • Gluteus maximus • Tensor fasciae latae

  23. Posterior muscles • Semimembranosus • Semitendinosus • Long head of Biceps Femoris

  24. Synovial bursae • Iliopsoas bursa • Peritrochantric bursa divided into: large,midium,smallbursae

  25. What probe to use? • Curved linear probe

  26. 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

  27. Position of the thigh

  28. Positioning the probe

  29. US of the Hip

  30. US of the GTB

  31. Injection of hip joint

  32. 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

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