Hip Case 3

Clinical History:

An example of ultrasound-guided LATERAL approach to hip joint injection.




Ultrasound-guided hip joint injection: LATERAL APPROACH


Reasons to use this method: (a) avoids passage of the needle through any of the ramifications of the femoral nerve which can occur with the anterior approach; (b) more ergonomic than the awkward anterior approach when using ultrasound guidance, allowing very wide separation of the transducer from the skin puncture point and easier positioning for both the tech holding the probe and the radiologist wielding the needle; and (c) simulates the arthroscopic approach to the hip joint, safely avoiding all major neurovascular structures. The lateral approach can still be painful if the needle approaches from either too anterior (passing through the rectus femoris tendon) or too posterior (passing through the ITB). A shallow angled course anywhere between these two structures is therefore the aim. The transducer is positioned in the axial plane and centred over the convexity of femoral head. Note the ‘bent needle’ artefact created by beam refraction caused by the curve of the overlying rectus femoris tendon (arrowhead). A post-injection long-axis image confirms injectate within the anterior joint recess (asterisk).