Ultrasound Diagnostic and Therapeutic Injections of the Hip and Groin

Abstract

Hip and groin pain often presents a diagnostic and therapeutic challenge. The differential diagnosis is extensive, comprising intra-articular and extra-articular pathology and referred pain from lumbar spine, knee and elsewhere in the pelvis. Various ultrasound-guided techniques have been described in the hip and groin region for diagnostic and therapeutic purposes. Ultrasound has many advantages over other imaging modalities, including portability, lack of ionising radiation and real-time visualisation of soft tissues and neurovascular structures. Many studies have demonstrated the safety, accuracy and efficacy of ultrasound-guided techniques, although there is lack of standardisation regarding the injectates used and long-term benefit remains uncertain.

Pelvis and Groin

“…Indeed, sonography and MRI have become frontline tools in many practices owing to the low diagnostic yield of radiography, as well as concerns related to radiation exposure associated with radiography, CT, and scintigraphy in young athletes. Sonography has numerous strengths, including point-ofcare evaluation, dynamic assessment (e.g., for hernia [7], tendon snapping), real-time sonopalpation at the exact site of pain, and guiding percutaneous injections for diagnostic and therapeutic purposes [8,9].…”

Ultrasound-guided Musculoskeletal Interventions for the Most Common Hip and Pelvis Conditions: A Step-by-Step Approach

“…33 Due to the close proximity of the iliopsoas tendon and bursa to the hip joint, it may be subject to mechanical stress caused by acute trauma, chronic microtrauma and impingement after total hip arthroplasty or a minimally invasive hip replacement, secondary to the prominent anterior rim of the acetabular implant or the collar of the femoral prosthesis. 2 The hip joint communicates with the iliopsoas bursa in 15% of the healthy population. In patients with rheumatoid arthritis, osteoarthritis and septic arthritis, however, the iliopsoas bursa acts as a reservoir for synovial fluid.…”

“…Thus, an accurate diagnostic work-up is needed before establishing the correct treatment. 2 Over the years, percutaneous musculoskeletal procedures have become increasingly popular to diagnose and treat painful conditions around the hip and the pelvis. Most intraand extra-articular procedures are performed under ultrasound (US) guidance, 3 whereas bone procedures such as biopsies, thermal ablation of benign and malignant lesions, associated or not with bone consolidation, are invariably performed using computed tomography (CT) guidance or fluoroscopy.…”

Ultrasound-guided injections in pelvic entrapment neuropathies

“…Ultrasound-guided injections can be divided into diagnostic and therapeutic procedures. Diagnostic procedures are performed with a local anesthetic in order to confirm the diagnosis, while therapeutic procedures involve adjunct substances, most commonly corticosteroids, to initiate treatment ( 12 ) . In the following manuscript, we present the most common entrapment neuropathies in the pelvic region with an emphasis on US-guided treatment.…”