Ultrasound of the hip in rheumatology

Abstract

Recent advances in musculoskeletal (MSK) ultrasound and transducer technology have enabled increased utilization of high-quality ultrasound in rheumatology clinics and by the bedside as an adjuvant to the clinical examination of the hip. Ultrasound is also an integral part of image-guided joint aspirations, injections, biopsies, and bursa injections. In this article, we will focus on basic ultrasound scanning technique and findings related to common rheumatologic pathologies of the adult symptomatic hip. Transducer positioning and essential sonographic bony landmarks will be reviewed and scanning in two orthogonal planes (both long and short axes of the structure) will be emphasized. Common hip pathologies such as synovitis, joint effusion, bursitis, greater trochanter pain syndrome, and hamstring pathology will be discussed. The reader will also be made aware of limitations of ultrasound in the evaluation of hip and emphasize the complementary role of ultrasound with other imaging modalities (radiographs, computed tomography, and magnetic resonance imaging). The diagnostic ability of MSK ultrasound is based on an operator's training and experience, the patient's habitus, and aptly chosen clinical indications. A good grasp of anatomy, sound ultrasound technique, and knowledge of limitations of ultrasound modality are essential for a safe ultrasound practice. A long-standing commitment of time and resources is needed to become competent and comfortable in scanning. Where possible, the training should be inbuilt into the postgraduate training. It is best that a rheumatologist adopts a career plan of learning, inclusive of MSK ultrasound, relevant to rheumatology.

Keywords

• Hip
• indications
• rheumatology
• technique
• ultrasound