Semin Musculoskelet Radiol 2019; 23(03): e58-e67
DOI: 10.1055/s-0039-1683965
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Georgina Allen
1   St. Luke's Radiology Oxford Ltd. and the University of Oxford, United Kingdom
,
Marina Obradov
2   Sint Maartenskliniek, Nijmegen, The Netherlands
,
Vito Chianca
3   IRCCS Istituto Ortopedico Galeazzi, Milano Italy
,
Carmelo Messina
3   IRCCS Istituto Ortopedico Galeazzi, Milano Italy
4   Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano Italy
,
Luca Maria Sconfienza
3   IRCCS Istituto Ortopedico Galeazzi, Milano Italy
4   Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
04 June 2019 (online)

Abstract

Pain around the hip and pelvis is a very common condition. Pain may be generated within the joint space (i.e. the hip joint itself, the sacroiliac joints or the pubic symphysis) or from surrounding myotendinous, bursal, or nerve structures. Over the years, percutaneous musculoskeletal procedures have become increasingly popular to diagnose and treat painful conditions around the hip and the pelvis. Most intra- and extra-articular procedures are performed under ultrasound guidance. This article reviews the most common diagnostic and therapeutic procedures that can be performed around the hip and the pelvis under ultrasound guidance.

All authors contributed equally to this article.


 
  • References

  • 1 McSweeney SE, Naraghi A, Salonen D, Theodoropoulos J, White LM. Hip and groin pain in the professional athlete. Can Assoc Radiol J 2012; 63 (02) 87-99
  • 2 Yeap PM, Robinson P. Ultrasound diagnostic and therapeutic injections of the hip and groin. J Belg Soc Radiol 2017; 101 (Suppl. 02) 6
  • 3 Albano D, Chianca V, Tormenta S, Migliore A, Sconfienza LM. Old and new evidence concerning the crucial role of ultrasound in guiding intra-articular injections. Skeletal Radiol 2017; 46 (07) 963-964
  • 4 Espinosa LA, Jamadar DA, Jacobson JA. , et al. CT-guided biopsy of bone: a radiologist's perspective. AJR Am J Roentgenol 2008; 190 (05) W283-9
  • 5 Dodré E, Lefebvre G, Cockenpot E, Chastanet P, Cotten A. Interventional MSK procedures: the hip. Br J Radiol 2016; 89 (1057): 20150408
  • 6 Bierma-Zeinstra SM, Bohnen AM, Verhaar JA, Prins A, Ginai-Karamat AZ, Laméris JS. Sonography for hip joint effusion in adults with hip pain. Ann Rheum Dis 2000; 59 (03) 178-182
  • 7 Rowbotham EL, Grainger AJ. Ultrasound-guided intervention around the hip joint. AJR Am J Roentgenol 2011; 197 (01) W122-W127
  • 8 MacMahon PJ, Eustace SJ, Kavanagh EC. Injectable corticosteroid and local anesthetic preparations: a review for radiologists. Radiology 2009; 252 (03) 647-661
  • 9 Vincent HK, Percival SS, Conrad BP, Seay AN, Montero C, Vincent KR. Hyaluronic acid (HA) viscosupplementation on synovial fluid inflammation in knee osteoarthritis: a pilot study. Open Orthop J 2013; 7: 378-384
  • 10 Bowman S, Awad ME, Hamrick MW, Hunter M, Fulzele S. Recent advances in hyaluronic acid based therapy for osteoarthritis. Clin Transl Med 2018; 7 (01) 6
  • 11 Conrozier T, Patarin J, Mathieu P, Rinaudo M. Steroids, lidocain and ioxaglic acid modify the viscosity of hyaluronic acid: in vitro study and clinical implications. Springerplus 2016; 5: 170
  • 12 Ye Y, Zhou X, Mao S, Zhang J, Lin B. Platelet rich plasma versus hyaluronic acid in patients with hip osteoarthritis: a meta-analysis of randomized controlled trials. Int J Surg 2018; 53: 279-287
  • 13 Viganò M, Sansone V, d'Agostino MC, Romeo P, Perucca Orfei C, de Girolamo L. Mesenchymal stem cells as therapeutic target of biophysical stimulation for the treatment of musculoskeletal disorders. J Orthop Surg Res 2016; 11 (01) 163
  • 14 Kreuz PC, Steinwachs M, Angele P. Single-dose local anesthetics exhibit a type-, dose-, and time-dependent chondrotoxic effect on chondrocytes and cartilage: a systematic review of the current literature. Knee Surg Sports Traumatol Arthrosc 2018; 26: 819-830
  • 15 Di Pietto F, Chianca V, de Ritis R. , et al. Postoperative imaging in arthroscopic hip surgery. Musculoskelet Surg 2017; 101 (Suppl. 01) 43-49
  • 16 Lungu E, Moser TP. A practical guide for performing arthrography under fluoroscopic or ultrasound guidance. Insights Imaging 2015; 6 (06) 601-610
  • 17 Daniels EW, Cole D, Jacobs B, Phillips SF. Existing evidence on ultrasound-guided injections in sports medicine. Orthop J Sports Med 2018; 6 (02) 2325967118756576
  • 18 Fabbro E, Ferrero G. Hip intra-articular injections. In: Sconfienza LM, Orlandi D, Silvestri E. , eds. Ultrasound-guided Musculoskeletal Procedures. Milan, Italy: Springer Milan; 2015: 25-28
  • 19 Foremny GB, Pretell-Mazzini J, Jose J, Subhawong TK. Risk of bleeding associated with interventional musculoskeletal radiology procedures. A comprehensive review of the literature. Skeletal Radiol 2015; 44 (05) 619-627
  • 20 Conway R, O'Shea FD, Cunnane G, Doran MF. Safety of joint and soft tissue injections in patients on warfarin anticoagulation. Clin Rheumatol 2013; 32 (12) 1811-1814
  • 21 Chan D, Downing D, Keough CE. , et al; Society of Interventional Radiology; Association of PeriOperative Registered Nurses. Joint Practice Guideline for Sterile Technique during Vascular and Interventional Radiology Procedures: From the Society of Interventional Radiology, Association of periOperative Registered Nurses, and Association for Radiologic and Imaging Nursing, for the Society of Interventional Radiology [corrected] Standards of Practice Committee, and Endorsed by the Cardiovascular Interventional Radiological Society of Europe and the Canadian Interventional Radiology Association. J Vasc Interv Radiol 2012; 23 (12) 1603-1612
  • 22 Allen GM, Wilson DJ. Ultrasound Guided Musculoskeletal Injections. Philadelphia, PA: Elsevier; 2017
  • 23 Bowden DJ, Byrne CA, Alkhayat A, Eustace SJ, Kavanagh EC. Injectable viscoelastic supplements: a review for radiologists. AJR Am J Roentgenol 2017; 209 (04) 883-888
  • 24 Mallow M, Nazarian LN. Greater trochanteric pain syndrome diagnosis and treatment. Phys Med Rehabil Clin N Am 2014; 25 (02) 279-289
  • 25 Strauss EJ, Nho SJ, Kelly BT. Greater trochanteric pain syndrome. Sports Med Arthrosc Rev 2010; 18 (02) 113-119
  • 26 Tortolani PJ, Carbone JJ, Quartararo LG. Greater trochanteric pain syndrome in patients referred to orthopedic spine specialists. Spine J 2002; 2 (04) 251-254
  • 27 Di Pietto F, Chianca V, Zappia M, Romano S. Articular and peri-articular hip lesions in soccer players. The importance of imaging in deciding which lesions will need surgery and which can be treated conservatively?. Eur J Radiol 2018; 105: 227-238
  • 28 Sher I, Umans H, Downie SA, Tobin K, Arora R, Olson TR. Proximal iliotibial band syndrome: what is it and where is it?. Skeletal Radiol 2011; 40 (12) 1553-1556
  • 29 Brinks A, van Rijn RM, Willemsen SP. , et al. Corticosteroid injections for greater trochanteric pain syndrome: a randomized controlled trial in primary care. Ann Fam Med 2011; 9 (03) 226-234
  • 30 Brennan KL, Allen BC, Maldonado YM. Dry needling versus cortisone injection in the treatment of greater trochanteric pain syndrome: a noninferiority randomized clinical trial. J Orthop Sports Phys Ther 2017; 47 (04) 232-239
  • 31 McEvoy JR, Lee KS, Blankenbaker DG, del Rio AM, Keene JS. Ultrasound-guided corticosteroid injections for treatment of greater trochanteric pain syndrome: greater trochanter bursa versus subgluteus medius bursa. AJR Am J Roentgenol 2013; 201 (02) W313-7
  • 32 Ali M, Oderuth E, Atchia I, Malviya A. The use of platelet-rich plasma in the treatment of greater trochanteric pain syndrome: a systematic literature review. J Hip Preserv Surg 2018; 5 (03) 209-219
  • 33 McCarthy E, Hegazi TM, Zoga AC. , et al. Ultrasound-guided Interventions for core and hip injuries in athletes. Radiol Clin North Am 2016; 54 (05) 875-892
  • 34 Tormenta S, Sconfienza LM, Iannessi F. , et al. Prevalence study of iliopsoas bursitis in a cohort of 860 patients affected by symptomatic hip osteoarthritis. Ultrasound Med Biol 2012; 38 (08) 1352-1356
  • 35 Sconfienza LM, Albano D, Allen G. , et al. Clinical indications for musculoskeletal ultrasound updated in 2017 by European Society of Musculoskeletal Radiology (ESSR) consensus. Eur Radiol 2018; June 6 (Epub ahead of print)
  • 36 Blankenbaker DG, De Smet AA, Keene JS. Sonography of the iliopsoas tendon and injection of the iliopsoas bursa for diagnosis and management of the painful snapping hip. Skeletal Radiol 2006; 35 (08) 565-571
  • 37 Adler RS, Buly R, Ambrose R, Sculco T. Diagnostic and therapeutic use of sonography-guided iliopsoas peritendinous injections. AJR Am J Roentgenol 2005; 185 (04) 940-943
  • 38 Payne JM. Ultrasound-guided hip procedures. Phys Med Rehabil Clin N Am 2016; 27 (03) 607-629
  • 39 Leopold SS, Battista V, Oliverio JA. Safety and efficacy of intraarticular hip injection using anatomic landmarks. Clin Orthop Relat Res 2001; (391) 192-197
  • 40 Omar IM, Zoga AC, Kavanagh EC. , et al. Athletic pubalgia and “sports hernia”: optimal MR imaging technique and findings. Radiographics 2008; 28 (05) 1415-1438
  • 41 Weir A, Brukner P, Delahunt E. , et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med 2015; 49 (12) 768-774
  • 42 Bisciotti GN, Volpi P, Zini R. , et al. Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment in groin pain in athlete. BMJ Open Sport Exerc Med 2016; 2 (01) e000142
  • 43 Bisciotti GN, Di Marzo F, Auci A. , et al. Cam morphology and inguinal pathologies: is there a possible connection?. J Orthop Traumatol 2017; 18 (04) 439-450
  • 44 Schilders E, Talbot JC, Robinson P, Dimitrakopoulou A, Gibbon WW, Bismil Q. Adductor-related groin pain in recreational athletes: role of the adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections. J Bone Joint Surg Am 2009; 91 (10) 2455-2460
  • 45 Schilders E, Bismil Q, Robinson P, O'Connor PJ, Gibbon WW, Talbot JC. Adductor-related groin pain in competitive athletes. Role of adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections. J Bone Joint Surg Am 2007; 89 (10) 2173-2178
  • 46 Scholten PM, Massimi S, Dahmen N, Diamond J, Wyss J. Successful treatment of athletic pubalgia in a lacrosse player with ultrasound-guided needle tenotomy and platelet-rich plasma injection: a case report. PM R 2015; 7 (01) 79-83
  • 47 Topol GA, Reeves KD, Hassanein KM. Efficacy of dextrose prolotherapy in elite male kicking-sport athletes with chronic groin pain. Arch Phys Med Rehabil 2005; 86 (04) 697-702
  • 48 Choi H, McCartney M, Best TM. Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review. Br J Sports Med 2011; 45 (01) 57-64
  • 49 Chu SK, Rho ME. Hamstring injuries in the athlete: diagnosis, treatment, and return to play. Curr Sports Med Rep 2016; 15 (03) 184-190
  • 50 Fader RR, Mitchell JJ, Traub S. , et al. Platelet-rich plasma treatment improves outcomes for chronic proximal hamstring injuries in an athletic population. Muscles Ligaments Tendons J 2015; 4 (04) 461-466
  • 51 Obradov M, Gielen JL. eds. Image-guided Intra- and Extra-articular Musculoskeletal Interventions: An Illustrated Practical Guide. New York, NY: Springer; 2018
  • 52 Robinson P, Bhat V, English B. Imaging in the assessment and management of athletic pubalgia. Semin Musculoskelet Radiol 2011; 15 (01) 14-26
  • 53 Cheatham SW, Kolber MJ, Salamh PA. Meralgia paresthetica: a review of the literature. Int J Sports Phys Ther 2013; 8 (06) 883-893
  • 54 Ivins GK. Meralgia paresthetica, the elusive diagnosis: clinical experience with 14 adult patients. Ann Surg 2000; 232 (02) 281-286
  • 55 Grossman MG, Ducey SA, Nadler SS, Levy AS. Meralgia paresthetica: diagnosis and treatment. J Am Acad Orthop Surg 2001; 9 (05) 336-344
  • 56 Kho KH, Blijham PJ, Zwarts MJ. Meralgia paresthetica after strenuous exercise. Muscle Nerve 2005; 31 (06) 761-763
  • 57 Parisi TJ, Mandrekar J, Dyck PJB, Klein CJ. Meralgia paresthetica: relation to obesity, advanced age, and diabetes mellitus. Neurology 2011; 77 (16) 1538-1542
  • 58 Philip CN, Candido KD, Joseph NJ, Crystal GJ. Successful treatment of meralgia paresthetica with pulsed radiofrequency of the lateral femoral cutaneous nerve. Pain Physician 2009; 12 (05) 881-885
  • 59 Tagliafico A, Serafini G, Lacelli F, Perrone N, Valsania V, Martinoli C. Ultrasound-guided treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy): technical description and results of treatment in 20 consecutive patients. J Ultrasound Med 2011; 30 (10) 1341-1346
  • 60 Klauser AS, Abd Ellah MMH, Halpern EJ. , et al. Meralgia paraesthetica: ultrasound-guided injection at multiple levels with 12-month follow-up. Eur Radiol 2016; 26 (03) 764-770
  • 61 Tagliafico A, Bignotti B, Rossi F, Sconfienza LM, Messina C, Martinoli C. Ultrasound of the hip joint, soft tissues, and nerves. Semin Musculoskelet Radiol 2017; 21 (05) 582-588
  • 62 Klauser AS, De Zordo T, Feuchtner GM. , et al. Fusion of real-time US with CT images to guide sacroiliac joint injection in vitro and in vivo. Radiology 2010; 256 (02) 547-553
  • 63 Sartoris R, Orlandi D, Corazza A. , et al. In vivo feasibility of real-time MR-US fusion imaging lumbar facet joint injections. J Ultrasound 2017; 20 (01) 23-31