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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5779_Библиотеки_им_академика_М_И_Перельмана
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Hip
Mohini Rawat, DPT, MS, ECS, OCS, RMSK
Contents
• Anterior Hip
Joint Anatomy
º
Iliopsoas Tendon
º
Tendons Originating From the Anterior Superior Iliac Spine
º
Tendons Originating From the Anterior Inferior Iliac Spine
º
• Lateral Hip
Greater Trochanter and Gluteal Tendon Attachments
º
• Posterior Hip
Piriformis and Sciatic Nerve
º
Other Small Rotators of the Hip
º
Hamstring Tendon Origin at the Ischial Tuberosity
º
• Inguinal and Medial Hip Regions
Inguinal Canal and Its Contents
º
Adductor Group of Muscles
º
7
- 201 -
Atlas of Musculoskeletal Ultrasound of the E xtremities (pp 201-229).
Rawat M.
© 2021 SLACK Incorporated.
202 Chapter 7
ANTERIOR HIP
Joint Anatomy
1. Patient position: Supine with the hip in extension and slight abduction
2. Probe/transducer position: The probe is along the long axis (LX) of the femur anteriorly at the
level of greater trochanter (but not placed on the lateral aspect over the greater trochanter),
and then the probe is rotated medially toward the midline and moved proximally to be along
the LX of the femoroacetabular joint (Figures 7-1 through 7-3).
Figure 7-1. Probe positioning for the
LX view of the femoroacetabular joint.
AB
Figure 7-2. LX view of the hip joint. (A) Probe placement. (B) LX view of the hip joint showing the acetabulum (Ace),
femoral head (FH), femoral neck (FN), iliopsoas muscle-tendon complex (IP), hyperechoic labrum (white arrow), and
hyperechoic capsuloligamentous layer (yellow arrow).
Hip 203
A
Figure 7-3. Short axis (SX) view of the hip joint. (A) Probe placement. (B) SX view of the hip joint showing the femoral
head (FH), iliopsoas muscle-tendon complex (IP), hyperechoic femoral nerve (yellow arrow), and anechoic femoral
artery (red arrow).
B
3. Relevant anatomy: The acetabulum, labrum, and femoral head and neck are visualized.1 The
capsuloligamentous structure follows the bony contour of the head and neck of the femur.
2
4. Points to remember: The joint is evaluated for excess fluid, capsular thickening, synovial
hypertrophy, labral pathology (limited view), loose bodies, or bony irregularity or erosion,
or to study the soft tissue structures overlying the joint like the iliopsoas bursa and iliopsoas
muscle-tendon complex. Femoroacetabular impingement is suspected with the following
changes in the anterior hip joint: presence of nonspherical head neck junction (cam deformity), focal bony protuberance at the femoral neck, or waist deficiency or convexity at the
femoral head-neck junction (Figure 7-4).
3
Figure 7-4. The femoral head is
normally spherical. Femoroacetabular
impingement is suspected with the
following changes in the anterior hip
joint: presence of nonspherical headneck junction (cam deformity), focal
bony protuberance at the femoral
neck, or waist deficiency or convexity
at the femoral head-neck junction.
204 Chapter 7
Iliopsoas Tendon
1. Patient position: Supine using the flexion, abduction, and external rotation (FABER) maneuver, where the patient is asked to place the lateral aspect of the foot on the side to be studied
on the contralateral knee at the suprapatellar region
2. Probe/transducer position: The probe is initially placed along the LX of the femoral head to
identify the iliopsoas tendon overlying the joint, then the iliopsoas tendon is followed to its
insertion site at the lesser trochanter (Figures 7-5 and 7-6).
4
A
Figure 7-5. LX view of the iliopsoas
tendon. (A) Probe placement with
the patient supine using the FABER
maneuver. The probe is initially placed
along the LX of the femoral head to
identify the iliopsoas tendon overlying
the joint, then the iliopsoas tendon
is followed to its insertion site at the
lesser trochanter. (B) LX view of the
hyperechoic iliopsoas tendon (white
arrows). (FH = femoral head; LT = lesser
trochanter.)
B
Hip 205
A B
Figure 7-6. (A) Relevant anatomy of the iliopsoas muscle-tendon complex. (B) Corresponding LX view of the iliopsoas
tendon (white arrows) inserting on the lesser trochanter (LT). (FH = femoral head.)
3. Relevant anatomy: The main tendon in the distal iliopsoas is the psoas tendon, including
fibers from the medial portion of the iliacus. The lateral iliacus muscle runs parallel to the
iliopsoas tendon and attaches directly onto the proximal femoral shaft (Figures 7-7 and 7-8).
Figure 7-7. Relevant cross-sectional anatomy of the iliopsoas muscle-tendon complex at the level of the iliopectineal
eminence.
5,6
206 Chapter 7
A
B
Figure 7-8. (A) SX view of the iliopsoas muscle-tendon complex at the level of
the iliopectineal eminence showing the lateral iliacus muscle (LI), medial iliacus
muscle (MI), tendon (T), psoas muscle (PM), and femoral artery (red A). (B) Relevant
anatomy
4. Points to remember: The most medial fibers of the iliacus form an accessory tendon that
merges with the psoas tendon to form the main tendon. There is a fatty fascial plane that
separates the distal iliopsoas tendon from the intramuscular tendon within the lateral portion
of the iliacus muscle, which should not be confused with a split tear of the iliopsoas muscletendon complex.
5
Hip 207
Tendons Originating From the Anterior Superior Iliac Spine
Anatomy of the anterior superior iliac spine (ASIS) and surrounding iliac crest region is shown
in Figures 7-9 and 7-10.
Figure 7-9. Relevant anatomy showing the footprints of various structures originating from the ASIS, iliac crest, and
ilium. (ITB = iliotibial band.)
208 Chapter 7
Figure 7-10. Relevant anatomy of the iliotibial band and lateral thigh muscles. (ITB = iliotibial band; TFL = tensor fascia
lata.)
Hip 209
1. Patient position: Supine
2. Probe/transducer position: The probe is placed in the SX orientation at the ASIS to evaluate the
sartorius and tensor fascia lata origin in SX view (Figure 7-11), and then rotated to LX orientation to evaluate the sartorius (Figure 7-12) followed by the tensor fascia lata, proximal iliotibial
band, and gluteal aponeurotic fascia in LX view (Figure 7-13). To scan these structures as they
attach to the pelvic bone, a good understanding of the anatomy is required.
A
B
C
Figure 7-11. SX view of the sartorius and tensor fascia lata. (A) Probe placement. First the probe is placed on the ASIS
and then moved slightly distal to visualize the sartorius medially and the tensor fascia lata laterally. (B) SX view at the
ASIS. (C) SX view at the level just distal to the ASIS showing the sartorius (S) medially and the tensor fascia lata (TFL)
laterally.
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