| Ultrasound Innovation Award |
| Online Abstract Submission |
| (Author: Hariharan Shankar ) |
| Abstract |
| Type: New block technique |
| Title: Description of a new scanning technique of hip joint interventions for reliable location and teaching |
| Disclosure Statements |
| My research & development of my invention is not supported by a commercial company |
| Abstract |
| Introduction: Hip joint steroid injections have been performed under ultrasound guidance for many years now and have been shown to be safe and reliable. The traditional description of the anterior sagittal technique suffers from a lack of a proper starting bony landmark. The anterior superior iliac spine, hitherto used as a bony landmark is a few centimeters away and there is a loss of continuity during scanning leading to incorrect identification of similar bony structures with curved outlines, e.g. greater sciatic notch, in the vicinity of the hip joint. The following technique provides continuity with the femur until the target ensuring that the target is indeed the femoral hip joint. Technique: An appropriate transducer frequency depending on the body habitus is chosen. The shaft of the femur is scanned anteriorly in a transverse view. The shaft will appear as a semi circular hyperechoic shadow. Keeping the hyperechoic shadow in the middle of the screen always, the transducer is slowly moved cephalad. Once the hyperechoic shadow changes configuration and becomes straighter, it indicates that the inter-trochanteric area is reached. The upper level of the inter-trochanteric area is reached by scanning further cephalad to the greater trochanter. If scanned further the hyperechoic area will disappear. At the level of the trochanters the transducer is moved medial so that the hyperechoic shadow is in the lateral part of the screen. The transducer is then slowly moved/rotated cephalad at its medial edge keeping the lateral end stationary until the rounded hyperechoic femoral head and straight hyperechoic line denoting the neck are visualized. The image optimization may require adjusting the transducer tilt or obliquity. The target for injection is the anterior synovial recess located at the junction of the head and neck. Conclusion: This technique in the author’s experience provides continuous visualization of the femur until reaching its target at the hip joint thus ensuring safe targeting and also is a useful technique for demonstration to trainees. References: 1. Pourbagher MA, Ozalay M, Pourbagher A. Accuracy and outcome of sonographically guided intra-articular sodium hyaluronate injections in patients with osteoarthritis of the hip. J Ultrasound Med. 2005 Oct;24(10):1391-5. 2. Smith J, Hurdle MF, Weingarten TN. Accuracy of sonographically guided intra-articular injections in the native adult hip. J Ultrasound Med. 2009 Mar;28(3):329-35. 3. Sofka CM, Saboeiro G, Adler RS. Ultrasound-guided adult hip injections. J Vasc Interv Radiol. 2005 Aug;16(8):1121-3. |
| Clinical Significance |
| Clinical impact: The use of ultrasound guidance for pain medicine is increasing. Hip joint injections traditionally done with fluoroscopy are now being done with ultrasound guidance. The currently practised ultrasound technique for hip joint visualisation and guidance creates a small period when the bony structures are not visualised. This may lead to incorrect identification of the target. The new technique described by the author provides continous visualisation ensuring that the femur can be traced to the hip joint. This technique will avoid other rounded bony structures in the vicinity. |
| Ultrasound Equipment |
| Manufacturer: GE |
| Model: LOGIQe |
| Probe Used |
| Type: Curved array (4C-RS) and linear array (12L-RS) |
| Size: 65 X16mm and 42 X 7mm |
| Frequency: 5 and 10 Mhz |
| Files |
|
1. Filename: Sonographic view of Femur shaft.jpg
2. Filename: Proximal femur shaft view.jpg
3. Filename: View of greater trochanter.jpg
4. Filename: Hip joint & Neck.jpg
5. Filename: At the level of greater trochanter.WMV 6. Filename: Final adjustment to view the hip joint.WMV |
