Ultrasound examination of the hip joints

You get 10% cashback when purchasing a gift certificate More details All promotions

Ultrasound of the hip joints is a painless and accessible method of assessing the condition and identifying pathologies of the joints themselves and the tissues surrounding them. In adult patients, this ultrasound examination is more likely to be an additional diagnostic method: it is rarely performed independently, more often as an addition to or MRI. However, ultrasound is recommended for patients with an artificial heart pacemaker or metal dental implants, since MRI is contraindicated for such people.

You can get an ultrasound of the hip joints at the clinics of JSC Family Doctor.

Indications

Ultrasound of the hip joints is indicated for:

• traumatic injuries of the pelvis, lower extremities;
• inflammatory processes in the joint and surrounding tissues;
• congenital or acquired connective tissue defects;
• oncological pathology;
• aseptic necrosis of the femoral head;
• intermittent claudication;
• osteomyelitis.

The study allows you to examine the hip joint during functional tests.

Advantages and disadvantages

MRI and CT are the two preferred diagnostic modalities for identifying pathologies in the hip joint. With their help, doctors determine the smallest changes in the structure of the joint and can begin timely treatment, avoiding unwanted joint changes. Due to the difference in the physics of image acquisition, there are some parameters that are taken into account when choosing a tomographic examination method:

• Computed tomography cannot be used frequently due to radiation exposure to the body, but MRI, on the contrary, can be used without restrictions.
• CT examination of the joints is done faster (2-5 minutes), and MRI of the hip joints is done slowly (20-40 minutes). In both cases, you must remain still, and this may be difficult for some patients.
• MRI examination is prohibited if the body contains steel endoprostheses, metal particles, pacemakers and other electrical life support devices. For CT, metal and pacemakers will not be contraindications.
• Due to radiation exposure, computed tomography is prohibited for pregnant women at any stage of gestation.

How is it carried out?

Ultrasound examination of joints is carried out on the day of treatment and does not require prior preparation. To obtain objective data, the doctor performs an ultrasound in several projections (anterior, posterior, lateral, medial). This allows you to visualize:

• structural elements of the hip joint (capsule, joint cavity, ligamentous apparatus);
• femoral head;
• iliac bones;
• muscles;
• nerves and blood vessels.

The duration of the diagnostic procedure is 15-20 minutes.

The doctor lubricates the skin on the examined area of ​​the body with gel for better contact with the ultrasound sensor, and then scans the affected hip joint. The image is displayed in real time on the monitor. During the examination, the specialist may ask the patient to turn over from his back to his side, pull his leg towards his stomach, and spread his lower limbs to the sides. Such actions allow maximum visualization of the pathological area.

Examination of a patient with arthrosis of the hip joint - examinations for coxarthrosis

What examinations must be carried out for a patient with arthrosis of the hip joint ( coxarthrosis )?

Nowadays, to clarify the diagnosis of coxarthrosis, they most often resort to clinical and biochemical blood tests, radiography and magnetic resonance or computed tomography. Somewhat less often, the patient is prescribed an ultrasound (ultrasound examination) of the joints.

Clinical blood test. For this test, blood is taken from a finger. With arthrosis, a clinical blood test, as a rule, does not show any specific changes. Only in some cases may there be a very slight increase in the erythrocyte sedimentation rate (ESR or ROE): up to 20 mm.

On the contrary, a significant increase in ESR (higher) in combination with night pain in the joint should prompt us to think about the rheumatic, inflammatory origin of these pains. That is, perhaps the patient has arthritis. Or ankylosing spondylitis.

If the patient also has an increased number of leukocytes, then this circumstance confirms the presence of some kind of infectious-inflammatory process in the body, which affects the joints in particular.

However, in any case, a clinical blood test does not give clear answers; it only indicates trends and narrows the circle of diagnostic search.

Analysis for rheumatic tests . When performing this test, blood is taken from a vein, and always on an empty stomach. A blood test taken from a vein can provide significant assistance to the doctor in making a differential diagnosis of joint damage: arthrosis or arthritis?

Thus, with rheumatic diseases (arthritis), the level of so-called inflammatory markers in the blood significantly increases: C-reactive protein, seromucoid, ACCP.

With arthrosis, these indicators, on the contrary, remain normal.

True, there are cases when certain types of arthritis also do not lead to a significant change in inflammatory parameters. But still, such an analysis, as a rule, helps to make a clear distinction between inflammatory and metabolic-dystrophic diseases of the joints (between arthritis and arthrosis).

Attention! In cases where we detect “inflammatory” changes in blood parameters taken from a finger or from a vein in a patient with arthrosis, we should be wary - after all, arthrosis does not cause any changes in the tests. And if inflammation indicators are elevated, there is a high probability that we are dealing not with arthrosis, but with arthritis. Then it is necessary to continue examining the patient until the diagnosis is finally confirmed or refuted.

X-ray of joints . Radiography is the most common and one of the most important methods for diagnosing coxarthrosis. In most cases, even the stage of arthrosis is established solely on the basis of an x-ray: after all, x-rays clearly show changes in the shape of the joint and bone deformations; compaction of the bones under the damaged cartilage is noticeable and osteophytes (“spikes”) are clearly visible. In addition, an x-ray can be used to judge the width of the joint space, that is, the distance between the articulating bones.

But X-ray examination has a serious disadvantage: only bones are captured on the X-ray image. But we will not be able to see the soft tissues of the joint (cartilage, joint capsule, etc.) on an x-ray. Therefore, using only X-rays, we will not be able to assess with one hundred percent accuracy the degree of damage to the articular cartilage and joint capsule. Fortunately, in recent years, magnetic tomography has become increasingly widespread.

Magnetic resonance imaging (MRI) . The research uses, as the name suggests, magnetic waves. They are able to reflect the smallest details of the joint in the resulting image.

The magnetic resonance imaging method is very accurate: it allows you to detect the earliest changes in cartilage tissue (which are not yet visible on a regular x-ray), and also helps to see the first signs of the onset of aseptic necrosis (joint infarction), when it exists. Therefore, I often recommend that my patients, in addition to X-rays, carry out magnetic resonance imaging of the joint to clarify the diagnosis.

Although here one thing must be kept in mind. Usually, having received tomographic examination data, doctors are so confident in their infallibility that they do not consider it necessary to double-check the research results and conduct a personal examination of the patient. It is not right.

Firstly, the specialist in the tomography department who interprets the images is also a person and can make mistakes. In particular, I have repeatedly encountered situations where ordinary age-related changes or other diseases similar in picture to arthrosis were mistaken for arthrosis. This happens very often.

Secondly, coxarthrosis detected on a tomogram may not be the patient’s only disease. And the main cause of pain, even in the presence of coxarthrosis, may be another disease: for example, a herniated intervertebral disc, which will need to be treated in parallel with coxarthrosis.

In general, even after receiving a “full package” of patient examinations (X-rays, tests, tomogram), the doctor must still first conduct a personal examination of the patient and only then prescribe treatment.

Computed tomography (CT) . In addition to magnetic resonance imaging, some hospitals still use computed tomography. In essence, computed tomography is the most advanced version of x-ray: computed tomography uses the same x-rays as in a conventional x-ray examination.

The only difference is that with computed tomography, the tomograph “shreds” the joint with a series of x-rays, and as a result, the image is more voluminous and detailed than with x-rays. But it is still an order of magnitude inferior in terms of information content to a magnetic resonance imaging scan. Therefore, CT should be used only in cases where for some reason we cannot perform magnetic resonance imaging on the patient (for example, if the patient has a pacemaker, a pacemaker, and magnetic waves can disrupt its operation).

Ultrasound of joints (ultrasound examination) . In recent years, ultrasound has been actively used to diagnose joint diseases. After all, ultrasound, like magnetic resonance imaging, allows you to see changes in the soft tissues of the joint - for example, using ultrasound you can detect thinning of cartilage tissue in arthrosis or an increase in the amount of joint fluid in arthritis; it is possible to detect damage to the menisci in the knee, etc. However, the method has a significant drawback - it is very subjective, and the data obtained depend entirely on the qualifications of the specialist conducting the study.

Of course, this does not mean that joint ultrasound specialists are always wrong. But even if such an accurate method as tomography leaves room for discrepancies in the interpretation of the data obtained and disagreements in the diagnosis, then the data from ultrasound examination of joints raises questions especially often.

Therefore, I am not inclined to blindly trust the diagnosis obtained by ultrasound of the joints, and I always double-check such conclusions (through a personal examination of the patient, as well as using X-rays or magnetic resonance imaging).

***

Article by Dr. Evdokimenko© for the book “Arthrosis”, published in 2003. Edited in 2011. All rights reserved.

READ MORE:

• No more medications needed?
• Symptoms of coxarthrosis
• What is arthrosis of the hip joint (coxarthrosis) often confused with?
• Causes of arthrosis of the hip joint (coxarthrosis)
• Structure of the hip joint
• Changes in the hip joint with coxarthrosis
• X-ray diagnosis of coxarthrosis: the most common mistakes
• Treatment of arthrosis of the hip joint: prospects
• Surgical treatment of arthrosis of the hip joint
• Therapeutic treatment of arthrosis of the hip joint
• Our best exercises for the treatment of coxarthrosis

All articles by Dr. Evdokimenko

How to do an MRI of the pelvic bones

Before the procedure, you should notify the doctor about the presence of allergic reactions and tell about chronic diseases. Next, you need to remove all metal objects from yourself - jewelry, watches, glasses. If you have a fear of closed spaces, tell your doctor, he will prescribe a sedative.

Next, the patient is positioned on the table and moved into the tomograph chamber. During the procedure, he hears a slight crackling sound from the device and can communicate with the doctor via a microphone. The examination lasts a quarter of an hour, with the use of contrast - up to an hour.

Depending on what the MRI of the hip joint shows, a person should consult a rheumatologist, neurosurgeon, or oncologist.

• MRI of the shoulder joint.
• MRI of the knee joint.

Osteoarthritis of the hip joint: treatment at Dr. Dlin’s clinic

One of the main activities of the clinic in Moscow is effective prevention, rehabilitation treatment and rehabilitation of the disease. The full course of therapy begins with a comprehensive diagnosis, identifying the causes of pain, and continues until the discomfort is completely eliminated and the usual full standard of life is returned. The specialists providing highly professional assistance have undergone training in the world's leading medical centers - leaders in the treatment of joint problems, and have extensive successful experience in this area.

The clinic offers:

• exclusive treatment of international level using innovative technologies;
• the latest diagnostic and treatment equipment;
• services of the best specialists in the treatment of arthrosis;
• immediate relief of pain;
• caring staff and comfortable environment.

We are waiting for you for a free initial appointment!

Differential diagnosis

Orthopedic/rheumatological causes:

• Osteoarthritis.
• Septic arthritis.
• Osteomyelitis.
• Hip dislocation.
• Gout.
• Femoral neck fracture.

Other pathological causes:

• Trochanteritis of the hip joint.
• Iliotibial tract syndrome.
• Meralgia paresthetica.
• Damage to the labrum.
• Irradiation from the lumbar region or sacroiliac joint.
• Kidney stone.
• Avascular necrosis.
• Abscess of the iliopsoas muscle.

Hernias, aneurysms and benign tumors:

• Inguinal lymphadenopathy.
• Inguinal hernia.
• Femoral hernia.
• Aneurysm of the femoral artery.
• Lipoma.
• Atheroma.

Oncology:

• Osteosarcoma.
• Metastatic diseases such as prostate cancer or tumors in the pelvic area.

Rating scales

• Harris Hip Score (HHS).
• Hip Disability and Osteoarthritis Outcome Score (HOOS).
• Oxford Hip Score (OHS).
• Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH)
• American Academy of Orthopedic Surgeons (AAOS) Hip and Knee Questionnaire.
• Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).