Ultrasound of the hip joints in infants, Ultrasound of the hip joints in newborns: when to do?

Ultrasound of the hip joints in infants is carried out at the Health 365 clinics at the address: st. Bazhova, 68, Ekaterinburg.

An ultrasound of the hip joints is recommended when a newborn (age from birth to 4 weeks) becomes an infant (from 4 weeks to 1 year), i.e., when the baby is 1 month old. Ultrasound of the hip joints is a study that allows a baby to detect the presence of dysplasia (impaired formation), subluxation or dislocation of the hip joints using harmless ultrasound. Ultrasound diagnostics is highly informative, as it makes it possible to obtain an image of the cartilaginous structures of the hip joint, make a diagnosis at the right time, draw a precise line between neurological and orthopedic pathology, and determine treatment tactics, which in each of these cases has its own specifics.

Until recently, the leading role in the diagnosis of developmental disorders of the hip joints was given to the x-ray method. However, the radiation exposure that accompanies the X-ray method and the difficulty of correctly positioning the child for examination are its disadvantages.

The modern approach to the early diagnosis of developmental disorders of the hip joints involves the active identification of infants with this pathology using ultrasound, to solve the main problem - making the diagnosis as early as possible and starting treatment before 6 weeks of age.

Such an early start of treatment allows you to use the high growth potential of the structures of the hip joint, achieve complete anatomical and functional restoration in a short time, prevent possible complications such as necrosis of the head, early arthrosis, and eliminate the possibility of surgical intervention.

Indications for examination

Ultrasound of the hip joints in newborns, when to do:

if there is suspicion of dysplasia;
during multiple pregnancy;
at the birth of a child in a breech presentation;
with neurological disorders.

Ultrasound of the hip joints in infants, when to do it? Parents can also identify indications for using this diagnostic method. It allows you to take action if you notice in your child:

asymmetry of folds on the buttocks;
shortening of one of the lower limbs;
insufficient hip abduction;
characteristic sounds when trying to retract it;
hypertonicity of the legs.

Scanning technique

Coronal views can be obtained with the hip in a physiologically neutral position (15-20° flexion) or in a flexed position. The ultrasound probe is placed in the anatomical coronal plane (Figure 2A). The sensor is then moved back and forth from the base position to identify the circular structure of the hip joint. If the superior edge of the transducer is rotated back 10–15° into an oblique coronal plane, the ilium appears straight (Figure 3A, C). In hip dislocation, lateral and posterior displacement of the femoral head prevents visualization of the femoral head and center of the acetabulum in the standard plane. Therefore, if displacement of the femoral head follows, the scanning plane is no longer in the standard view. The direction of displacement of the femoral head means that the posterior sectional plane is usually visible (Fig. 3A-D)

Figure 2 : Standard coronal ultrasonography through the right hip of a 5-week-old boy with a normal clinical examination of the hip. A .
The ultrasonic linear transducer is positioned parallel to the baby's lateral thigh. IN . Ultrasonography of the infant's hip in the coronal plane has three landmarks: 1 - straight iliac line; 2 – apex of the acetabulum; and 3 – transition from the ilium to the Y-shaped cartilage.

Figure 3 : Ultrasound through the left hip joint of a 6-month-old girl with a normal clinical examination of the hip. A.
Schematic representation of the acetabulum showing the anterior sectional plane (1), standard sectioning plane (2), and posterior sectioning plane (3). B. _ In the anterior sectional plane, the silhouette of the ilium curves towards the anterior part, that is, towards the sensor. C. _ In the mid-sectional planes (standard plane), the contour and silhouette of the ilium is straight and parallel to the transducer. D. _
In the posterior sectional plane, the silhouette of the ilium curves posterior to the transducer. The American College of Radiology also recommends performing a standard transverse ultrasound examination with the hip flexed at 90° (Figure 4A). To identify a displaced hip, the transducer is placed in a posterolateral position during the Ortolani and Barlow maneuvers. If the relationship between the posterior acetabulum and the femoral head changes with slight changes in position, the hip is unstable.

Figure 4 : Transverse flexion ultrasound in a 5-week-old boy with a normal clinical hip examination. A. _
The hip and knee are flexed 90° and the ultrasound transducer is positioned perpendicular to the lateral aspect of the child's thigh. B. _ Transverse ultrasound image shows the gluteal muscles (G), cartilaginous femoral head (FH), metaphysis, ischium (I), and labrum (L).

How to prepare a newborn for an ultrasound of the hip joints?

To properly perform an ultrasound of the hip joints in newborns, preliminary preparation is necessary. The results are largely influenced by the position of the newborn's body, so you need the baby to lie quietly on his side.

It is necessary to feed the child first.
There is a possibility of regurgitation, so the baby is fed half an hour before the procedure.
If the child is breastfed, then the mother should avoid foods that provoke intestinal colic for three days before the examination.
Bring a diaper and several replacement diapers with you.
You can take your favorite toy or pacifier with you.
The presence of parents is important during the procedure. This will help create a favorable emotional background for the child.

Planned study

Correction of the condition and treatment of dysplasia is most effective at an early age.
Therefore, it is important to do an ultrasound of the hip joint when the child reaches 1 month, then at the ages of 3 and 6 months, then at 1 year. After a year, the likelihood of developing dysplasia decreases significantly, so the problem most likely will not appear. Primary instability of the joint leads to the fact that at 1 month there may be no signs of pathology, but later the disease develops. This is why doctors recommend such a frequency of examinations.

How is ultrasound performed?

How is ultrasound of the hip joints performed in newborns? An ultrasound of the hip joints in infants takes about an hour, during which time the doctor carefully examines both joints.

The examination is carried out in a lateral decubitus position. The leg needs to be pulled towards the stomach.
After completing the examination, an additional functional test is performed, namely, the thigh is pulled towards the stomach and a slight turn is made.
Any movements during the examination may lead to incorrect results.
If necessary, the doctor may prescribe repeated diagnostics to track the dynamics.

Peculiarities of pediatric diagnostics

The hip joint is a ball-and-socket joint in the human body. It is formed by the lunate surface of the pelvic bone and the articular surface of the head of the femur. The main properties are circular rotation, flexion, extension, abduction, adduction of the hip. The functionality of the musculoskeletal system largely depends on intrauterine development. Initially, the baby is born with “soft” bones in order to safely pass through the birth canal and be born. But already in the first months of life, the bone skeleton becomes stronger, which makes it possible to track norms and pathologies.

Decoding the results

Parents receive a study protocol after the procedure. It is compiled by an ultrasound specialist. Next, you need to show this document to a pediatrician or treating specialist for correct interpretation. Parents should not decipher the result and try to make a diagnosis on their own!

Indicators of norm and deviation

When performing an ultrasound of the hip joints, the angles of the drawn lines must be measured. Ultrasound of the hip joints in newborns, normal:

The line coming from the bottom of the ischial muscle passes to the ilium, normally it should be smooth.
The transition zone of the cartilaginous region of the acetabulum bends at an angle. This projection creates angles alpha and beta. Normally, the alpha angle should be 60 degrees, and the beta should be at least 55 degrees.

A decrease in these indicators indicates joint subluxation. An increase indicates a dislocated joint or congenital pathologies.

It is worth remembering that during ultrasound of the hip joints in infants, the normal angles are different for each age.

the alpha value increases to 70 degrees by 6 months;
beta decreases to 43 degrees.

A special table of normal angle indicators for different ages has been developed. It helps in deciphering ultrasound of the hip joints in newborns, norms and abnormalities.

If there are pathological changes, the following parameters will appear:

The head of the femur is deviated.
The cartilaginous lip is deformed.
The protrusion of the acetabulum has a rounded shape.
In very serious disorders, the head is located above the acetabulum, the cartilaginous lip is inverted and located above the head. The glenoid cavity consists of surrounding fatty and connective tissue that has penetrated inside.

During an ultrasound of the hip joints
in infants, the interpretation is made by the doctor, since only he can correctly draw a conclusion regarding the condition of the joint spaces.

What is dysplasia?

Hip dysplasia is a congenital pathology, which is based on more or less pronounced underdevelopment of all its elements and structures. Standard signs for determining hip dysplasia in infants:

asymmetry of skin folds;
slipping symptom (clicking symptom);
limitation of hip abduction;
relative shortening of the limb;
external rotation of the hip.

Each of them has limits of reliability that should be taken into account

When researching:

pay attention to the condition of the bone roof, the cartilaginous protrusion (how much it covers the head of the femur);
study the centering of the head at rest and during provocation;
The angle of inclination of the acetabulum is calculated, indicating the degree of its maturation.

Without adequate treatment, hip dysplasia leads to:

progressive secondary changes in the affected joint;
curvature of the spine;
violation of the position of the pelvis, subluxation of the opposite joint.

As a result, dysplastic coxarthrosis develops, a disease leading to early disability.

Ultrasound of joints in children

Ultrasound of joints in newborns and children up to one year old

ultrasound of the hip joints in newborns to identify dysplasia, possible signs of subluxation or dislocation of the hip;
Ultrasound diagnostics to identify the consequences of birth injuries to joints in newborns and babies up to one year old.

ULTRASOUND OF JOINTS IN CHILDREN OF ANY AGE ACCORDING TO MEDICAL INDICATIONS

Ultrasound diagnostics (sonography) of joints in newborns and children is a safe and informative study that uses sound waves to obtain a clear computer picture of the condition of tendons and ligaments, cartilage tissue, joint capsules and crevices. Examination of joints using ultrasound allows us to identify congenital developmental anomalies, consequences of birth injuries and acquired diseases.

Why ultrasound is absolutely safe for children of any age:

Ultrasound imaging in ultrasound machines is based on the same principles as sonar used by fishermen, dolphins and bats. Sound waves are emitted by the tip of the ultrasound machine and penetrate the joints, reflecting differently from their structures, returning as an echo back to the tip. The ultrasound machine's computer, by measuring these echo waves, can determine how far away the object is, as well as its size, shape and structure, and build an accurate image of the joint from this data.

Ultrasound machines do not use ionizing radiation (as in X-ray machines), so the child is not exposed to radiation during the examination.

To obtain images of the joints, the doctor scans the joints using a soft, warm tip glided over the baby's skin. For better contact of the tip of the ultrasound machine with the child’s skin, a special acoustic gel, neutral in color and odor, is applied to it. The gel is absolutely harmless; after the procedure, it can be wiped off the child’s skin with a regular napkin.

Ultrasound of joints in newborns and children up to one year old

Ultrasound of the hip and shoulder joints of newborns is included in the mandatory screening (preventive) study carried out in babies aged one to three months. Such ultrasound examinations allow timely detection of congenital joint defects (dysplasia), joint development disorders (subluxation, dislocation) and the consequences of birth injuries.

Advantages of the ultrasound diagnostic method:

During ultrasound scanning of joints, the sensor does not penetrate the child’s body and does not affect his skin in any way.
Ultrasound scanning is safe and does not use ionizing radiation.
Ultrasound scanning gives a clear picture of the soft tissues of the joints, which are difficult to see on x-rays .
The examination is painless and safe for your baby; if necessary, it can be repeated many times at any time.

Indications for ultrasound of the joints of a newborn baby:

1. Toxicosis or a decrease or increase in the amount of amniotic fluid during pregnancy (may indicate the presence of inflammatory processes or infection, which can subsequently impair the development of cartilage and bone tissue).

2. Pelvic or breech presentation of the fetus or an anatomically narrow pelvis in the mother (risk of physical damage to the joints during childbirth).

3. Premature, rapid or difficult birth, caesarean section.

4. Diseases of the mother that could limit the mobility of the fetus (uterine adhesions, fibroids), previous infectious diseases during pregnancy, poor nutrition during pregnancy.

5. Established birth injuries.

6. Large size of the newborn.

7. The birth of twins or triplets.

8. The presence of hip dysplasia in one of the parents.

How to prepare a newborn or infant for an ultrasound examination of joints?

Your child should wear comfortable, loose-fitting clothing for the ultrasound exam that can be easily removed.

Contraindications to ultrasound of joints:

There are no contraindications for standard diagnostic examination of joints in newborns and children.

Why are newborns required to undergo screening ultrasound examinations of joints:

1. to detect dysplasia, subluxation or dislocation of the hip joints

2. to identify the consequences of birth joint injuries

Ultrasound of the hip joints in newborns to detect dysplasia, possible signs of subluxation or dislocation of the hip

The most common problem is congenital underdevelopment (dysplasia) of the hip joints, which occurs in 0.5-5% of newborns. Dysplasia is manifested by a violation of the correct position of the femoral head inside the joint. Due to bone displacement, the blood supply and nutrition of the joint tissues deteriorate, which gradually leads to the destruction of cartilage, bone deformation and muscle atrophy (coxarthrosis), which can subsequently lead to serious consequences: lameness, difference in limb length, and even disability if leave the problem unattended and untreated.

If a problem with the hip joints is detected, the ultrasound procedure must be repeated regularly to monitor the healing process. Constant ultrasound monitoring is canceled only after the period when the baby’s femoral head has completely ossified. As a rule, ossification of the femoral head in a child occurs before the first 36 weeks of life. Regular ultrasound monitoring of joints allows you to monitor whether joints are developing correctly and monitor the effectiveness of treatment measures.

What other signs may indicate hip dysplasia?

Indications for an ultrasound of the hip joints in newborns may include the following signs indicating possible hip dysplasia:

The skin folds on the buttocks and thighs of a newborn are not symmetrical.
The length of the baby's legs is not the same.
When the newborn's hip is abducted to the side, the angle does not reach 90 degrees.
When the hip is abducted, a click is heard in the hip joint.
When the baby's legs are simultaneously bent at the knees while lying on his back, one of the knees is higher than the other.
Hypertonicity of the muscles of the lower extremities is observed.
During sleep, the baby's leg is slightly turned out.
There are signs of other developmental anomalies: a keeled chest, curvature of the fingers, shortening of the neck and widening of the bridge of the nose.

How is ultrasound examination of the hip joint performed in newborns and children under one year of age?

The doctor places your baby on his side, bending his leg at an angle of 20-30°. The thigh is lubricated with acoustic gel and a soft and warm tip is passed over it, emitting sound waves. Then the leg is sequentially bent, extended, abducted and adducted to take five consecutive photographs and evaluate the relationship between the parts of the joint and the possible angles of abduction of the limb. Then the baby is turned over to the other side and the procedure is repeated.

Decoding the research results

Based on the relative position of the bones in the ultrasound image, the doctor can determine the presence and severity of a problem with the joint. The initial stages of hip dysplasia, left without attention and treatment, can lead to subluxation and subsequently to dislocation of the hip joint, which, in turn, if untreated, leads to incorrect positioning of the leg, coxarthrosis and lameness.

What to do if signs of hip dysplasia are detected?

In order to prevent the progression of the baby’s disease, it is necessary to urgently examine the child’s orthopedist , who will monitor and treat him. If the doctor suspects that the child is suffering from a subluxation or dislocation of the hip, the child will be required to undergo an X-ray of the hip joints to confirm the diagnosis.

Ultrasound diagnostics to identify the consequences of birth injuries to joints in newborns and babies up to one year old.

Also, with the help of ultrasound, it is possible to identify birth injuries that were undetected during visual examination or radiography, which could occur during the passage of the child through the birth canal during active obstetric assistance, in the case of breech presentation of the fetus and in other cases of difficult childbirth. The joint ligaments in newborn babies are extremely elastic (this is necessary so that the child at birth can more easily pass through the mother’s birth canal), but, unfortunately, precisely because of this feature, the child’s joints themselves can be damaged during childbirth. It is ultrasound diagnostics that allows you to quickly determine the condition of ligaments, joint capsules and joint spaces, and the presence of excess amounts of joint fluid and blood in them.

What signs may indicate the consequences of birth injuries to the joints?

Signs of joint damage during childbirth may include:

Swelling (edema), change in skin color in the joint area, the appearance of hematomas.
Restricted or unnatural mobility of a limb.
Baby crying when moving a limb.
Asymmetrical arrangement of the limbs, differences in their length, differences in the position and depth of skin folds, visible differences in the shape of symmetrical joints.
In the joint, a formation is felt under the skin that is absent in a symmetrical healthy joint.

What to do if ultrasound reveals signs of birth injuries to the joints of a baby?

If ultrasound sonography detects signs of joint injury during childbirth, you should immediately seek advice from a pediatric orthopedist-traumatologist , who will confirm the diagnosis, prescribe treatment and observe the baby.

ULTRASOUND OF JOINTS IN CHILDREN OF ANY AGE ACCORDING TO MEDICAL INDICATIONS

Unfortunately, at any age, be it in the neonatal period, infancy, nursery or school periods of life, children can suffer joint injuries and suffer from acquired joint diseases. In these cases, ultrasound is also the first choice diagnostic method. If the condition of the bones is better determined by X-ray examinations, then the condition of tendons and ligaments, muscles, joint capsules and crevices that could be damaged by injury or damage caused by disease (inflammation) can be assessed with great accuracy by ultrasound examination.

Which joints can be examined using ultrasound scanning?

Almost all joints of the arms and legs, joints of the head (mandibular joints) are accessible for ultrasound.

What joint pathology can be detected in children using ultrasound?

damage to the joints as a result of injuries and increased stress (stretching or rupture of the joint capsule, tear or tear of the ligament);
damage and inflammatory diseases of ligaments and tendons, joint capsules, cartilaginous surfaces;
the presence of fluid, blood, foreign bodies or neoplasms inside the joint capsule.

What are the indications for examining joints in children using ultrasound?

to consult an orthopedic traumatologist and conduct an ultrasound examination of the joint if you notice or your child complains of:

Pain in any joint that occurs when moving or resting the arms, legs, or head.
Any joint disorders: discomfort, excessive mobility, stiffness, blocking of movements, crunching and clicking during movements.
Swelling, redness of the skin in the joint area, the appearance of hematomas, unusual formations under the skin.
A sharp manifestation of complaints after a jump, fall, blow, damage by an object, spraining, performing an exercise, or prolonged physical activity.

How to prepare a child for an ultrasound examination of joints?

No special preparation is required for ultrasound examination of joints. Your child should wear comfortable, loose-fitting clothing for the ultrasound exam that can be easily removed. You can feed the child 2 hours in advance so that he is fed and calm, and immediately before the examination you can take him to the toilet (or change his diaper).

How will the child feel during the procedure?

Ultrasound examinations are painless and easily tolerated by most infants and children. The child will feel warmth and slight pressure from the device’s sensor moving across the gel-lubricated skin. He will also hear pulsed sounds emitted by the sensor. Once the examination is completed, the gel will be gently removed from the surface of the skin using regular wipes. An ultrasound examination of each joint takes only a few minutes.

Ultrasound diagnostics of joints is one of the most accessible, safe and fastest research methods, which will allow you to accurately establish a diagnosis and carry out the required treatment with maximum efficiency, or get rid of worries and doubts about your baby’s health.

You can get additional information about ultrasound of joints and make an appointment for diagnostics at a medical center by phone.