Administrators, Editors, Administrators
3,484
edits
Changes
Jump to navigation
Jump to search
[[<gallery mode=packed heights=200>File:Ultrasonography of hip joint injection by anterior longitudinal approach.jpg|Anterior longitudinal approach. The needle is introduced from an inferior and anterior approach, lateral to the femoral neurovascular bundle (arrow). A, acetabulum; H, femoral head; N, femoral neck; double arrow – anterior joint recess.<ref name="YeapRobinson2017"/>File:Ultrasonography of hip joint injection by anterolateral approach.jpg|thumb|Anterolateral approach, here shown as a transverse image. The needle will rest on the femoral head (arrow). A, acetabulum; H, femoral head; N, femoral neck; LAT, lateral; MED, medial.<ref name="YeapRobinson2017"/>]]</gallery>
→Procedure: Format
*Perform a '''preliminary sonography''', including color Doppler of the area to be punctured, to define the relationship of adjacent neurovascular structures.<ref name="YeapRobinson2017"/>
*Decide which '''approach''' to use. Two common anterior approaches are typically used both with the patient lying supine:
[[File:Hip joint injection by anterior longitudinal approach.jpg|thumb|left|200px|Anterior longitudinal approach. An arrow parallel to the long axis of the transducer is drawn on the skin adjacent to the end of transducer where the needle will be introduced.<ref name="YeapRobinson2017"/>]][[File:Ultrasonography of hip joint injection by anterior longitudinal approach.jpg|thumb|Anterior longitudinal approach. The needle is introduced from an inferior and anterior approach, lateral to the femoral neurovascular bundle (arrow). A, acetabulum; H, femoral head; N, femoral neck; double arrow – anterior joint recess.<ref name="YeapRobinson2017"/>]]
:*The '''anterior longitudinal''' approach: the probe is aligned along the long axis of the femoral neck. The needle is introduced from an anteroinferior approach and is passed into the anterior joint recess at the femoral head-neck junction.
:*The '''anterolateral approach''', with the ultrasound probe oriented axially and the femoral head and acetabular rim in view. This often shortens the distance from needle skin entry to joint compared to the longitudinal approach making it a useful approach in larger patients. The introduced needle remains lateral to the femoral neurovascular bundle, and the needle is advanced until its tip rests on the femoral head.
*'''Draw''' a line parallel to the long axis of the transducer, on the skin adjacent to the end of the transducer is where the needle will be introduced.
*Perform '''sterile preparation''' of the entire injection field, including adjacent skin where the gel and probe are applied. Areas of superficial infection such as cellulitis or abscess should be avoided to prevent deeper spread.<ref name="YeapRobinson2017"/>
