Hip Tendons Muscles

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The superficial muscles and tendons about the hip can be evaluated with so-nography. Normal tendons demonstrate a hyperechoic fibrillar echo texture; this is believed to be secondary to a highly organized collagenous makeup [10]. Partial tears are characterized by hypoechoic or anechoic focal defects involving either the surface or substance of the tendon (Fig. 2); however, partial tears can be difficult to differentiate from tendinopathy, because imaging findings may overlap. Complete tears demonstrate disruption of all fibers and retraction of the torn edges, which may be seen within a hypoechoic or anechoic hematoma. Sonography allows dynamic evaluation, which often

Longitudinal Echo Imaging Hip

Fig. 1. Hip joint effusion. (A) Longitudinal sonographic image of the left hip joint shows an effusion measuring 1.0 cm. (B) Longitudinal image of the right hip joint for comparison without effusion. (C) Aspiration of the left hip was performed under real-time sonographic imaging; long arrow marks the needle, tip of the needle (thin arrow] is within the fluid.

Fig. 1. Hip joint effusion. (A) Longitudinal sonographic image of the left hip joint shows an effusion measuring 1.0 cm. (B) Longitudinal image of the right hip joint for comparison without effusion. (C) Aspiration of the left hip was performed under real-time sonographic imaging; long arrow marks the needle, tip of the needle (thin arrow] is within the fluid.

can be helpful in distinguishing between a partial or complete tear by demonstration of a fluid-filled gap when the tendon is stressed.

The major limitation to assessment of the hip musculature by sonography is the reduced resolution when scanning in areas of the body with extensive overlying soft tissue. Because of absorption of the sound waves by soft tissue, deep tissue detail can be limited on sonography. For this reason, the authors usually use MRI rather than ultrasound when the suspected pathology is deep within the hip soft tissues. At this time, MRI is the most commonly used imaging modality of choice in visualizing sport-related muscle injuries [11]. Depending on the patient's body habitus and location of the injury, MRI may more accurately demonstrate muscle and tendon injuries than sonography.

Tendinopathy usually visualized as swelling and a diffusely heterogeneous hypoechoic appearance at sonography (Fig. 3). These findings may be subtle or equivocal in mild cases, in which case comparison with the asymptomatic side is invaluable.

Hematoma or subcutaneous seromas occurring around the pelvis following trauma can also be evaluated with sonography. Seromas appear as anechoic or hypoechoic collections, whereas hematomas have mixed hyper-, hypo-, and

Stress Fracture Hip
Fig. 2. Partial tear of the gluteus minimus. Longitudinal sonographic image of the hip shows a partial tear of the gluteus minimus (arrow) as it inserts onto the greater trochanter.

anechoic areas. MRI with gadolinium is often preferable in evaluation of soft-tissue fluid collections, especially if there is concern for the presence of an abscess.

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