Best Practice Case Studies-Case 135 Asset 4 Ultrasound Evaluation of Lateral Hip

Video Transcription

Video Summary

A 64-year-old male jogger and custodian presented with greater trochanteric pain, worse on stairs and at night when lying on the affected side. Physical therapy helped somewhat, but pain persisted with jogging, prompting referral for musculoskeletal ultrasound to rule out gluteus medius/minimus tear.<br /><br />The speaker reviewed a detailed lateral hip ultrasound protocol, emphasizing that evaluation should begin with the anterior hip because hip joint pathology, especially osteoarthritis and labral degeneration, can present as lateral hip pain. In this case, radiographs showed hip osteoarthrosis. Ultrasound of the anterior hip identified a degenerative anterior labral tear, plus enthesiopathic changes at the sartorius insertion.<br /><br />Lateral scanning then assessed the greater trochanter, iliotibial band, gluteus minimus, gluteus medius anterior and posterior bands, and trochanteric bursa. The greater trochanter was mostly smooth, but the iliotibial band and proximal IT band insertion showed enthesiopathic change. The gluteus minimus had a small partial-thickness undersurface tear, while the gluteus medius anterior band had a more significant tendinosis with a moderate partial-thickness undersurface tear corresponding to maximal tenderness. The posterior band was normal.<br /><br />The talk stressed careful probe positioning, correlation with sonopalpation, use of radiographs, and recognizing when body habitus limits the exam. The final report summarized multiple pain generators, with gluteal tendon pathology felt to be most clinically relevant.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 135

Topic Hip

Keywords

4th Edition

4th Edition, Case 135

Hip

greater trochanteric pain

musculoskeletal ultrasound

gluteus medius tear

gluteus minimus tear

hip osteoarthritis

labral tear

iliotibial band enthesiopathy