The Pain Source

By Chris Faubel, M.D. –

Left Hip Injection under Fluoroscopy

Video of a left hip intraarticular steroid injection under fluoroscopic guidance. Click the black title link above (if you can’t see the video).

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Transducer: SonoSite C60

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Transducer: SonoSite C60 (curved)

Structures visualized:

• Acetabulum
• Femoral head
• Femoral neck
• Femoral shaft
• Joint capsule and cartilage
• Femoral joint space — injection site
• Femoral artery and vein

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Adapted from "Color Atlas of Anatomy, 4th edition"

Technique: Lateral approach with fluoroscopic guidance

Outpatient procedure

Patient position: Prone

Needle used: a 22-gauge 3.5″ quincke spinal needle is sufficient for most patients, although a 5″ may be needed for larger patients

Steps:

• Prep and drape
• Use the fluoroscope to find the skin over the greater trochanter
• Make skin wheal and deeper anesthesia with local anesthetic (1% lidocaine) with 27- or 25-gauge needle at a spot 4-6cm cephalad to the greater trochanter
• With 3.5″ 22-gauge needle, enter the skin through the skin wheal and go towards the top of the greater trochanter (#1 in the photo)
  • This will tell you you’re in the correct coronal plane
• Redirect the needle and aim towards the femoral head/neck junction (#2 in the photo)
  • Do NOT try to inject between the femoral head and the acetabulum
• Inject contrast to confirm intraarticular flow
  • You should be looking for the circular pattern noted in the fluoroscopic image below
• Inject the corticosteroid or steroid/local anesthetic injectate
• Remove needle.  Place band-aid.  Patient can go home immediately, with instructions to take it easy with that hip for 3-5 days.

Corticosteroid Hip Injection under Fluoroscopy - Courtesy Dr. Hazem Eissa - Ochsner Pain Management

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By Chris Faubel, MD –

PM&R. 2010 Mar;2(3):174-81.
The diagnostic validity of hip provocation maneuvers to detect intra-articular hip pathology.
Maslowski E, Sullivan W, Forster Harwood J, Gonzalez P, Kaufman M, Vidal A, Akuthota V.
Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Mail Stop F-493, 12631 East 17th Avenue, Academic Office 1, Room 2513, Aurora, CO 80045, USA. elmaslow@hotmail.com

http://www.pmrjournal.org/article/S1934-1482%2810%2900051-1/abstract

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