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Sartorius

Iliopsoas muscle

Iliopsoas tendon jr

FIGURE 4.20. Normal hip anatomy on ultrasound. Transverse image at the level of the femoral head using a linear array 8-MHz transducer demonstrates the normal appearance of the iliopsoas tendon, right common femoral artery (CFA), iliopsoas muscle, and sartorius muscle.

examination is performed using a high-frequency linear or curved array transducer. The tendon is best evaluated in the transverse plane with the transducer immediately anterior to the hip at the level of the femoral head and anterior acetabular rim. Scanning is performed as the patient reproduces the popping sensation typically with extension of the leg from the flexed, externally rotated, and abducted position. A cine clip of the tendon motion can be stored and potentially downloaded to CD for future review by the referring physician.

Bursitis

Inflammation of bursa around the hip can be an important extraarticular source of hip pain. MRI and CT have the ability to demonstrate abnormal accumulation of bursal fluid around the hip, but MRI is better suited to demonstrate these collections due to better soft tissue contrast.25,26,69 An abnormal amount of fluid in the iliopsoas bursa or greater trochanteric bursa may imply bursitis, although a small amount of fluid in bursa can be seen in asymptomatic patients.69 Fluid accumulating in a bursa is dark on T1-weighted images and bright on T2-weighted images. In the iliopsoas bursa, this fluid collection courses in a longitudinal fashion posterior to the iliopsoas muscle (Figure 4.21).25,26,69

Septic Arthritis

Acute septic arthritis is an uncommon cause of hip pain in the adult, but one that needs to be diagnosed expediently to avoid the consequences of delayed therapy. Plain radiographs are typically normal in early septic arthritis or at best may show widening of the joint space. Radionuclide bone scanning may demonstrate increased activity in the hip but is nonspecific. Much of the experience with MRI and septic arthritis of the hip has been in children focused on efforts to distinguish transient synovitis from septic arthritis.70 In septic arthritis MRI may demonstrate a pathologic effusion and may show edema in the paraarticular soft tissues (Figure 4.22). MRI cannot distinguish a sterile

FIGURE 4.21. Iliopsoas bursitis. (A) Axial T2-weighted fat- don and muscle. (B) Coronal T2-weighted fat-suppressed image suppressed image reveals an increased amount of fluid in the il- demonstrates the longitudinal orientation of the distended iliopsoas iopsoas bursa (arrow) along the posterior margin of the iliopsoas ten- bursa (arrow).

FIGURE 4.21. Iliopsoas bursitis. (A) Axial T2-weighted fat- don and muscle. (B) Coronal T2-weighted fat-suppressed image suppressed image reveals an increased amount of fluid in the il- demonstrates the longitudinal orientation of the distended iliopsoas iopsoas bursa (arrow) along the posterior margin of the iliopsoas ten- bursa (arrow).

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Arthritis Joint Pain

Arthritis Joint Pain

Arthritis is a general term which is commonly associated with a number of painful conditions affecting the joints and bones. The term arthritis literally translates to joint inflammation.

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