Ultrasound-Guided Hip Injections

The diagnosis of hip pain can be difficult to isolate because the discomfort can originate from several locations and compensatory pain patterns. Pain generators can include the intra- and extra-articular hip structures, the lumbar spine, the pelvic floor, or a combination of these. It can also be referred as pain from the bowel, bladder, or reproductive organs. Injections into and around the hip have become an important part of both diagnostic and nonsurgical treatment algorithm for hip pain. The proximity of the hip to important neurovascular structures, lack of palpable anatomic landmarks, and deep location of targets can make use of ultrasonography-guided injections ideal. These injections have been growing in popularity in the orthopedic community because ultrasonography allows for a real-time visualization of dynamic anatomy without any radiation exposure to the patient and physician. The use of ultrasonography has allowed for in-office image guidance with improved accuracy for more targeted and advanced procedures. The patient's response to these injections can help guide patient selection for surgery and allow for better pain control of the soft-tissue pathology that often accompanies intra-articular pathology. This article highlights the diagnostic and therapeutic value of ultrasonography-guided hip injections for an orthopedic practice. The focus is on sonographic anatomy, introduction to technique, common indications, and pearls and pitfalls of these procedures.