Figure 12
Normal anatomy of the proximal adductor muscles. The adductor (Add) longus muscle originates at the anterior pubic bone and forms a common aponeurosis with the rectus abdominis (abd) muscle. The adductor brevis and magnus muscles are located posteriorly and the gracilis muscle medially.
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Traumatic and overuse hip injuries occur frequently in amateur and professional athletes. After clinical assessment, imaging plays an important role in diagnosis and in defining care management of these injuries. Ultrasonography (US) is being increasingly used in assessment of hip injuries because of the wide availability of US machines, the lower...
Citations
... On US, a distended bursa is deep to the femoral vessels and superficial over the iliopsoas tendon; it may appear compartmentalized when the tendon is bifid or contains multiple slips (Fig. 10). The iliopsoas bursa frequently communicates with the hip joint, so joint disease and joint effusion may led to distension of the bursa (21) . ...
This paper reviews ultrasound of the hip, which is a commonly requested examination for symptomatic hip issues. This includes both intra-articular and extra-articular causes of hip pain. Ultrasound is easily acces- sible, lacks radiation exposure, and allows for evaluation of the contralateral hip as well as assessment of dy- namic maneuvers. Ultrasound can be used to guide interventional procedures. Ultrasound of the hip can be challenging due to the deep location of structures and complex anatomy. Typically, high-frequency trans- ducers are used to examine the hip, however the choice of ultrasound transducer depends on the patient’s body habitus, with lower frequency transducers required to penetrate deep structures in obese patients. It is important to have an approach to ultrasound of the hip which includes assessment of the anterior, lateral, posterior, and medial aspects of the hip. The technique and relevant anatomy of each of these compart- ments are discussed as well as the use of Doppler examination of the hip. Several dynamic maneuvers can be performed to help determine the cause of hip pathology in various locations, and these are described and illustrated. Ultrasound is useful for guided procedures about the hip, and these indications will be reviewed.
... Histological evaluation of BN typically shows a predominant fibrous component with myxoid degeneration, partial adipose tissue necrosis, and occasional formation of a pseudocyst [4,[8][9][10]. Clinically, BN may manifest as a solitary or bilateral nodular lesion posterior to the scrotum, usually measuring 2-3 cm [2,11]. In females, the location can vary from the perineum to one or both labia majora [8]. ...
Biker's nodule, also known as ischial hygroma, is a rare condition described predominantly in male cyclists. Only a few cases of affected female cyclists or horse riders have been reported.
This case presents a biker's nodule in a 57-year-old woman who was referred due to a progressively enlarging tumor on her right labia majora. Due to discomfort and pain, the patient opted for surgical excision. The histological examination showed the aforementioned diagnosis. Alongside the case report, a review of the literature on biker's nodules in the female population has been included.
Physicians should be aware of this entity and inquire about the patient's physical activity as part of the medical history assessment.
... M = Metacarpal, P = Proximal Phalanx, T = Flexor Tendon. defined mass (outlined in dashed lines) in the subcutaneous tissue with a maximum length of approximately 4.5 cm in keeping with perineal nodular induration or Biker's nodule, sometimes also referred to as ischiatic hygroma or third testicle [17]. This condition is almost exclusively seen in male cyclists and represents a fibroblastic hypovascular pseudotumor in the paramedian soft tissues of the perineum [17]. ...
... defined mass (outlined in dashed lines) in the subcutaneous tissue with a maximum length of approximately 4.5 cm in keeping with perineal nodular induration or Biker's nodule, sometimes also referred to as ischiatic hygroma or third testicle [17]. This condition is almost exclusively seen in male cyclists and represents a fibroblastic hypovascular pseudotumor in the paramedian soft tissues of the perineum [17]. The treatment is aimed to avoid the causative factor, i. e. rubbing between the saddle and the ischial tuberosity [17]. ...
... This condition is almost exclusively seen in male cyclists and represents a fibroblastic hypovascular pseudotumor in the paramedian soft tissues of the perineum [17]. The treatment is aimed to avoid the causative factor, i. e. rubbing between the saddle and the ischial tuberosity [17]. ...
Introduction Ultrasound is a powerful technique in musculoskeletal (MSK) imaging, and it can replace MR imaging in many specific clinical scenarios. This article will feature some common and less common spot diagnoses in musculoskeletal ultrasound.
Spot diagnosis Cases were collected by members of the Educational Committee of the ESSR ( European Society of Musculoskeletal Radiology) with expertise in musculoskeletal ultrasound. Sixteen clinical entities are discussed based on the features that allow US spot diagnosis.
Conclusion Clinical history, location, and ultrasound appearance are the keys to spot diagnoses when performing musculoskeletal ultrasound.
Key Points:
Citation Format
... Road crashes are the main cause of MLLs [1,5]. Sports requiring sliding actions (such as football, soccer, or baseball) rank second in order of frequency [8,9]. ...
The Morel-Lavallée lesion is an infrequent traumatic lesion that the forensic physician may need to evaluate during examination of a victim. Using a review of the literature and an illustrative case, the objective of this paper is to discuss the medico-legal issues (accountability, functional recovery and healing times, and aftermath) associated with Morel-Lavallée lesions. We describe the case of a 24-year-old motorcycle driver who was hit by a car. Clinically, the right lumbar region had a large 16 × 15 cm ecchymosis with subcutaneous fluid swelling found by palpation. A body scan revealed a Morel-Lavallée lesion among other lesions. On day 7, its thickness was decreased by half. Morel-Lavallée lesions are specifically induced by shearing force with moderate-to-high kinetics in an anatomical area with an underlying fascia. The associated functional disability is globally moderate, but a large lesion or recurrences can extend the time needed to recover. Apart from some exceptions, care without any delay in diagnosis and treatment allows evolution of the lesion without functional consequences, but these lesions are frequently unnoticed in the initial phase.
Sonographic evaluation of hamstring tendon muscle injuries has become routine for many professional sports teams. Although magnetic resonance imaging is the modality most useful immediately after an acute hamstring injury, ultrasound later helps with re-assessment and guides treatment, including injecting biocellular therapy, planning physical therapy, and projecting recovery time. The piriformis syndrome, in which there is muscular compression of the sciatic nerve, mimics lumbar radiculopathy and is challenging to treat. According to one cadaver study, ultrasound-guided injections for the treatment of piriformis syndrome are 95% accurate, compared with only 30% accuracy for fluoroscopically guided injections. Ischial bursitis, an excruciating condition, can be diagnosed by ultrasound; ultrasound-guided bursal injection avoids damaging the nearby sciatic nerve. Ultrasound has also been playing an increasing role in guiding sacroiliac joint injections.
Groin and thigh pain are common complaints after athletic injuries. A sports hernia is a general description for several soft tissue conditions causing pain in the groin and lower abdomen. Pain in this location may be due to the tearing of abdominal muscles or the abductor longus tendon insertion on the pubic bone. Muscle strain in the abductor longus and gracilis is detectable by ultrasound. Likewise, ultrasound may distinguish between a tendon tear and tendinosis. Thigh splints causing posteromedial pain may be due to repetitive stress trauma resulting in abductor tendon avulsion from the femur; this disorder tends to occur in athletes, cheerleaders, and military recruits. Other conditions causing groin pain that are evaluable by ultrasound include inguinal hernias and femoroacetabular impingement. This Manual does not cover the evaluation of inguinal hernia, but information about femoroacetabular impingement is found in Chap. 20. Clinicians treating athletes frequently utilize ultrasound for point-of-care determination of injury type and severity.
Lateral hip pain may be due to greater trochanteric pain syndrome. Improved resolution of ultrasound equipment enables evaluation of the greater trochanter region, including the gluteus tendons. The sonographer can quickly evaluate for tendinosis, frank tendon tears, and underlying bursitis. Another cause of lateral thigh pain is a snapping iliotibial band, which causes the external lateral snapping hip syndrome; this condition is easily delineated with dynamic ultrasound. Lateral hip pain from tensor fascia latae tendinopathy and proximal iliotibial band syndrome is definable by ultrasound. Morel-Lavallee lesions due to blunt, soft tissue trauma are also readily diagnosed by ultrasound. Finally, ultrasound needle guidance is instrumental in providing pinpoint therapeutic injections.
Nerve/tendon snapping can occur due to their sudden displacement during the movement of an adjacent joint, and the clinical condition can really be painful. It can actually be challenging to determine the specific anatomic structure causing the snapping in various body regions. In this sense, ultrasound examination, with all its advantages (especially providing dynamic imaging), appears to be quite promising. To date, there are no comprehensive reviews reporting on the use of dynamic ultrasound examination in the diagnosis of nerve/tendon snapping. Accordingly, this article aims to provide a substantial discussion as to how US examination would contribute to ‘seeing’ and ‘hearing’ these pathologies’ different maneuvers/movements.
Purpose:
To determine the ultrasound imaging manifestations associated with subspine impingement (SSI), including the osseous and soft-tissue injuries adjacent to anterior inferior iliac spine (AIIS) and to investigate the diagnostic value of ultrasound for SSI.
Methods:
We retrospectively evaluated patients who attended the sports medicine department of our hospital and underwent arthroscopic treatment for femoroacetabular impingement (FAI) between September 2019 and October 2020, with preoperative hip joint ultrasound and CT examination within 1 month before surgery. All the FAI patients were divided into the SSI group and non-SSI group according to the clinical and intraoperative findings. The preoperative ultrasound and CT findings were assessed. The sensitivity, specificity, and positive predictive value (PPV) of some indicators were calculated and compared. Multivariable logistic regression and receiver operating characteristic curve (ROC) were also used.
Results:
A total of 71 hips were included, with a mean age of 35.4±10.4 years, 56.3% were women. Of these, 40 hips had clinically confirmed SSI. The bone morphology type III, heterogeneous hypoecho in anterosuperior joint capsule and the direct head of rectus femoris (dRF) tendon adjacent to AIIS on the Standard Section of dRF in ultrasound were associated with SSI. Among them, the heterogeneous hypoecho in the anterosuperior joint capsule had the best diagnostic value for the SSI (85.0% sensitivity, 58.1% specificity, AUC=0.681). The AUC of the ultrasound composite indicators was 0.750. The AUC and PPV of CT low-lying AIIS for the SSI diagnosis was 0.733 and 71.7%, which could be improved when CT was combined with the ultrasound composite indicators with AUC=0.831 and PPV=85.7%.
Conclusions:
Bone morphology abnormalities and soft-tissue injuries adjacent to the AIIS through sonographic evaluation were associated with SSI. Ultrasound could be used as a feasible method to predict SSI. The diagnostic value for SSI could be improved when ultrasound is combined with CT.
