AANA Lab Course 905 - 2nd Annual Fellows Course-Ultrasound-Rachel M. Frank, M.D., Sanjeev Bhatia, M.D., Kyle Pilz, PA, and Kevin Shinsako, PA

Ultrasound-Rachel M. Frank, M.D., Sanjeev Bhatia, M.D., Kyle Pilz, PA, and Kevin Shinsako, PA

Pdf Summary

This presentation by Dr. Sanjeev Bhatia focuses on incorporating ultrasound (U/S) guided hip injections into clinical practice for diagnostic and therapeutic management of hip pain. Hip and groin pain can stem from various causes categorized by location: anterior, lateral, posterior, and other systemic origins. Common conditions include muscle strains, labral tears, osteoarthritis, inflammatory arthritis, femoroacetabular impingement (FAI), bursitis, and tendonopathies. Diagnosing hip pain is challenging, often delayed (average 21 months to diagnosis) with multiple providers involved.<br /><br />A layered understanding of hip pathology is proposed—considering osteochondral, inert (labrum, capsule), dynamic (musculature), and neural layers—to properly localize pain and tailor treatment.<br /><br />U/S guided hip injections offer real-time accuracy, cost-effectiveness (6% the cost of fluoroscopy-guided OR injections), efficiency, and are relatively easy to learn but require ultrasound equipment and training. Billing codes differ from large joint injections, with U/S injections reimbursed at higher wRVUs (20611 vs. 20610).<br /><br />Injection indications include intra-articular hip pain (e.g., FAI, arthritis), iliopsoas tendonitis/internal snapping hip, peritrochanteric pain syndromes (greater trochanteric bursitis, gluteus medius tears, external snapping hip), and ischial bursitis/ischiofemoral impingement. Injection agents include corticosteroids, anesthetics, PRP, and viscosupplements (off-label).<br /><br />Technical pearls involve proper patient and ultrasound setup, identification of femoral head and neck, avoiding neurovascular structures, and needle guidance under U/S visualization. Specific techniques for intra-articular, iliopsoas, peritrochanteric, and ischial injections were discussed with emphasis on minimizing risk (e.g., positioning to reduce sciatic nerve injury).<br /><br />The presentation highlights that injections can significantly aid in both diagnostics and treatment, allowing a precision approach to hip pain often complicated by multifactorial origins. Dr. Bhatia provides evidence-based insights and practical guidance for clinicians aiming to adopt or refine ultrasound-guided hip injection techniques.

Keywords

ultrasound guided hip injections

hip pain diagnosis

therapeutic hip injections

femoroacetabular impingement

greater trochanteric bursitis

iliopsoas tendonitis

peritrochanteric pain syndrome

corticosteroid injections

musculoskeletal ultrasound

hip joint pathology