Acute or recurrent hip pain in adults can be a challenging presentation in the emergency department. While ultrasound is routinely used in the evaluation of pediatric patients with hip pain and a new limp, it is not commonly used for this purpose in adult emergency medicine. This case series demonstrates the clinical utility of point-of-care ultrasound (POCUS) in adult patients with acute or recurrent hip pain because performance of POCUS was the critical action that led to the identification of pathologic hip effusions in this series of adults.
This case series includes 5 patients in whom clinical suspicion existed for the presence of a hip effusion and possible septic arthritis, despite nondiagnostic radiographic findings. Ultrasound was used to detect the effusion and guide subsequent arthrocentesis, imaging, or surgical intervention. In all patients, computed tomography scans or magnetic resonance imaging scans were later used to confirm the presence of effusion. In all 5 patients (2 women and 3 men, with a mean age of 47.4 years), POCUS accurately detected the presence of hip effusion. Two of 5 synovial collections were caused by septic arthritis as confirmed by synovial fluid microbiologic examination.
Why Should an Emergency Physician Be Aware of This?
This case series emphasizes the clinical utility of POCUS in adult patients with acute and recurrent hip pain to detect a hip effusion, particularly in patients with significant risk factors for septic arthritis. POCUS can also be used to guide further imaging, arthrocentesis, surgical consultation, and intervention.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Emergency Medicine
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Ultrasound guidelines: emergency, point-of-care and clinical ultrasound guidelines in medicine.Ann Emerg Med. 2017; 69: e27-e54
- Ultrasound-guided hip arthrocentesis in the ED.Am J Emerg Med. 2007; 25: 80-86
- Utility of bedside sonography to distinguish soft tissue abnormalities from joint effusions in the emergency department.J Ultrasound Med. 2010; 29: 519-526
- Accuracy of clinician-performed point-of-care ultrasound for the diagnosis of fractures in children and young adults.Injury. 2010; 41: 862-868
- Bedside hip ultrasonography in the pediatric emergency department: a tool to guide management in patients presenting with limp.Pediatr Emerg Care. 2014; 30: 285-287
- Emergency department diagnosis of pediatric hip effusion and guided arthrocentesis using point-of-care ultrasound.J Emerg Med. 2008; 35: 393-399
- Bedside ultrasonography to identify hip effusions in pediatric patients.Ann Emerg Med. 2010; 55: 284-289
- Hip ultrasound.Eur J Radiol. 2012; 81: 3824-3831
- Ultrasonography of hip joint effusions.Skel Radiol. 1987; 16: 607-611
- The normal width of anterior hip synovial recess in children.J Pediatr Orthop. 2000; 20: 264-266
- Targeted musculoarticular sonography in the detection of joint effusions.Acad Emerg Med. 2001; 8: 361-367
- Emergency physician-performed ultrasonography-guided hip arthrocentesis.Acad Emerg Med. 1999; 6: 84-86
Published online: January 22, 2020
Accepted: November 23, 2019
Received in revised form: October 11, 2019
Received: April 16, 2019
Reprints are not available from the authors.
© 2019 Elsevier Inc. All rights reserved.