November 10-15

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ACR Convergence 2023

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MSUS plays key role in diagnosing anterior hip pain


2 minutes

Anterior hip region pain is a common, and often challenging, presentation in clinical rheumatology. Although hip joint pathology is a potential cause, there are multiple other potential musculoskeletal and non-musculoskeletal structures that may cause or contribute to this problem.

Ingrid Möller, MD, PhD

Ingrid Möller, MD, PhD, Assistant Professor of Anatomy at the University of Barcelona in Spain, will describe relevant structures in the anterior hip that may generate pain during Sunday morning’s Anatomy for the Clinician I: Hip Pain, Not from the Hip Joint – Anterior Hip Pain. This symposium, part of the new series of “Anatomy for the Clinician” sessions being offered this year, will be held from 8:30 – 10:00 am in Salon B.

“A thorough understanding of the anatomy of this region is essential to disciplined problem solving,” Dr. Möller said. “This knowledge is even more relevant to clinical practice with the widespread use of musculoskeletal ultrasound (MSUS) imaging among rheumatologists. Not only does MSUS enable the production of high-resolution static and dynamic images of these structures, it is also portable, cost-effective, and rapid in the hands of an appropriately trained clinician.”

In addition to the patient’s history and clinical exam, she said, MSUS has proved an excellent complementary tool for the study of the non-visceral causes of anterior hip region pain, whether local, regional, or referred. In her lecture, Dr. Möller will address non-articular anterior hip pain due to local static and dynamic musculoskeletal pathologies.

“Through the use of clinical cases, an anatomic foundation will be built from the osseous, ligamentous, musculotendinous, fascial, and neurovascular structural components of this region so that the clinician and/or sonologist has a clear understanding of their normal appearance and relationship to one another at rest and with movement,” she said.

This will include looking at three of the major muscle groups that affect hip motion, and their muscular and tendinous trajectories: the flexors anteriorly, the adductors medially, and the abductors laterally.

“We will also look at the important insertions (entheses) in this region — the multifaceted greater trochanter for the abductors, the lesser trochanter for the flexors, and the origin of the adductors along the pubic portion of the innominate bone,” Dr. Möller said. “Major neurovascular structures can also contribute directly or indirectly to anterior hip pain —the femoral bundle consisting of nerve, artery, and vein, for example.”

At the end of this session, Dr. Möller hopes attendees, whether they are practitioners of musculoskeletal ultrasound or not, will have a better understanding of this complex region and be able to approach problems in this area with a more sound and clinically relevant anatomic foundation.

Anatomy for the Clinician I: Hip Pain, Not from the Hip Joint – Anterior Hip Pain
8:30 – 10:00 am Sunday • Salon B