Interactive Transcript
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A single spot sagittal view
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of the hip perhaps helps us highlight
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our search pattern a little bit.
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I'm not going to scroll through all the images
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right now since this is more introductory,
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but I'll tell you the most important
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thing to look for in this projection.
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Sometimes, and I mean 20% of the time
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or more, the only projection that
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you see a labral tear in is the sagittal.
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So you have to look very carefully and
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make sure there is not a line; there
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should be no line going either halfway
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through or all the way through the labrum.
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In fact, there shouldn't be any line at all.
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Now, if you have a tear like this,
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and you attempt to do a coronal
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projection, what are you going to see?
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A little tiny pinhead coming at you,
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which makes visualization of this type of tear
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that is running back to front very challenging.
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So you will miss this tear in the
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coronal projection but only see
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it in the sagittal projection.
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But don't be dismayed, because the sagittal
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is extremely reliable in showing you a
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contiguous labral structure without a line
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through it, without a sulcus through it.
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So this line has very important implications.
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Now occasionally you'll also see involvement of
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hyaline cartilage transitioning longitudinally.
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I think I may have to make
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my line a little smaller.
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I'm going to do that.
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transitioning into the labrum
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somewhat longitudinally.
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Now this will be detectable or detected
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on the sagittal and in other projections.
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But this horizontal type of tear
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that goes from back to front in the
1:35
labrum is the most important critical
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finding in the sagittal projection.
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The second most important critical finding
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in the sagittal projection is identification
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of an abrasion or an erosion in the labrum.
1:47
and the hyaline cartilage.
1:49
Let me make that green if I can.
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So you're looking for hyaline involvement or
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penetration in the bone anteriorly, which is
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usually seen directly adjacent to labral tears
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in patients with type 1 CAM type impingement.
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On the other hand, if you have pincer-type
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impingement, a lot of the hyaline disease
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is going to be in the back, and then it'll
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propagate to the front all the way around.
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And that's going to be pretty
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obvious and very easy once you
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make the connection of pincer-type.
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Or type 2 impingement.
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And then you go back and look at the
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posterior aspect of the labrum where
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the cup is too deep and everything is
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sort of forced backwards and then the
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hyaline disease propagates to the front.
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A couple of other, uh, salient points and
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areas to look at in the sagittal projection.
2:40
We have the iliofemoral ligament
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and the iliopsoas tendon.
2:44
Frequently, we'll have hip flexor disease,
2:46
so on the PD spur, I often look in this area
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to see if there's high signal intensity
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as a manifestation of a hip flexor
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strain, which you can see in any
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projection with a PD spur, but I do like
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to view it in the sagittal projection.
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I also like to view the iliopsoas
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tendon insertion on the lesser
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trochanter, which is not shown here.
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And don't forget the greater trochanter is
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the site where the piriformis is located.
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The superior gemellus, the inferior gemellus,
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the obturator internus and externus are all
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going to insert on this area, and you can
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follow these tendons serially from medial
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to lateral in straight orthogonal sections.
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You'll learn a little bit later on that
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there are specialized piriformis views
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for patients with piriformis syndrome.
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The other thing you'll want to do is
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you'll want to look at the sciatic nerve,
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which is not in this plane just yet,
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and follow it from proximal to distal.
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And, and we're not, we're just
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spot viewing this right now.
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One other identified structure here,
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which I will highlight in purple, is
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the transverse ligament, which some
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have, uh, uh, said looks like a St.
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Andrew's cross.
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It forms the inferior aspect of the hip support.
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There is no bone or labrum along the
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direct inferior aspect of the hip.
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The hip is supported by a little
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trampoline here, the transverse ligament.
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So that concludes our real quick diagrammatic
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approach, uh, to the hip with special
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attention to this area of the labrum whose
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tear may only be seen about 20 percent
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of the time and in no other projection.
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Let's move on, shall we?
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