0:00

A single spot sagittal view

0:03

of the hip perhaps helps us highlight

0:05

our search pattern a little bit.

0:07

I'm not going to scroll through all the images

0:08

right now since this is more introductory,

0:11

but I'll tell you the most important

0:12

thing to look for in this projection.

0:15

Sometimes, and I mean 20% of the time

0:18

or more, the only projection that

0:21

you see a labral tear in is the sagittal.

0:23

So you have to look very carefully and

0:25

make sure there is not a line; there

0:27

should be no line going either halfway

0:29

through or all the way through the labrum.

0:31

In fact, there shouldn't be any line at all.

0:35

Now, if you have a tear like this,

0:36

and you attempt to do a coronal

0:37

projection, what are you going to see?

0:39

A little tiny pinhead coming at you,

0:43

which makes visualization of this type of tear

0:46

that is running back to front very challenging.

0:49

So you will miss this tear in the

0:51

coronal projection but only see

0:53

it in the sagittal projection.

0:56

But don't be dismayed, because the sagittal

0:58

is extremely reliable in showing you a

1:01

contiguous labral structure without a line

1:04

through it, without a sulcus through it.

1:07

So this line has very important implications.

1:10

Now occasionally you'll also see involvement of

1:12

hyaline cartilage transitioning longitudinally.

1:15

I think I may have to make

1:16

my line a little smaller.

1:17

I'm going to do that.

1:19

transitioning into the labrum

1:20

somewhat longitudinally.

1:23

Now this will be detectable or detected

1:27

on the sagittal and in other projections.

1:31

But this horizontal type of tear

1:33

that goes from back to front in the

1:35

labrum is the most important critical

1:38

finding in the sagittal projection.

1:41

The second most important critical finding

1:42

in the sagittal projection is identification

1:45

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.

1:51

So you're looking for hyaline involvement or

1:55

penetration in the bone anteriorly, which is

1:58

usually seen directly adjacent to labral tears

2:01

in patients with type 1 CAM type impingement.

2:05

On the other hand, if you have pincer-type

2:07

impingement, a lot of the hyaline disease

2:09

is going to be in the back, and then it'll

2:12

propagate to the front all the way around.

2:14

And that's going to be pretty

2:15

obvious and very easy once you

2:18

make the connection of pincer-type.

2:20

Or type 2 impingement.

2:22

And then you go back and look at the

2:23

posterior aspect of the labrum where

2:26

the cup is too deep and everything is

2:28

sort of forced backwards and then the

2:31

hyaline disease propagates to the front.

2:33

A couple of other, uh, salient points and

2:37

areas to look at in the sagittal projection.

2:40

We have the iliofemoral ligament

2:42

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

2:50

to see if there's high signal intensity

2:53

as a manifestation of a hip flexor

2:55

strain, which you can see in any

2:57

projection with a PD spur, but I do like

3:00

to view it in the sagittal projection.

3:03

I also like to view the iliopsoas

3:05

tendon insertion on the lesser

3:07

trochanter, which is not shown here.

3:10

And don't forget the greater trochanter is

3:13

the site where the piriformis is located.

3:15

The superior gemellus, the inferior gemellus,

3:18

the obturator internus and externus are all

3:21

going to insert on this area, and you can

3:22

follow these tendons serially from medial

3:25

to lateral in straight orthogonal sections.

3:28

You'll learn a little bit later on that

3:30

there are specialized piriformis views

3:33

for patients with piriformis syndrome.

3:35

The other thing you'll want to do is

3:37

you'll want to look at the sciatic nerve,

3:39

which is not in this plane just yet,

3:41

and follow it from proximal to distal.

3:45

And, and we're not, we're just

3:46

spot viewing this right now.

3:49

One other identified structure here,

3:51

which I will highlight in purple, is

3:53

the transverse ligament, which some

3:56

have, uh, uh, said looks like a St.

3:58

Andrew's cross.

4:00

It forms the inferior aspect of the hip support.

4:04

There is no bone or labrum along the

4:07

direct inferior aspect of the hip.

4:09

The hip is supported by a little

4:11

trampoline here, the transverse ligament.

4:14

So that concludes our real quick diagrammatic

4:17

approach, uh, to the hip with special

4:20

attention to this area of the labrum whose

4:23

tear may only be seen about 20 percent

4:25

of the time and in no other projection.

4:29

Let's move on, shall we?