Presentation
OA. For fluoroscopically guided hip joint corticosteroid injection.
Patient Data
The first image shows a 22-gauge needle inserted using an 'eye of the needle' approach which is parallel to the x-ray beam and perpendicular to the long axis of the patient. It targets the lateral femoral neck. The subsequent image has been taken after iodinated contrast has been injected and shows a linear spread laterally but medially it distends the hip joint. Findings could be in keeping with a part intra- and part extra-articular needle tip position. Alternatively, the needle may have been repositioned after an initial extra-articular injection was extra-articular, and after needle repositioning, the tip is now intra-articular.
Administration injectate confirms the needle tip is in an intra-articular position with distension of the hip joint.
Case Discussion
The position of the needle bevel should be considered in every MSK procedure. It can both help guide the needle into position and then obtain a better contact with the often curved articular surface. Some practitioners will prefer 'oblique' needle entry techniques in hip arthrogram injections to obtain a better contact point. This is opposed to an 'eye of the needle' technique, where a flush contact with the bone surface is not fully obtainable as the needle around 90 degrees to the bone.
This case highlights the appearance of a mixed intra-articular and extra-articular contrast injection. Repositioning the needle too many times will be uncomfortable for the patient and injecting excess contrast into the adjacent soft tissues can obscure the targeted area. Further injection of iodinated contrast should be performed to confidently confirm an intra-articular needle tip position before giving further injectates.
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