Ultrasound-Guided Iliopsoas Bursa Injection Technique

MATERIALS 22-gauge 3.5-inch spinal needle <10-MHz curvilinear transducer Local anesthetic, steroid, and/or other injectate 2 × 3-ml syringe Ultrasound probe cover Sterile ultrasound gel Chlorohexidine Sterile gloves 4 × 4 gauze Band-Aid (Optional) standard needle holder PATIENT POSITIONING The patient is placed supine with the leg extended and the hip in a neutral position. The physician is lateral to the patient on the same side as the affected hip and the ultrasound screen is in the physician’s direct view while injecting. PROBE POSITIONING Place the transducer in the transverse plane over the iliopectineal eminence providing a transverse image of the iliopsoas tendon. Once the injection target is localized, turn on the color Doppler to visualize any vascular structures at risk of injury during the injection that the physician would want to avoid. NEEDLE TECHNIQUE The needle is introduced using an in-plane, lateral to medial approach toward the iliopsoas tendon. The ideal final position of the needle is deep lateral aspect of the iliopsoas tendon and superficial to the iliopectinal eminence. Confirm needle placement by visualizing the structure out-of-plane and inferior to the iliopsoas tendon in longitudinal view, although the injection is best visualized with needle in-plane to the transducer (Video). PEARLS AND PITFALLS You can create an anesthesia track with one needle attached to local anesthetic and then exchange for another needle attached to the injectate to drive it to the target. Another option is to create an anesthesia track, and once at target, exchange the syringe with the help of a needle holder placed at the needle hub. After syringe exchange, proceed to inject. A linear transducer may be suitable in situations necessitating less depth. Care should be taken to avoid the femoral neurovascular bundle, which lies medially to the iliopsoas tendon. The anterior inferior iliac spine can obscure the needle trajectory if the injection is performed too proximally. Avoid injecting into the hip joint by ensuring the femoral head is distal to the site of injection. Video Legends Ultrasound-Guided Video Injection Series: Iliopsoas Bursa, https://links.lww.com/PHM/C610