Hip Paralabral Cyst Aspiration and Injection

Other Names

• Hip Paralabral Cyst Aspiration
• Hip Paralabral Cyst Injection

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Background

Illustration of the hip joint including the acetabular labrum

Key Points

• Transducer: Linear or Curvilinear depending on body habitus
• Needle: 18 - 20 gauge, 3.5 inch needle
• Confirm cyst is not a vascular structure using color doppler

Anatomy of the Hip Labrum

• Fibrocartilagenous structure which outlines the acetebular rim
• Covers 170° of femoral head
• Functions: shock absorption, joint lubrication, pressure distribution, stability
• Horse-shoe shaped
• Continuous with the transverse acetabular ligament
• Articular side composed of fibrocartilage, capsular side composed of dense connective tissue

Palpation vs Ultrasound Guided

• This procedure can not safely be performed without ultrasound guidance

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Indications

• Hip Labral Tear
• Hip Paralabral Cyst

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Contraindications

• Absolute
  • Anaphylaxis to injectates
  • Overlying cellulitis, skin lesion or systemic infection
• Relative
  • Can be treated with less invasive means
  • Hyperglycemia or poorly controlled diabetes
  • Lack of symptom improvement with previous injection

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Procedure

A. Inferior-lateral approach for paralabral cyst aspiration. B. Image shows the paralabral cyst and needle trajectory (segmented arrow).

Equipment

• Sterile prep (i.e. chloraprep, chlorhexidine, iodine, etc)
• Gloves
• Needle: 18 - 20 gauge, 3.5 inch needle
• Syringe: 5-10 mL
• Gauze
• Ethyl Chloride
• Bandage
• Injectate
  • Local anesthetic
  • Corticosteroid
• Sterile probe cover

Ultrasound Findings

• Probe: Linear or curvi-linear depending on body habitus
• Common ultrasound findings include:

Technique: In Plane

• Patient Position
  • Supine
• Transducer position
  • Depends on the location of the cyst
  • Long Axis of the Femoral Neck
  • Transverse to thigh for lateral approach
• Needle Approach/ Orientation
  • In plane
  • Depends on location of the cyst
• Target
  • Middle of paralabral cyst
• Pearls and Pitfalls
  • Perform thorough pre-procedural scan to identify femoral triangle
  • Confirm not a vascular structure with color doppler
  • Choose approach based on optimal visualization of cyst
  • May need large gauge needle to aspirate or fenestrate cyst

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Aftercare

• No significant restrictions
• Can augment with ice, NSAIDS

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Complications

• Skin: Subcutaneous fat atrophy, skin atrophy, skin depigmentation
• Painful local reaction
• Infection
• Hyperglycemia
• Tendon, nerve or blood vessel injury

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See Also

Internal

• Procedures Main
• Ultrasound Main
• Hip Pain Main

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