A 70 year old Male referred to physical therapy status post a fall with a Left ORIF to a prior Left total hip replacement. The patient had an initial THR and then fell on it with an ORIF surgery resulting. Months later into outpatient physical therapy the patient developed worsening pain. Upon further imaging an infection was diagnosed and a 3rd surgery done. Currently the patient is in therapy after the 3rd surgery with worsening pain. Bone Scan/ x ray/ CT scan positive for joint effusion without infection. Diagnostic Musculoskeletal Ultrasound by the Doctor of Physical Therapy was done indicating a screw approximating into the vastus intermedius muscle concordant with the patients pain. The patient had no pain with passive motions of the hip and pain reproduced with active hip flexion.
A screw seen extending in both SAX and LAX from the femur compressing into the vastus intermedius muscle. Video with active knee extension with patient supine and boltster under bilateral knees.
Diagnostic musculoskeletal ultrasound is a valuable tool to use dynamic testing to see how hardware interacts with pathology in orthopedic cases. This will allow the sonographer to visualize pathology that is not seen on still MRI/CT/X RAY/ and Bone Scan. In this case we are clearly able to visualize how the hardware interacts with the deep head of the quadriceps the vastus intermedius.
Doctor of Physical Therapy, Registered in Musculoskeletal Sonography, Certified Orthopedic Manual Therapist, Certified Lymphedema Therapist, Certified in Vestibular Assessment and Management, and Founder of Mobile Therapy Services
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