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PubMed2001

Pneumococcal pyomyositis: a patient with diagnostic problems and complications.

Pyomyositis is an uncommon condition that may present a difficult problem in diagnosis. We report the development of Streptococcus pneumoniae pyomyositis involving the iliacus, iliopsoas, and gluteus muscles in a patient with elevated serum levels of antinuclear and antiphospholipid antibodies but without clinical evidence of connective tissue disease. Magnetic resonance imaging demonstrated rapid evolution of the infection, with progression from muscle edema to abscess formation over a period of 10 days. The diagnosis was initially missed, and osteomyelitis and sacroiliitis developed. Pyomyositis should be suspected in patients with the acute onset of severe, localized muscle pain and fever. As in this case, failure to promptly diagnose and treat this infection can result in significant morbidity.

Journal Article↗
PubMedDate not supplied

Two cases of fetal akinesia/hypokinesia sequence.

Two cases of fetal akinesia sequence are described. Both showed facial anomalies, arthrogryposis multiplex, bilateral camptodactyly, and pulmonary hypoplasia. One child had degeneration of large motor neurons of the thoracolumbosacral spinal cord and irregular atrophy of diaphragm; the other had left microphthalmia, hemiatrophy of the left temporal lobe with calcification of degenerated neurons, and hypoplasia of the cervothoracic spinal cord with decrease and degeneration of neurons. The iliopsoas and intercostal muscles showed focal myofiber atrophy. These findings suggested that some instances of this fetal akinesia syndrome might be due to neuromuscular dysfunction that occurred in utero and may have various causes.

Abnormalities, Multiple↗
PubMed1989

Conservative treatment of patellofemoral subluxation.

As pointed out in the preface of this book, patellofemoral subluxation is probably the most common knee problem seen in many orthopedists' offices today. Whereas the other authors have emphasized the anatomy and diagnosis, this article should serve as a dry but basic instruction on the exercise program that has been used in our clinic. We have had a success rate with this program of approximately 80 per cent. Certainly not all of the 20 per cent that fail require surgery. The classic exercises are quadricep sets, straight leg raises, hip abductors, hip adductors, hip flexors, and hamstring stretches, which have endured the test of time. The prevention of flexion extension activity, such as running the stadium stairs in order to strengthen the quadriceps of the patient with patellofemoral subluxation should be emphasized. Complications of conservative treatment, such as low back pain, iliopsoas tendinitis, and muscle soreness and the treatment of these is described. Finally, the importance of stretching the hamstring muscles is a cornerstone in the treatment of patellofemoral problems. Likewise, a tight IT band can put abnormal stress on the lateral aspect of the patella. In this article I have tried to point out our approach to conservative treatment of patellofemoral subluxation.

Exercise Therapy↗
PubMed1983

[Surgical treatment of dislocated hips after 5 years of age].

Fifty dislocated hips after the age of 5 were treated between 1975 and 1980. The surgical procedures performed combined tenotomy of the iliopsoas and adductor muscles, shortening of the femur, capsulorraphy and a pelvic osteotomy usually for re-orientation (Salter procedure) and rarely for widening of the acetabulum (Chiari procedure). It is thought that tenotomies and femoral shortening were more efficient than pre-operative traction which produced osteoporosis. However post-operative traction was used. In some cases plaster cast immobilisation was not used. The advantages of this technique were an acceleration of the surgical programme, better articular stability and early mobilisation. Osteochondritis and post operative stiffness were rare. The average range of movement included 90 degrees of flexion and lumbar balance was the most significantly improved factor. This type of surgical procedure aims to slow the development of coxarthrosis but it cannot diminish the risk. The limit of age for such treatment appears to be 10 years. After that, the indications need to be assessed carefully.

Age Factors↗
PubMed1998

[A case report of epidural abscess due to anaerobic bacteria, producing a mass of gas].

A 54-year-old female was admitted to our hospital on May 8, 1996, for evaluation of fever and headache. Her cerebrospinal fluid showed elevation of the cell count and total protein. The thoracic and lumbar MRIs revealed abnormal gas occupying the epidural space at the sacral level, and extended as high as 9th thoracic level. The gas spread inside the iliopsoas and paraspinal muscles. Anaerobic bacteria such as Bacteroides fragilis and Peptostreptococcus productus were cultured from the spinal fluid and Bacteroides was also detected from the epidural tissues obtained during laminectomy. The infectious source was decubitus extending around the sacral bone. The combination therapy of debridement with peroxide, catheter drainage of epidural abscess, intravenous and intrathecal antibiotics, and laminectomy presented her good outcome. This is a rare case of anaerobic bacterial spinal abscess, showing epidural and intramuscular gas as a prominent feature.

Abscess↗
PubMed1979

Tendon transfers in the paralytic hip.

We analyzed the results of transfers of the iliopsoas or external oblique muscles performed to augment the abductor power of the hips in 149 patients with flaccid paralysis of the hips. More than 800 supplemental procedures were performed on the lower extremities of these patients. Twenty-three of the thirty-eight hips that had been subluxated or dislocated became stable in the reduced position after the transfer operation. Every hip that had been stable before the transfer remained stable, and thirty-seven patients who had been brace-dependent became brace-free. We concluded that transfers of the iliopsoas or external oblique muscles are useful adjuncts in the treatment of paralytic disorders of the hips.

Adolescent↗
PubMed2004

Tropical pyomyositis (myositis tropicans): current perspective.

Tropical pyomyositis, a disease often seen in tropical countries, is characterised by suppuration within skeletal muscles, manifesting as single or multiple abscesses. The most common organism implicated is Staphylococcus aureus. In 20%-50% of cases there is a history of trauma to the affected muscles. Commonly involved muscles are quadriceps, glutei, pectoralis major, serratus anterior, biceps, iliopsoas, gastrocnemius, abdominal and spinal muscles. Early diagnosis is often missed because of lack of specific signs, unfamiliarity with the disease, atypical manifestations, and a wide range of differential diagnosis. Diagnostic techniques like ultrasound and computed tomography/magnetic resonance imaging are very useful in diagnosis. The diagnosis is confirmed either by biopsy or aspiration of pus from the affected muscles. The initial antibiotic of choice is cloxacillin. Incision and drainage are important components of management. Treatment for Gram negative or anaerobic organisms should be instituted, whenever indicated. Physicians should become more familiar with this potentially life threatening but curable infective disease entity.

Diagnosis, Differential↗
PubMed1995

Unexpected motor patterns for hindlimb muscles during slope walking in the cat.

1. Hindlimb kinematics and motor patterns were assessed from high-speed ciné film synchronized with electromyographic (EMG) data from cats trained to walk on a walkway placed at four grades (25, 50, 75, and 100%). 2. Flexor muscles of the hip (iliopsoas) and ankle (tibialis anterior) had similar activity patterns for the swing phase of up- and down-slope walking; both flexor muscles also had stance-related activity during down-slope walking and this was unexpected. Extensor muscles of the hip (anterior biceps femoris and anterior semimembranosus), knee [vastus lateralis (VL)], and ankle [lateral gastrocnemius (LG)] were active during the stance phase of up-slope walking. The VL and LG activity was reduced in duration during stance of down-slope walking and centered around paw contact. Hip extensors, however, were totally inactive during stance of down-slope walking, and this was not expected. 3. Flexor muscles at the hip and ankle (not extensor muscles) dominated the stance phase of down-slope walking, especially at the steeper slopes. This switch in motor patterns may be required to counterbalance external forces that produced extension at the hip and ankle joints during the stance phase of down-slope walking. Neural mechanisms for programming stance-related activity of flexor muscles are discussed.

Animals↗
PubMed2006

Acute iliopsoas and adductor brevis abscesses presenting with proximal leg muscle weakness.

Pyomyositis is a bacterial infection of skeletal muscle. We describe the clinical case of a 77-year-old woman affected by gait disturbance, repetitive falls, low back pain and left thigh and groin pain, but without symptoms of systemic infection. Computed tomography and magnetic resonance imaging of the abdomen and pelvis showed abscesses in the left psoas and adductor brevis muscles. Investigations of urogenital tract and gastrointestinal system were normal. Systemic antibiotic treatment alone was not efficient, while surgical drainage improved the clinical picture. The aetiological organism, isolated from the abscess, was Staphylococcus aureus. We suggest that this patient had a primary pyomyositis rather than a secondary form. This is the first report of concomitant abscesses of psoas and adductor brevis muscles with early neurological involvement.

Aged↗
PubMed2006

Unusual site of recurrent musculoskeletal hydatid cyst: case report and brief review of the literature.

A case of a large multiplex recurrent hydatid cyst involving the left gluteal muscle and the left iliopsoas, accompanied with degeneration of the musculature of the left upper leg is presented along with a review of the relevant literature. Very few such cases have been reported worldwide. The presented case is also distinguished by the involvement of muscles of distant anatomic areas.

Aged↗
PubMed2000

A comparative trial of botulinum toxin type A and methylprednisolone for the treatment of myofascial pain syndrome and pain from chronic muscle spasm.

Myofascial pain syndrome (MPS) is a common illness, characterised by acute or chronic focal pain, muscle stiffness and fatigue. The pathophysiology of MPS remains unclear. Previous preliminary studies have demonstrated therapeutic efficacy of the muscle relaxant botulinum toxin type A (BTX-A) in the treatment of MPS. A single-centre, randomised trial compared the effects of BTX-A with the steroid methylprednisolone (both administered intramuscularly with 0.5% bupivacaine), in 40 patients suffering from chronic myofascial pain in the piriformis, iliopsoas or scalenus anterior muscles. Thirty days after receiving an injection of either BTX-A or steroid followed by post-injection physiotherapy, pain severity had decreased significantly from baseline in both treatment groups, with no significant difference between the two treatment groups. However, the baseline pain score was significantly higher in the BTX-A treatment group compared with the steroid group (7.9 vs. 7.3), and the reduction in pain score between baseline and 30 days post-injection was greater in the BTX-A group compared with the steroid group (-3.9 vs. -3.5; P=0.06). At 60 days post-injection, the pain severity score for the BTX-A-treated patients was statistically significantly lower than the pain score for the steroid-treated population (2.3 vs. 4.9). Furthermore, the reduction in pain score in the BTX-A group at 60 days post-injection was greater than at 30 days (-5.5 vs. -3.9), whereas the effect of the steroid had begun to wane. These results indicate the superior efficacy of BTX-A over conventional steroid treatment in patients suffering from MPS, when combined with appropriate physiotherapy.

Adolescent↗
PubMed2001

Psoas abscess and cellulitis of the right gluteal region resulting from carcinoma of the cecum.

Although retroperitoneal or psoas abscess is an unusual clinical problem, the insidious and occult characteristics of this abscess sometimes cause diagnostic delays, resulting in considerably high morbidity and mortality. In particular, psoas abscess caused by perforated colon carcinoma is uncommon. We report a case of psoas abscess caused by a carcinoma of the cecum. A 72-year-old Japanese woman was admitted to our hospital, with pain in the right groin and buttock. The pain had appeared 6 months before admission, and the symptoms had then been relieved by oral antibiotics. On March 25, 1999, inflammatory signs in the right buttock indicated localized cellulitis, and incision and drainage was performed at a local hospital. The patient was referred to our hospital on the same day. On admission to our hospital, computed tomography (CT) scan revealed a thick right-sided colonic wall and enlargement of the right ileopsoas muscle. Barium enema and colonofiberscopy revealed an ulcerated tumor occupying the entire circumference of the cecum. A retroperitoneal abscess and fistula had been formed by the retroperitoneal perforation of cecum carcinoma: surgical resection was performed after remission of the local inflammatory signs. Operative findings indicated that the cancerous lesion and its surrounding tissues were firmly attached to the right iliopsoas and major psoas muscle, and en-bloc resection, including adjacent muscular tissue, was performed. The fact that carcinoma of the colon could be a cause of psoas abscess and cellulitis in the gluteal region should be considered when an unexplained psoas abscess is diagnosed.

Adenocarcinoma↗
PubMed2005

Force, work and power output of lower limb muscles during human maximal-effort countermovement jumping.

The purpose of this study was to simulate human maximal-effort countermovement jumping with a three-dimensional neuromusculoskeletal model. The specific aim was to investigate muscle force, work and power output of major lower limb muscles during the motion. A neuromusculoskeletal model that has nine rigid body segments, 20 degrees of freedom, 32 Hill-type lower limb muscles was developed. The neural activation input signal was represented by a series of step functions with step duration of 0.05 s. The excitation-contraction dynamics of the contractile element, the tissues around the joints to limit the joint range of motion, as well as the foot-ground interaction were implemented. A simulation was started from a standing posture. Optimal pattern of the activation input signal was searched through numerical optimization with a goal of maximizing the height reached by the mass center of body after jumping up. As a result, feasible kinematics, ground reaction force profile and muscle excitation profile were generated. It was found that monoarticular muscles had major contributions of mechanical work and power output, whereas biarticular muscles had minor contributions. Hip adductors, abductors and external rotator muscles were vigorously activated, although their mechanical work and power output was minor because of their limited length change during the motion. Joint flexor muscles such as m. iliopsoas, m. biceps femoris short head and m. tibialis anterior were activated in the beginning of the motion with an effect of facilitating the generation of a countermovement.

Computer Simulation↗
PubMed2005

Parallel reflex pathways from flexor muscle afferents evoking resetting and flexion enhancement during fictive locomotion and scratch in the cat.

Reflex actions of muscle afferents in hindlimb flexor nerves were examined on ipsilateral motoneurone activity recorded in peripheral nerves during midbrain stimulation-evoked fictive locomotion and during fictive scratch in decerebrate cats. Trains of stimuli (15-30 shocks at 200 Hz) were delivered during the flexion phase at intensities sufficient to activate both group I and II afferents (5 times threshold, T). In many preparations tibialis anterior (TA) nerve stimulation terminated ongoing flexion and reset the locomotor cycle to extension (19/31 experiments) while extensor digitorum longus (EDL) stimulation increased and prolonged the ongoing flexor phase activity (20/33 preparations). The effects of sartorius, iliopsoas and peroneus longus muscle afferent stimulation were qualitatively similar to those of EDL nerve. Resetting to extension was seen only with higher intensity stimulation (5T) while ongoing flexor activity was often enhanced at group I intensity (2T) stimulation. The effects of flexor nerve stimulation were qualitatively similar during fictive scratch. Reflex reversals were consistently observed in some fictive locomotor preparations. In those cases, EDL stimulation produced a resetting to extension and TA stimulation prolonged the ongoing flexion phase. Occasionally reflex reversals occurred spontaneously during only one of several stimulus presentations. The variable and opposite actions of flexor afferents on the locomotor step cycle indicate the existence of parallel spinal reflex pathways. A hypothetical organization of reflex pathways from flexor muscle afferents to the spinal pattern generator networks with competing actions of group I and group II afferents on the flexor and extensor portions of this central circuitry is proposed.

Adaptation, Physiological↗
PubMed2005

Combined femoral and obturator neuropathy caused by synovial cyst of the hip.

A 57-year-old man with a history of severe degenerative lumbar spine disease presented with painful proximal weakness of the right leg. Clinical examination suggested a femoral and obturator neuropathy with a palpable mass in the right groin. Magnetic resonance (MR) imaging disclosed a large synovial cyst of the underlying hip joint in the extrapelvic part of the iliopsoas and external obturator muscles, with femoral and obturator nerve compression. This case highlights the importance of detailed clinical examination in patients with multiple joint disease, the need for considering space-occupying cysts of degenerated joints as a potential cause of nerve damage in unusual locations, and the value of multiplanar MR imaging for proper diagnosis in such situations. Muscle Nerve, 2005.

Constriction, Pathologic↗
PubMed2003

High content of polyunsaturated fatty acids in muscle phospholipids of a fast runner, the European brown hare (Lepus europaeus).

To investigate both seasonal changes and possible intracorporal gradients of phospholipid fatty acid composition, skeletal muscles ( n=124), hearts ( n=27), and livers ( n=34) from free-living brown hares (Lepus europaeus) were analyzed. Phospholipids from both skeletal muscles and heart had a high degree of unsaturation with 66.8+/-0.63% and 65.7+/-0.5% polyunsaturated fatty acids, respectively. This is the highest proportion of polyunsaturated fatty acids reported in any mammalian tissue. Polyunsaturated fatty acid content in skeletal muscles was 2.3% greater in winter compared to summer (F(1,106)=17.7; P=0.0001), which may reflect thermoregulatory adjustments. Arachidonate (C20:4n-6) showed the greatest seasonal increase (+2.5%; F=7.95; P=0.0057). However, there were no pronounced differences in polyunsaturated fatty acid content between skeletal muscles from different locations in the body (m. iliopsoas, m. longissimus dorsi and m. vastus). Total muscle phospholipid polyunsaturated fatty acid content was correlated with polyunsaturated fatty acid content in triacyglycerols from perirenal white adipose tissue depots ( r(2)=0.61; P=0.004). Polyunsaturated fatty acids were enriched in muscle phospholipids (56.8-73.6%), compared to white adipose tissue lipids (20.9-61.2%), and liver phospholipids (25.1-54.2%). We suggest that the high degree of muscle membrane unsaturation is related to hare-specific traits, such as a high maximum running speed.

Animals↗
PubMed2006

Middle-term results of simultaneous bilateral femoral osteotomies for advanced bilateral coxarthritis.

BACKGROUND: Osteotomy as a treatment for bilateral osteoarthritis of the hip is controversial because of deterioration of the contralateral side. We tried to not cause the contralateral hip to deteriorate even more while curing osteoarthritis by simple methods (release of iliopsoas and adductor longus muscle tendons and lateral transfer of the greater trochanter; Maquet's operation) during the rehabilitation period of Pauwels' valgus osteotomy. METHODS: Eighteen patients (17 women, 1 man; mean age, 49 years) were indicated for bilateral operations performed simultaneously from 1984 to 2001 and followed for more than 3 years (mean, 105 months; range, 36-188 months). They were analyzed clinically (hip score of Hospital for Special Surgery) and radiographically. Pauwels' valgus osteotomy was indicated for 18 hips with or without additional operations. Maquet's operation was performed simultaneously on all contralateral sides. Three weeks after the operations, the Maquet's operation side was fully weight-bearing and the other side was under controlled weight-bearing for 1 year. RESULTS: The mean hip score of the valgus osteotomy side was 36 points before the operation and 73 points at the final follow-up, respectively; that of Maquet's operation side was 44 and 77 points, respectively. Two-thirds (24 of 36) of the hips maintained more than 70 points of hip score at the final follow-up. Four hips were converted to total hip arthroplasty. Kaplan-Meier survivorship analysis revealed that the congruous joint maintained its joint space width for 10 years. CONCLUSIONS: Bilateral simultaneous femoral osteotomies for the late stages of osteoarthritis could be an alternative to bilateral total hip arthroplasties.

Adult↗