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At least 307 records · Page 17Linked to original sources
PubMed1991

An unusual case of amyloidosis complicating light chain myeloma.

We present an unusual case of light chain myeloma complicated by systemic amyloidosis. There was massive infiltration of the left iliopsoas and quadratus femoris muscles with amyloid, manifesting itself clinically as a progressive, painless limp. We point out that accurate diagnosis by muscle biopsy in such cases has important prognostic implications and may avoid the unnecessary use of potentially toxic and ineffective treatment.

Aged↗
PubMed1979

Neonatal hip instability. Reason for failure of early abduction treatment.

A series of nine children with hip joint instability in 17 hips, diagnosed neonatally, is presented. Seven had bilateral idiopathic instability and two instability secondary to arthrogryposis, one of them bilateral. After reduction seven of the children (14 hips) were treated with abduction devices, which in all cases did not lead to stability in one or both hips. In these cases arthrography revealed that closed reduction was impossible due to narrowing of the joint capsule (hour-glass shape) and the interposition of a capsular fold including the acetabular labrum. The same types of changes were seen within 1 or 2 months after birth in three hips which had had no abduction treatment before arthrography. At open reduction of 11 hips it was found that the narrowing of the capsule was caused by the tendons of the iliopsoas and rectus femoris muscles. Excision of the capsular fold (labrum) was not necessary. The femoral head was deformed and anteverted. Failure of conservative treatment can be due either to incomplete reduction or to inadequate immobilization. Our analysis has shown that the most probable reason is incomplete reduction due to interposition. An obstacle to reduction should be suspected if abduction is restricted at birth, if primary reduction is difficult and the position difficult to maintain or if instability persists after 8 weeks of treatment. On the basis of our material the incidence of such an impediment to reduction was 0.08 per thousand births in the region studied during a 5-year period.

Acetabulum↗
PubMed1976

Traumatic anterior dislocation of hip joint with vascular damage.

Closed reduction of an anterior dislocation of the hip joint in a 15-year-old boy failed because of interposition of capsule, iliopsoas and rectus femoris muscles. The immediate complications were compression of the common femoral artery, tear of the femoral vein, and fat embolism 24 hours after the injury. The sequelae were periarticular ossification and avascular necrosis of the femoral head. The definitive treatment was a Charnley total hip arthroplasty.

Adolescent↗
PubMed1996

[Interrater studies of evaluating the reliability of somatic findings].

20 patients (11 female, 9 male) without low back pain were included in two interrater studies carried out by three physical therapists. The following variables were investigated: shape of the spine, iliac crest heights, twisting of the pelvis, spine test, length of legs, Patrick sign, Schober test, fingertip-to-floor measurements, flexion and extension of the lumbar spine, straight-leg raising, and length of the iliopsoas and the rectus muscles. Intraclass coefficients for the ordinal variables, and kappa coefficients for the nominal variables were calculated for evaluation of interrater agreement. In both investigations, the Schober sign, lumbar flexion, fingertip-to-floor measurements, straight-leg raising of the left leg, and lengths of both legs were almost perfectly reliable. All other variables exhibited a lower reliability between the three therapists.

Adult↗
PubMed1995

Iliopsoas compartment: normal anatomy and pathologic processes.

The iliopsoas compartment is an extraperitoneal space that contains the greater psoas, smaller psoas, and iliac muscles. Many pathologic processes may involve the iliopsoas compartment, including inflammatory, hemorrhagic, and neoplastic conditions. Psoas muscle infection is usually due to direct extension from contiguous structures. With the decreasing incidence of tuberculosis, the majority of psoas abscesses now encountered have a pyogenic origin. Hemorrhage into the psoas muscle can be spontaneous or secondary to various conditions. Neoplastic involvement of the psoas muscle is usually due to contiguous spread and is rarely primary. With the refinement of imaging modalities, there has been increased recognition of diseases that involve the iliopsoas compartment. Although these conditions may look similar radiologically, they can be correctly diagnosed by combining the radiologic findings with the clinical history. Biopsy is effective in diagnosis of such conditions; aspiration and drainage are effective in both diagnosis and therapy.

Abscess↗
PubMed1996

Activation of midlumbar neurones by afferents from anterior hindlimb muscles in the cat.

1. It has been suggested that a group of interneurones located in the midlumbar segments of the spinal cord might play a role in switching from the stance to swing phases of the step cycle during locomotion. We have further examined the input to these neurones from proprioceptive afferents to test whether the connections to these cells are consistent with this role. 2. Electrical stimulation of group I and group II afferents in branches of the femoral nerve which supply iliopsoas, the major hip flexor muscle, excited a large majority of intermediate zone midlumbar interneurones which receive input from quadriceps group II afferents. The central latencies and properties of the EPSPs indicate that both group I and group II afferents from iliopsoas make monosynaptic connections with many midlumbar interneurones. 3. Group II afferents from both the ankle flexor tibialis anterior and the digit dorsiflexor extensor digitorum longus excited midlumbar interneurones. Similarly, they were also excited by group II afferents from both of the two main anatomical divisions of the sartorius muscle. 4. The frequent and potent excitation of midlumbar neurones from group I and II afferents in iliopsoas suggests that they may be excited at the end of the stance phase of the step when these muscles are stretched. This possibility is discussed in relation to recent work on the functional control of the step cycle.

Animals↗
PubMed1995

[Mononeuropathy multiplex in a patient receiving interferon alpha therapy for chronic hepatitis C].

We report a case of mononeuropathy multiplex due to interferon alpha (IFN alpha) therapy for chronic hepatitis C. A 61-year-old man received IFN alpha (natural type 6 x 10(6) IU), every day for two weeks and three times a week for 22 weeks by intramuscular injection. Seventeen weeks after the initiation of IFN alpha therapy, he noticed painful dysesthesia, muscle weakness and muscular atrophy of the left lower extremity. Neurological examination revealed weakness of the left iliopsoas, quadriceps femoris and femoral adductor muscles, hypesthesia and dysesthesia. Electromyogram showed neuropathic change in the left vastus lateralis muscle. Muscle computed tomography showed muscular atrophy of the left lower extremity. Two months after discontinuation of the IFN alpha therapy, dysesthesia and muscle weakness of the left lower extremity improved spontaneously. He was diagnosed as mononeuropathy multiplex of the left femoral nerve and obturator nerve caused by IFN alpha therapy. Attention must be paid to dysesthesia, muscle weakness and muscular atrophy when IFN alpha therapy is initiated.

Chronic Disease↗
PubMed2001

Electrodiagnostic changes of the lower limbs in subjects with chronic complete cervical spinal cord injury.

OBJECTIVE: To assess the electrodiagnostic changes in the lower limbs as measured by nerve conduction studies (NCSs) and electromyography in individuals with chronic complete tetraplegia. DESIGN: Prospective testing of NCS and electromyography. SETTING: Model spinal cord injury rehabilitation center. PARTICIPANTS: Twenty-five individuals with chronic complete tetraplegia without risk factors for peripheral neuropathy or other lower motoneuron disorders. INTERVENTIONS: Nerve conduction parameters recorded from the peroneal, tibial, and sural nerves, and compared with normal values. The presence of spontaneous activity (SA), including fibrillation and positive sharp waves, recorded in 5 muscle groups-2 proximal (vastus medialis, iliopsoas), 2 distal (tibialis anterior, medial gastrocnemius), and L4 lumbar paraspinals. Analysis to see if the presence of SA correlated with the distance of the muscle from the spinal cord or with spasticity (measured by the modified Ashworth scale). MAIN OUTCOME MEASURES: Nerve conduction latencies and velocities; motor and sensory conduction latencies; compound muscle action potential (CMAP) and sensory nerve action potential amplitudes; spontaneous potentials: fibrillation and positive sharp waves; and spasticity. RESULTS: NCS responses were obtained at a decreased frequency relative to able-bodied subjects. Statistically significant results in comparison to normal means included a diminished sural amplitude, and diminished peroneal and tibial CMAP and nerve conduction velocity (p <.0001). SA was recorded in at least 1 of the muscles tested in 92% of subjects, with 72% having SA in more than 1 of the muscles tested affected. A significant difference was seen for SA in the medial gastrocnemius as compared with the iliopsoas (p =.039). No correlation was noted in terms of SA with degree of spasticity. CONCLUSION: A statistically significant difference in NCS responses in the lower limbs in chronic tetraplegia was found relative to normal control values. However, only the frequency of responses elicited and the decreased CMAP of the peroneal nerve are clinically significant. SA was present in many of the lower extremity muscles in the subjects. Predominantly axonal changes were evident in individuals with chronic complete tetraplegia.

Action Potentials↗
PubMed1991

Orientation and moment arms of some trunk muscles.

The orientations and moment arms of nine trunk muscles: latissimus dorsi, iliocostalis, longissimus dorsi, obliquii, rectus and transversalis abdominis, quadratus lumborum, and iliopsoas were obtained on embalmed specimens. Each muscle was considered as one or several, linear or curvilinear, lines of action. Origins, insertions, and points along the length of main bundles were digitized for each muscle using a three-dimensional digitizer. The results obtained from seven male specimens are presented and will permit more refined biomechanical models.

Abdominal Muscles↗
PubMed1996

Lower extremity injuries in college athletes: relation between ligamentous laxity and lower extremity muscle tightness.

OBJECTIVE: Two components of flexibility, muscle tightness, and ligamentous laxity in college athletes were studied to determine whether these factors were associated with the incidence of lower extremity injuries. DESIGN: Prospective cohort study. SETTING: College athletic department. PARTICIPANTS: 201 college athletes. OUTCOME MEASURES: College men and women athletes were tested for ligamentous laxity with the Beighton scale and for muscle tightness with a new scale based on the tightness of the iliopsoas, iliotibial band, hamstring, rectus femoris, and gastrocsoleus muscles. Lower extremity injuries incurred during practice and play were recorded during the following year. RESULTS: Of the 201 athletes tested, 71 sustained 115 injuries. For each additional point on the 9-point ligamentous laxity scale (9 = hyperlax), the risk of injury decreased 16%. For each additional point on the 10-point muscle-tightness scale (10 = all muscles tight), the risk of injury increased 23%. The two scores were moderately inversely correlated (Spearman's rho = -0.3; p < .001). Women had greater mean (+/- SD) laxity scores than men (3.3 +/- 2.2 vs. 1.8 +/- 2.0; p < .001) and lower mean overall muscle tightness scores (1.5 +/- 1.6 vs. 3.5 +/- 2.1; p < .001). Among Women athletes, the rate of lower extremity injury was unrelated to ligamentous laxity or to flexibility. Among men, lower extremity injuries were associated with lower ligamentous laxity scores (p = .008) and greater muscle tightness (p = .04). CONCLUSIONS: This study introduces a new scale for lower extremity muscle tightness. Tight ligaments and muscles are related to injury in men, but not women, college athletes. A preseason flexibility program may decrease injuries in college men athletes.

Adult↗
PubMed2004

Muscles that influence knee flexion velocity in double support: implications for stiff-knee gait.

Adequate knee flexion velocity at toe-off is important for achieving normal swing-phase knee flexion during gait. Consequently, insufficient knee flexion velocity at toe-off can contribute to stiff-knee gait, a movement abnormality in which swing-phase knee flexion is diminished. This work aims to identify the muscles that contribute to knee flexion velocity during double support in normal gait and the muscles that have the most potential to alter this velocity. This objective was achieved by perturbing the forces generated by individual muscles during double support in a forward dynamic simulation of normal gait and observing the effects of the perturbations on peak knee flexion velocity. Iliopsoas and gastrocnemius were identified as the muscles that contribute most to increasing knee flexion velocity during double support. Increased forces in vasti, rectus femoris, and soleus were found to decrease knee flexion velocity. Vasti, rectus femoris, gastrocnemius, and iliopsoas were all found to have large potentials to influence peak knee flexion velocity during double support. The results of this work indicate which muscles likely contribute to the diminished knee flexion velocity at toe-off observed in stiff-knee gait, and identify the treatment strategies that have the most potential to increase this velocity in persons with stiff-knee gait.

Gait↗
PubMed2005

Extension of lumbar spine infection into osteoarthritic hip through psoas abscess.

We present a case of pyogenic lumbar discitis and septic hip arthritis, accompanied by a psoas abscess and pyogenic iliopsoas bursitis, for which the correct diagnosis was delayed. The patho-mechanism was speculated to be initial hematogenous infection in the lumbar spine that spread along the psoas muscle as a psoas abscess and then extended into the hip joint via the iliopsoas bursa. For an early correct diagnosis, clinicians should be aware that the lumbar spine and hip joint regions communicate through the psoas muscle space and iliopsoas bursa, making it possible for infection to spread.

Bursitis↗
PubMed2000

Synchronous pyomyositis and septic hip arthritis.

The authors report a rare concomitant pyogenic infection of the iliopsoas, iliacus and external obturator muscles and of the hip joint in a 68-year-old woman. Because the patient showed the classic symptomatic triad of limping, hip pain and fever, in addition to positive hip arthrocentesis, the diagnosis of septic hip arthritis was routine, but the simultaneous pyomyositis was almost overlooked. Unusual localised heat and swelling on the front of the proximal thigh prompted a CT scan that identified remarkable muscle abscesses in addition to the septic arthritis. Surgical debridement and antibiotics resolved the infection relatively rapidly without sequelae. We noted that reaching a definitive diagnosis of such a concomitant infection requires a suspicion of the presence of pyomyositis, which can be definitively determined using advanced imaging studies.

Aged↗
PubMed1995

Tropical Pyomyositis in a Patient From St. Croix.

A 70-year-old man living in St. Croix, developed persistent swelling of his right leg approximately 1 year after undergoing pelvic lymph node dissection and irradiation in the United States for locally invasive adenocarcinoma of the prostate. Approximately 1 month prior to admission, he had noticed slow, painful swelling of his right groin associated with erythema and increased warmth. He reported no history of trauma. A computed tomography (CT) scan demonstrated an intramuscular soft tissue mass in the right iliopsoas, obturator, and adductor magnus muscles. A 19-day course of corticosteroids provided symptomatic improvement; however, cessation of this medication resulted in the rapid return and distal extension of the swelling. In addition, edema and a firm, "woody" mass developed in the lateral aspect of the right thigh, although there were no constitutional symptoms. Because of the recrudescence of symptoms, the patient was again placed on corticosteroids. After noting no improvement in 48 hours, the patient sought treatment in the United States, where he was diagnosed with tropical pyomyositis. Imaging studies demonstrated copious purulent material distributed in and between the anterior femoral muscles (Fig. 1). Culture of the pus drained intraoperatively yielded Streptococcus anginosus and Bacteroides vulgaris. The patient recovered after repeated surgical drainage and treatment with intravenous penicillin and metronidazole.

Journal Article↗
PubMed1988

Snapping tendon syndrome: hip tenography with fluoroscopic monitoring.

The snapping tendon syndrome may be caused by abnormalities of the fascia lata, gluteus maximus muscle, or less commonly, the iliopsoas tendon. One case is reported in which fluoroscopic monitoring after computed tomography-guided injection of contrast material confirmed the diagnosis of snapping iliopsoas tendon syndrome.

Adult↗
PubMed1975

Pathways of extrapelvic spread of disease: Anatomic-radiologic correlation.

Extrapelvic spread of disease, particularly from gastrointestinal tract perforations which may be clinically occult, may first present in the buttock, hip, thigh, and even lower leg, and the extraperitoneal space of the abdomen itself. Clinical manifestations at these remote sites may be very misleading. Anatomic and roentgenologic observations establish the preferential pathways of extrapelvic spread. These are related to the insertions and fascial investments of the iliopsoas, pyriformis, and obturator internus muscles and the ensheathed penetrations of the superior gluteal arteries. Superiorly, extension from the pelvic tissues seeks out the posterior pararenal compartment of the extraperitoneal region of the abdomen. Roentgenologic signs may first identify the presence, extent, and localization of the primary process.

Adult↗
PubMed2002

Sartorius muscle afferents influence the amplitude and timing of flexor activity in walking decerebrate cats.

Recent investigations have demonstrated that afferent signals from hindlimb flexor muscles can strongly influence flexor burst activity during walking and during fictive locomotion in decerebrate cats. We have reported previously that modifying afferent feedback from the sartorius (Sart) muscles by assisting or resisting hip flexion has a marked effect on the magnitude and duration of activity in iliopsoas (IP) as well as the sartorius muscles. The objective of the present investigation was to identify the afferents responsible for these effects by examining, in walking decerebrate cats, the influence of electrically stimulating sartorius afferents on burst activity in the IP and tibialis anterior (TA) muscles. Stimulation of the sartorius nerve at group I strength resulted in an increase in the duration of IP and TA bursts and an increase in the magnitude of IP bursts. The effect on burst durations was only observed at stimulus strengths of 1.6 T and higher. At lower stimulus strengths, there was a strong excitatory effect on IP bursts but no effect on TA bursts. Stimulation of the sartorius nerve at group II strength yielded variable results. When group II stimulation was delivered repeatedly during a walking sequence, the initial response was usually a strong inhibition of burst activity in IP and TA followed by a progressive reduction in inhibition and the emergence in IP of an excitatory response. This observation, together with findings of previous studies, suggests the existence of parallel excitatory and inhibitory pathways from sartorius group II afferents to flexor motoneurons. Taken together, these results support an earlier speculation that feedback from large afferents from the sartorius muscles has a strong influence on the generation of flexor burst activity in walking cats.

Afferent Pathways↗