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Topography of the femoral nerve in relation to components of the iliopsoas muscle in human fetuses.

Studies were performed on 60 human fetuses of both sexes of 35 to 365 mm C.-R. length (9-40 weeks). The psoas minor muscle was found in 25.8% of cases independently of sex and body side. In 6.45% of cases the muscle continued into psoas major muscle by short, weakly developed tendon. In 97.5% of studied fetuses junctions between tendons of psoas major and iliacus muscles was observed. In 2.5% of cases an independent, short tendon was found in the half of length of the iliacus muscle. In 7.5% of cases connection between the psoas major and iliacus muscles was found. In all cases femoral nerve originated from the lumbar plexus between two layers of the psoas major muscle and it ran in the groove between the psoas major and iliacus muscles towards the muscular lacuna. In 5.0% of cases the nerve divided into crura. In 2.5% of cases the crura embraced anteriorly and posteriorly bundles of the psoas major muscle as well as in 2.5% of cases bundles of the iliacus muscle.

Embryonic and Fetal Development↗

Femoral nerve dysfunction after retroperitoneal hemorrhage: pathophysiology revealed by computed tomography.

In three patients receiving anticoagulation therapy who developed retroperitoneal hemorrhage computed tomography (CT) clearly localized the resulting hematoma in each case. Three distinct syndromes are described. A hemorrhage within the iliacus muscle resulted in femoral nerve dysfunction. A large hemorrhage within the iliacus muscle which extended into the psoas muscle produced both femoral and obturator nerve dysfunction. A retroperitoneal hemorrhage extrinsic to both the iliacus and psoas muscles did not produce peripheral nerve dysfunction. The pathophysiology of peripheral nerve dysfunction in retroperitoneal hemorrhage is reviewed in detail.

Adult↗

The anatomical basis for femoral nerve palsy following iliacus hematoma.

With increased use of anticoagulant agents, femoral neuropathy subsequent to hemorrhage within the iliacus muscle has become a frequent clinical problem. The mechanism for this type of femoral nerve palsy was studied in dissections of the iliac region and by injections of latex into fascial planes in that area. In most dissections, up to four fascial layers, parallel to the iliacus sheath, could be identified. Variable states of fusion of these layers often produced up to three pouches, separated by loose connective tissue or fat. These fasciae (called "lamina peritonealis," "lamina transversalis," "lamina preiliaca," and "lamina iliaca") appear to be variable adult remnants of distinct fascial layers present in the posterior abdominal wall during embryological development, and serve to strengthen the intrinsic fascia of the iliacus muscle. Latex injected into the iliacus sheath spread from the midlumbar region to the femoral triangle, surrounding, compressing, and stretching the femoral nerve in different parts of its course. These observations suggest an anatomical basis for femoral nerve palsy during iliacus hematoma.

Abdominal Muscles↗

Relative EMG levels in training exercises for abdominal and hip flexor muscles.

The main purpose of our study was to compare systematically EMG levels in sub-maximal training exercises for the trunk and hip flexor muscles with those voluntarily attainable in corresponding situations. Six healthy subjects performed three types of standardized training exercises, whose static positions, movement velocity and range of motion were reproduced during maximal voluntary isokinetic strength tests. EMG was recorded with wire electrodes from the iliacus muscle and with surface electrodes from the rectus femoris, sartorius, rectus abdominis, obliquus externus and internus muscles. The relative EMG values demonstrated a task dependency which could differ between individual muscles. The maximal voluntary activation levels were relatively constant across conditions. Exceptions were present, particularly for the rectus femoris and iliacus muscles. These findings highlight the consequences of using different methods of normalizing EMG. The relative EMG values presented may serve as guidelines when selecting training exercises for specific trunk and hip flexor muscles in sports and rehabilitation.

Abdominal Muscles↗

Arthroscopic psoas tenotomy.

Tenotomy may be indicated for psoas tendinitis or painful snapping if conservative treatment remains unsuccessful. Because of significant complications with open techniques, endoscopic operations have been developed. We present a new arthroscopic technique to access and release the psoas tendon from the hip joint. This procedure can be performed in addition to other arthroscopic procedures of the hip joint or alone. To exclude additional hip disease, a diagnostic round of the joint should be completed. After hip arthroscopy of the central compartment has been performed, traction is released and the 30 degrees arthroscope is placed via the proximal anterolateral portal lying on the anterior femoral neck. The medial synovial fold can be identified. This fold lies slightly medially underneath the anteromedial capsule at the level of the psoas tendon. The arthroscope is turned toward the anterior capsule. Sometimes, the tendon shines through a thin articular capsule, or it may even be accessed directly via a hole connecting the hip joint and the iliopectineal bursa at the level of the anterior head-neck junction. If this cannot be done, an electrothermic probe is introduced via the anterior portal to make a 2-cm transverse capsular incision. The tendon is released with the back side of the electrothermic device turned to the iliacus muscle that lies anterior to the psoas tendon. A complete release is achieved when the tendon stumps can be seen gapping at a distance and the fibers of the iliacus muscle are visible. The first 9 patients who underwent surgery performed according to this technique developed no complications, and their hip flexion strength was restored to normal within 3 months.

Arthroscopy↗

Iliacus abscess.

Iliacus muscle abscess originating from the sacroiliac joint was diagnosed prior to operation in a 13-year-old boy with the assistance of technetium-99m bone imaging and computerized tomography. Preoperative identification of the iliacus abscess enabled the surgeon to select an anterior (apophyseal splitting) retroperitoneal approach, which permitted drainage of both the ilium and the iliacus muscle.

Abscess↗

Purine nucleotides and AMP deamination during maximal and endurance swimming exercise in heart and skeletal muscle of rats.

The purine nucleotides, phosphocreatine (PCr), ammonia, and lactic acid were investigated in skeletal muscles of rats with prominent type I, type IIa, type IIb fibers, and the heart after exhaustive and endurance swimming tests. ATP, ADP, AMP, IMP, and PCr were determined by HPLC with UV detection in controls after maximal and endurance training for 6 weeks with or without a respective final test and also after final exhaustive or endurance test without preceding training. The swimming time in these tests was longer with than without training. A pronounced ATP decrease and a large increase in IMP, up to 4.9 mumol/g wet weight, were found in type IIb fibers after the maximal final test without preceding training. Compared with skeletal muscle, the IMP concentration in the heart was significantly lower after all exercise bouts, even though after maximal exercise AMP augmentation was highest, ATP reduction was greatest, and energy charge was lowest. The difference between the heart and skeletal muscle in the production of IMP indicates that despite AMP and ADP accumulation, myoadenylate deaminase (MAD) activity in the heart is considerably lower than in skeletal muscle, especially in type IIb fibers. The smaller amount of MAD per tissue, and also the different MAD isozyme pattern of the heart as reported in the literature, may be attributed to lower activation. The difference between MAD activation of the soleus muscle and of the iliacus muscle, both consisting predominantly of type I fibers, suggests that MAD activity may be influenced by biochemical demand and oxygen supply, varying with the anatomical localization. Even though ammonia and lactic acid were highly correlated, it is questionable whether the H+ ion increase due to the lactate accumulation itself triggers MAD activation, as has been found for AMP and ADP in skeletal muscle.

AMP Deaminase↗

Electromyographic analysis of hip and knee musculature during running.

The purpose of this study was to describe the firing pattern of 11 hip and knee muscles during running. Thirty recreational runners volunteered to run at 3 different paces with indwelling electromyographic electrodes while being filmed at 100 frames per second. Results demonstrated that medial and lateral vasti muscles acted together for knee extension during terminal swing and loading response, possibly providing a patella stabilizing role. The vastus intermedius muscle functioned with the other vasti, plus eccentrically controlled knee flexion during swing phase. The rectus femoris muscle fired with the vastus intermedius muscle and assisted the iliacus muscle with hip flexion. The hamstrings fired primarily to eccentrically control hip flexion. The adductor magnus, tensor fascia lata, and gluteus maximus muscles afforded pelvic stabilization while assisting with hip flexion and extension. Forward propulsion was provided mainly by hip flexion and knee extension, which is contrary to the view that posterior calf muscles provide propulsion during toe off. Faster running paces lead to increased activity in the muscles. This may lead to more injuries, primarily in the muscles that were contracting eccentrically.

Adult↗

Primary malignant tumors of the iliopsoas compartment.

BACKGROUND AND OBJECTIVES: Primary malignant tumors of the iliopsoas compartment are rare entities that have been infrequently reported. We present our experience of iliopsoas malignancy to better characterize and define the natural history of this condition. METHODS: Primary iliopsoas tumors occurring from January 1990 were identified from the Royal Marsden Hospital's (RMH) Sarcoma Unit prospective database. RESULTS: Nineteen malignant tumors (11 limited to the psoas muscle only, 1 involving only the iliacus muscle and 7 involving both the iliacus and psoas) of the iliopsoas compartment were evaluated and treated at the RMH during this period. Leiomyosarcoma (n = 5) and liposarcoma (n = 3) were the most frequent histologic types. There were 3 G1, 5 G2, 10 G3 tumors and grade could not be assessed in 1 patient. There were 17 T2 tumors and size was not available in 2 patients. Surgery was done in 14 patients (negative microscopic margins-7, positive microscopic margins-3, and positive gross margins-3 and the margin of excision was not known in 1 patient). Five of 14 surgically treated patients had local recurrence and 6 of 19 patients developed metastases. Ten patients died of their disease at a median follow-up of 12 months. The estimated 2 and 5 year survival rates were 44 and 23%, respectively. CONCLUSIONS: Tumors in this location have a poor prognosis due to the lack of early diagnosis, large size at presentation, multiple attachments of the psoas muscle, and being relatively surgically inaccessible.

Chemotherapy, Adjuvant↗

Abdominal and hip flexor muscle activation during various training exercises.

The purpose of this study was to provide objective information on the involvement of different abdominal and hip flexor muscles during various types of common training exercises used in rehabilitation and sport. Six healthy male subjects performed altogether 38 different static and dynamic training exercises trunk and hip flexion sit-ups, with various combinations of leg position and support, and bi- and unilateral leg lifts. Myoelectric activity was recorded with surface electrodes from the rectus abdominis, obliquus externus, obliquus internus, rectus femoris, and sartorius muscles and with indwelling fine-wire electrodes from the iliacus muscle. The mean electromyogram amplitude, normalised to the highest observed value, was compared between static and dynamic exercises separately. The hip flexors were highly activated only in exercises involving hip flexion, either lifting the whole upper body or the legs. In contrast, the abdominal muscles showed marked activation both during trunk and hip flexion sit-ups. In hip flexion sit-ups, flexed and supported legs increased hip flexor activation, whereas such modifications did not generally alter the activation level of the abdominals. Bilateral, but not unilateral, leg lifts required activation of abdominal muscles. In trunk flexion sit-ups an increased activation of the abdominal muscles was observed with increased flexion angle, whereas the opposite was true for hip flexion sit-ups. Bilateral leg lifts resulted in higher activity levels than hip flexion sit-ups for the iliacus and sartorius muscles, while the opposite was true for rectus femoris muscles. These data could serve as a basis for improving the design and specificity of test and training exercises.

Abdominal Muscles↗