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Spontaneous rupture of the distal iliopsoas tendon: clinical and imaging findings, with anatomic correlations.

We report the clinical and imaging findings in two elderly female patients with spontaneous rupture of the distal iliopsoas tendon from the lesser trochanter of the femur. We emphasize the key contribution of magnetic resonance (MR) imaging to this diagnosis and provide an anatomic correlation. Spontaneous rupture of the distal iliopsoas tendon should be kept in mind in the differential diagnosis of acute groin pain in the elderly. MR imaging enables positive diagnosis, by showing mass effect on the anterior aspect of the hip joint, proximal muscle thickening, and abnormal signal intensity, and by demonstrating interruption of the psoas tendon, whereas the distal insertion of the lateral portion of the iliacus muscle remains muscular and is preserved.

Aged↗

Surgical aspects of iliopsoas compartment tumours.

AIM: To demonstrate the pathological variety and highlight the surgical principles involved in the management of tumours of the iliopsoas compartment (IPC). METHODS: Review of four clinical cases. RESULTS: Adequate surgical resection or palliation was achieved in each case. CONCLUSION: Resection of IPC tumours is feasible but access to the most superior part of the muscle may be impossible. An extraperitoneal approach is advocated.

Abdominal Neoplasms↗

[A transposition of iliopsoas in replacement of pelvic floor for incontinence of urination and/or defecation in children].

Fourteen patients, the age ranged from 2 to 12 years, with fecal and/or urinary incontinence were treated between 1991 and 1993 using a transposition of iliopsoas in replacement or strengthening of pelvic floor. The results were encouraging. The evaluation of the function of pelvic floor was described. Levator plays an important role in normal mechanism of defecation as well as urination. Several types of incontinence develop while the disfunction of pelvic floor occur and some function of continence could be restored by an operation of transposition of iliopsoas.

Child↗

Referred knee pain treated with electroacupuncture to iliopsoas.

This is a case report of a 33-year-old woman who presented with an eight year history of deep left knee pain. The pain was originally diagnosed as deriving from osteoarthrosis of the hip secondary to dysplasia, however, the same pain returned at seven months, and again at 10 months, after successful hip resurfacing arthroplasty. Six to eight weeks after the start of the second relapse of referred knee pain, the patient sought acupuncture treatment at the British Medical Acupuncture Society's London Teaching Clinic. A single myofascial trigger point was found in iliopsoas that reproduced the patient's pain. It was successfully treated with two sessions of electroacupuncture applied directly to the point. Pain referral to the knee from trigger points in the upper part of rectus femoris is well recognised, however, this pattern of referral from iliopsoas has not been described previously.

Acupuncture Points↗

Optimization of walking ability of children with cerebral palsy.

A new paradigm based on an appreciation of the biomechanics of normal and pathologic gait and a better understanding of muscle-tendon unit anatomy and physiology has emerged for orthopaedic clinical decision making to optimize the ambulatory abilities of children with cerebral palsy. This quantitative, biomechanically based approach has been accepted as a research and teaching tool and as an instrument of outcome assessment; however, controversy remains concerning the expense of using this approach and about its accuracy and repeatability. This paradigm is used within a diagnostic matrix consisting of five data sources. Members of the clinical and technical teams from the motion analysis laboratory interpret data from the clinical history, physical examination, diagnostic imaging, quantitative gait analysis, and examination under anesthesia. The certainty of intervention selection is proportional to the consistency of the data within the diagnostic matrix. When inconsistencies in the data exist, input from both the clinical and technical teams is needed to resolve discrepancies. Working within the framework of the diagnostic matrix, it is possible to identify the indications used in the selection and recommendation of musculoskeletal surgical interventions to optimize gait in children with cerebral palsy. It is important to examine indications and controversies for surgical intervention related to iliopsoas recession, femoral rotational osteotomy, medial hamstring lengthening, rectus femoris transfer, and gastrocnemius recession.

Biomechanical Phenomena↗

Retroperitoneal iliac fossa pyogenic abscess.

Five cases of retroperitoneal iliac fossa abscess are presented. Abnormal excretory urogram and plain films, coupled with a history of either hip pain, limp, or pelvic mass should suggest the diagnosis. The excretory urogram is the most sensitive means of detecting iliopsoas abscess; all patients had medial displacement on the distal ureter. The upper urinary tract was normal in all cases. Study of the gastrointestinal tract may be of additional help in localizing the abscess and ruling out other pathology. A retroperitoneal muscle splitting approach is the preferred surgical procedure. Drainage of the abscess cavity and systemic antibiotic coverage are curative.

Abscess↗

The role of hip muscle function in the treatment of patellofemoral pain syndrome.

BACKGROUND: Previous literature has associated hip weakness with patellofemoral pain syndrome. HYPOTHESIS: Improvements in hip strength and flexibility are associated with a decrease in patellofemoral pain. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Thirty-five patients with patellofemoral pain syndrome, aged 33 +mn; 16 years (29 women, 6 men; 43 knees), were evaluated and placed on a 6-week treatment program. Hip flexion, abduction, and adduction strengths, Thomas and Ober test results, and visual analog scale scores for pain with activities of daily living as well as with exercise were documented on initial evaluation and again 6 weeks later. Treatment consisted of strength and flexibility exercises primarily focusing on the hip. RESULTS: Hip flexion strength improved by 35% +/- 8.4% in 26 lower extremities treated successfully, compared with -1.8% +/- 3.5% in 17 lower extremities with an unsuccessful outcome (P < .001). Before treatment, there were positive Ober test results in 39 of 43 lower extremities; positive Thomas test results were seen in 31 of 43 lower extremities. A successful outcome with a concurrent normalized Ober test result was seen in 83% (20/24) of lower extremities, and successful outcomes with normalized Thomas test results were seen in 80% (16/20) of lower extremities. A combination of improved hip flexion strength (> 20%) as well as normal Ober and Thomas test results was seen in 93% of successfully treated cases (14/15 lower extremities), compared with 0% success (0/5 lower extremities) if there was no change in hip flexion strength (< 20%) and if Ober and Thomas test results remained positive. CONCLUSIONS: Improvements in hip flexion strength combined with increased iliotibial band and iliopsoas flexibility were associated with excellent results in patients with patellofemoral pain syndrome.

Adult↗

Imaging of iliopsoas metastasis.

The imaging features of four patients with metastasis to the iliopsoas are presented with emphasis on the ultrasound, CT and MRI appearances. In patients with a known primary tumour, the possibility of iliopsoas metastasis, although uncommon should be considered.

Adult↗

Iliopsoas abscesses.

Iliopsoas abscess is a relatively uncommon condition that can present with vague clinical features. Its insidious onset and occult characteristics can cause diagnostic delays, resulting in high mortality and morbidity. The epidemiology, aetiology, clinical features, and management of iliopsoas abscess are discussed.

Adult↗

Neurapraxia of the femoral nerve in a modern dancer.

We have presented a case of an acute onset femoral nerve neurapraxia in a pure modern dancer. Repeated mild stretching of the femoral nerve during an established dance routine over a period of several months is implicated as the etiology. The thigh muscles quickly weakened, but regained strength within 3 months. Electromyographic evidence of specific femoral nerve injury initially was negative, but was evident 6 weeks following injury. Overuse syndrome in dancers can cause rapid loss of strength. Other conditions such as herniated intervertebral disc, acute hemorrhage, trauma, iliopsoas rupture, and acute stretching must be ruled out. Complete recovery was the natural outcome.

Athletic Injuries↗

Muscle selection and walking performance of multichannel FES systems for ambulation in paraplegia.

A minimal set of muscles (8 to 16) were identified as candidates for implantation in a clinical system to provide walking function to individuals with complete paraplegia using functional electrical stimulation (FES). Three subjects with complete motor and sensory paraplegia had percutaneous intramuscular electrodes implanted in all major muscles controlling the trunk, hips, knees, and ankles. Stimulation patterns for walking with FES were generated for different sets of eight and 16 muscles. The quality and repeatability of the resulting gait produced by walking patterns consisting of various combinations of muscles were determined. Most eight-channel stimulation patterns resulted in scissoring or insufficient hip flexion, preventing forward progression. One eight-channel system allowed a maximum speed of 0.1 m/s with a cadence of 22 steps/min and a stride length less than 0.3 m. Improved walking performance was observed with 16 channels of stimulation. This ranged from slow step- to gait at 0.1 m/s to smooth reciprocal gait at 0.5 m/s. In all three subjects, the favored combination of 16 channels included erector spinae for trunk extension; gluteus maximus, posterior portion of adductor magnus and hamstrings for hip extension; tensor fasciae latae and either sartorius or iliopsoas for hip flexion; vastus lateralis/intermedius for knee extension; and tibialis anterior/peroneous longus for ankle dorsiflexion. In one subject the 16-channel FES system provided repeatable day-to-day gait averaging 0.4 m/s, 58 steps/min and a stride length at 0.8 m. A maximum repeatable walking distance with 16 channels was 34 m. Multiple 34-m trials were possible with minimal rests between walks. Fatigue of both the hip extensors and upper body was a limiting factor. The selection of target muscles for implantation is critical to the performance of FES systems. This study provides guidelines to muscle selection for walking with FES based on objective measures of gait performance. The findings indicate that a 16-channel FES system for total implantation is feasible for repeatable short distance, independent, walker-support walking in paraplegia.

Adult↗

Percutaneous drainage of large tuberculous iliopsoas abscess via a subinguinal approach: a report of two cases.

Two patients who had large tuberculous abscesses that were successfully treated with percutaneous drainage alone are reported. A new approach, called the "subinguinal approach," was used. This new technique avoids the bowel loops and pelvic organs (which can be limitations when using the anterior abdominal approach) by inserting the catheter through the subinguinal portion of the psoas muscle into the abscess. Compared to the posterior approach, this technique is more comfortable for the patient (who prefers a supine position) and is not limited by the iliac bone. The technique, clinical course, and outcome are described.

Adult↗