Review of iliopsoas anatomy and pathology.
The iliopsoas compartment acts as a conduit for the spread of disease within the body. Knowledge of its anatomy facilitates the early diagnosis of some potentially fatal lesions.
Abscess↗
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Atypical retroperitoneal extension of iliopsoas bursitis.
We report two rare cases of iliopsoas bursitis extending into the retroperitoneal space. The first lesion contained much gas, mimicking a retroperitoneal abscess, and the second was responsible for atypical inguinal pain. The diagnosis was made by contrast-enhanced CT in both cases and arthrography in the first case. Iliopsoas bursitis in these two patients, it is hypothesized, extended into the retroperitoneum, at least in part, by way of intraneural or perineural structures.
Aged↗
Imaging features of iliopsoas bursitis.
The aim of this study was firstly to describe the spectrum of imaging findings seen in iliopsoas bursitis, and secondly to compare cross-sectional imaging techniques in the demonstration of the extent, size and appearance of the iliopsoas bursitis as referenced by surgery. Imaging studies of 18 patients (13 women, 5 men; mean age 53 years) with surgically proven iliopsoas bursitis were reviewed. All patients received conventional radiographs of the pelvis and hip, US and MR imaging of the hip. The CT was performed in 5 of the 18 patients. Ultrasound, CT and MR all demonstrated enlarged iliopsoas bursae. The bursal wall was thin and well defined in 83% and thickened in 17% of all cases. The two cases with septations on US were not seen by CT and MRI. A communication between the bursa and the hip joint was seen, and surgically verified, in all 18 patients by MR imaging, whereas US and CT failed to demonstrate it in 44 and 40% of the cases, respectively. Hip joint effusion was seen and verified by surgery in 16 patients by MRI, whereas CT (4 of 5) and US ( n=12) underestimated the number. The overall size of the bursa corresponded best between MRI and surgery, whereas CT and US tended to underestimate the size. Contrast enhancement of the bursal wall was seen in all cases. The imaging characteristics of iliopsoas bursitis are a well-defined, thin-walled cystic mass with a communication to the hip joint and peripheral contrast enhancement. The most accurate way to assess iliopsoas bursitis is with MR imaging; thus, it should be used for accurate therapy planning and follow-up studies. In order to initially prove an iliopsoas bursitis, US is the most cost-effective, easy-to-perform and fast alternative.
Bursitis↗
Iliopsoas haemorrhage in patients with haemophilia: results from one centre.
Iliopsoas haematoma is a well-recognized complication of haemophilia, and is considered as potentially life threatening and significantly associated with morbidity. There are only rare reports on the incidence or outcomes of iliopsoas bleeding since the widespread usage of modern therapies for haemophilia. In this study, we present the experience of Ege University Haemophilia Centre with iliopsoas bleeding and its early and late complications. We reviewed 146 haemophiliacs (106 haemophilia A, 40 haemophilia B). Fourteen iliopsoas bleeding episodes were identified in eight haemophiliacs. Three patients (37%) had one episode, four (50%) had two episodes and one (13%) had three episodes. Two patients had a high titre inhibitor against factor VIII and accounted for three bleeding episodes (21%). We did not observe any episodes in six patients receiving prophylaxis. Iliopsoas haematomas were confirmed by ultrasonography in all patients. In physical examination, the most common symptoms were thigh, hip and groin pain, hip flexion contracture, abdominal tenderness and paraesthesia in the distribution of the femoral nerve. The mean duration of therapy with clotting factor concentrate was 7.8 +/- 1.6 days. The mean duration of hospitalization was 4.8 +/- 2.0 days. All patients started to receive a physical therapy program 6.0 +/- 2.4 days after the initiation of haemostatic therapy which lasted 20.0 +/- 6.0 days. Ultrasonographic findings related to iliopsoas haematoma disappeared in all patients within 3 months from the initial episodes. Only in one patient with mild haemophilia A, heterotopic bone formation (myositis ossificans) developed as a long-term complication. In conclusion, pain around the hip joint, femoral neuropathy and hip flexion contracture in a patient with haemophilia should alert the physician to the possibility of an iliopsoas haematoma. Early and effective factor replacement therapy is essential in the prevention of the complications.
Adolescent↗
The human spinal cord interprets velocity-dependent afferent input during stepping.
We studied the motor response to modifying the rate of application of sensory input to the human spinal cord during stepping. We measured the electromyographic (EMG), kinematic and kinetic patterns of the legs during manually assisted or unassisted stepping using body weight support on a treadmill (BWST) in eight individuals with spinal cord injury (SCI). At various treadmill speeds (0.27-1.52 m/s), we measured the EMG activity of the soleus (SOL), medial gastrocnemius (MG), tibialis anterior (TA), medial hamstrings (MH), vastus lateralis (VL), rectus femoris (RF) and iliopsoas (ILIO); the hip, knee and ankle joint angles; the amount of body weight support (BWS); and lower limb loading. The EMG amplitude and burst duration of the SOL, MG, TA, MH, VL, RF and ILIO were related to the step cycle duration during stepping using BWST. EMG mean amplitudes increased at faster treadmill speeds, and EMG burst durations shortened with decreased step cycle durations. Muscle stretch of an individual muscle could not account for the EMG amplitude modulation in response to stepping speed. The effects on the EMG amplitude and burst duration were similar in subjects with partial and no detectable supraspinal input. We propose that the human spinal cord can interpret complex step-related, velocity-dependent afferent information to contribute to the neural control of stepping.
Adolescent↗
Surgical correction of internal coxa saltans: a 20-year consecutive study.
PURPOSE: To report the complications associated with surgical correction of internal snapping hip. STUDY DESIGN: Retrospective review. METHODS: A review of 92 cases of internal coxa saltans (12 bilateral) from 1982 to 2002 was performed to identify complications following primary surgical correction. An inguinal approach was used for iliopsoas tendon fractional lengthening. The average follow-up time per patient was 5.4 years. RESULTS: A total of 40 complications occurred in 32 patients. Complications included persistent hip pain (n = 6), sensory deficit (n = 8), and hip flexor weakness persisting longer than 1 month (n = 3). Additionally, painful bursa formation (n = 1), hematoma requiring reexploration (n = 1), and superficial infection (n = 1) were noted. Some patients developed recurrent snapping after a 3-month snapping-free interval (n = 9), and some patients never had complete resolution of snapping and were considered failures (n = 11). Of these failures/recurrences, 8 patients had a second tenotomy with 4 failures. Two had a third tenotomy, with 1 failure. CONCLUSIONS: In this series, primary iliopsoas tendon lengthening in patients with internal coxa saltans was without any complication in only 60% of patients; however, overall patient satisfaction was 89%.
Adolescent↗
Diagnostic and therapeutic use of sonography-guided iliopsoas peritendinous injections.
OBJECTIVE: Our objective was to review our experience performing sonography-guided iliopsoas bursal/peritendinous injections as a diagnostic and therapeutic tool in the workup and treatment of patients with hip pain. CONCLUSION: Sonography-guided iliopsoas bursal/peritendinous injections are useful in determining the cause of hip pain. They can provide relief to most patients with iliopsoas tendinosis/bursitis after hip replacement. The results of injection alone are not as successful in cases of idiopathic iliopsoas tendinosis/bursitis, but the technique can help determine which patients may benefit from a surgical tendon release.
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The functional anatomy of the hindlimb of some African Viverridae (Carnivora).
The functional anatomy of the hindlimb of 12 species of viverrids was studied with relation to locomotion. The animals were allocated to primary locomotor categories on the basis of their anatomy and locomotion. The climbing, arboreal walking category (Nandinia binotata) is characterized by a small sacroiliac articulation, the iliopsoas inserts onto a medially located lesser trochanter and the femoral condyles are not posteriorly placed. The hindfoot is plantigrade and its structure permits considerable movement. The pads are soft and the claws retractile. Representatives of the arboreal and terrestrial walking and jumping category (Genetta genetta, G. servalina, G. tigrina) have a plantigrade forefoot and digitigrade hindfoot. The lesser trochanter is more posteriorly placed than in the climbing category. A previously undescribed muscle, the caudofemoralis profundus extends from several anterior caudal vertebrae to the femur. The tibio-astragular joint restricts supination of the foot. There is little mediolateral movement in the digitidgrade foot. The claws are retractile. In the general terrestrial walking and scrambling group (Helogale parvula, Mungos mungo, Atilax paludinosus, Bdeogale crassicauda, Herpestes ichneumon, H. sanguineus) the animals have essentially similar hindlimbs except for size differences and modifications to the feet. Helogale and Mungos have large medial epicondyles on the humerus and large terminal phalanges. Bdeogale has a vestigial first metatarsal, while Atilax can splay its digits. In all species the distal phalanges are non-retractile. The trotting category (Civettictis civetta, Ichneumia albicauda) is characterized by longer epipodials and metapodials and a more proximal position of muscle bellies. Most of the adaptations minimize rotation, adduction and abduction of the leg and supination of the foot. The metatarsals are closely adjoined and the distal phalanx is stout and non-retractile. There appear to be two levels of locomotory adaptation. Major adaptations affect the whole appendicular skeleton and are used to assign animals to primary locomotor categories. Minor adaptations occur mainly in the foot and indicate the more specific habits of the animal.
Africa↗
The relationship between loading conditions and fracture patterns of the proximal femur.
In an attempt to test the hypothesis of spontaneous hip fracture, seven pairs of femurs, with ages ranging from 59 to 90, were tested under two loading conditions designed to simulate muscular contraction. Simulated iliopsoas contraction produced femoral neck fractures at an average normalized ultimate load of 5.2 +/- 0.8 times body weight. Simulated gluteus medius contraction produced sub-/inter-trochanteric fractures at an average normalized ultimate load of 4.1 +/- 0.6 times body weight. The average ultimate load for all specimens was 3040 +/- 720 N. Fracture patterns produced by both loading conditions were clinically relevant. The results from this study suggest that abnormal contraction produced by major rotator muscles could induce hip fracture.
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Iliopsoas bursitis following total hip replacement.
We report the imaging features of a 52-year-old man presenting with a groin mass and gross lower limb oedema secondary to venous occlusion by massive cystic enlargement of the iliopsoas bursa 4 years after uncemented primary total hip replacement. Ultrasonography of the groin mass demonstrated a large cystic lesion extending into the pelvis. CT showed displacement of the external iliac vessels with venous compression. Bursography showed the bursa's margins and no communication with the hip joint. Diagnostic aspiration excluded infection, but fluid recollection occurred subsequently. Complete resolution of symptoms, including limb swelling, followed surgical excision with no recurrence at the 5-year follow-up. We believe iliopsoas bursitis occurred as a tissue response to polyethylene wear within the prosthetic hip and occurred even in the absence of loosening or a direct communication between bursa and joint.
Arthroplasty, Replacement, Hip↗
Selective dorsal rhizotomy and rates of orthopedic surgery in children with spastic cerebral palsy.
If the spasticity of cerebral palsy (CP) is reduced in children at a young age by selective dorsal rhizotomy, the incidence of lower-extremity deformities requiring orthopedic surgery may be reduced; however, this has never been investigated in detail. The authors examined the effects of selective dorsal rhizotomy on rates of lower-extremity orthopedic surgery in 178 children with CP. Age at selective dorsal rhizotomy ranged from 2 to 19.3 years (mean 5.5 years) with follow-up intervals ranging from 24 to 70 months (mean 44 months). Spastic CP was classified as quadriplegia (33%), diplegia (65%), and hemiplegia (2%). To assess the effects of early versus late rhizotomy on rates of orthopedic surgery, patients were grouped as follows: Group I underwent rhizotomy between 2 and 4 years of age (54 patients), and Group II underwent rhizotomy between 5 and 19 years of age (124 patients). Comparison of Kaplan-Meier plots of lifetime orthopedic surgery rates revealed that Group II underwent orthopedic surgery at a higher rate than Group I (p = 0.037). Analysis by procedure type revealed higher orthopedic surgery rates in Group II than Group I for heel cord releases (p = 0.0025), adductor releases (p = 0.018), and hamstring releases (p = 0.02). Orthopedic surgery rates were no higher for Group II compared to Group I for ankle/foot operations (p = 0.023), femoral osteotomy (p = 0.25), iliopsoas releases (p = 0.35), and "other" operations (p = 0.013). The data indicate that early rhizotomy reduces the need for orthopedic surgery for heel cord, hamstring, and adductor releases.
Adolescent↗
A case of femoral compressive neuropathy in AL amyloidosis.
We describe a case of a 54-yr-old AL amyloidosis patient who developed femoral compressive neuropathy due to iliopsoas pseudohypertrophy. The patient, who presented with end stage renal disease, was referred to our clinic because of lower extremity weakness and polyarthritis. Finally, he was diagnosed as having kappa-AL amyloidosis, complicated by femoral compressive neuropathy, hypertrophic amyloid myopathy, amyloid arthropathy, carpal tunnel syndrome, and end stage renal disease. Femoral compressive neuropathy has never been reported in association with amyloid induced iliopsoas hypertrophic myopathy. This report expands the clinical spectrum of AL amyloidosis.
Amyloidosis↗
Postpartum retroperitoneal fasciitis: a case report and review of literature.
We present a case of a postpartum female with iliopsoas fasciitis in the puerperium. Two days after a spontaneous vaginal delivery at 38 weeks without any complications, the patient complained of pain in the left thigh and hip, associated with a temperature of 38 degrees C. Consequently, she could not walk 4 days after delivery and her body temperature had increased to 39 degrees C. Extreme left flank pain and tenderness in the left pelvic wall were prominent, whereas the tenderness in the pelvis was moderate. Magnetic resonance imaging led us to diagnose iliopsoas fasciitis. This was complicated by sepsis but improved after a protracted antibiotic treatment without any surgical intervention. A literature review revealed that serious complications, including sepsis or permanent functional disturbance, could arise although retroperitoneal fasciitis and/or abscesses are very rare after vaginal delivery. Iliopsoas fasciitis could be considered when patients complain of extreme pain in the pelvic wall, sacroiliac joint region, or thigh-symptoms that are uncommon in uncomplicated endometritis.
Adult↗
Gait pattern in patients with spastic diplegic cerebral palsy who underwent staged operations.
Fifteen patients with spastic diplegic cerebral palsy (CP) were monitored for a mean length of 9.5 years after they underwent staged operations and were evaluated by gait analysis, including joint motion in the sagittal plane and the ground reaction force (GRF) in three dimensions. Results showed an increased hip flexion (132%) at midstance, a reduction of peak knee flexion (PKF) during swing (45%) accompanied by an augmented time of PKF during swing (50%), and an increased dorsiflexion of the ankle during swing (293%) as well as its time during the gait cycle, in comparison with normal values. Moreover, significant decreases of the vertical GRF at the terminal stance and the forward and backward GRF were present. Additionally, it was found that a bilateral popliteal angle < 20 degrees is acceptable in spastic CP. Staged operations gave unpredictable results in the correction of contracture of the hamstrings, the Achilles tendon, and the iliopsoas. The authors are convinced that gait analysis is useful in evaluating these patients and enhances the results of operative treatment, and they have since changed their approach toward multilevel simultaneous corrections.
Adolescent↗
Bilateral giant iliopsoas bursitis presenting as refractory edema of lower limbs.
A 69-year-old man with rheumatoid arthritis presented with bilateral leg swelling. Magnetic resonance studies revealed bilateral giant iliopsoas bursitis with intrapelvic expansion and compression of pelvic vessels and bladder. The case was refractory to intensive systemic and local medical treatment.
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Computed tomography in the diagnosis of iliopsoas abscesses.
Two cases in which patients presented with lower back pain and bacteraemia, and in which the diagnosis of iliopsoas abscess was made by computed tomography, are reported. Before the introduction of computed tomography, this diagnosis was difficult to establish by means of clinical and radiological investigations. Computed tomography makes it possible to obtain a clear view of the retroperitoneum.
Abscess↗
[Iliopsoas impingement after cementless total hip arthroplasty. Case reports].
Postoperative pain after total hip arthroplasty can be caused by several conditions. We describe two cases of postoperative persistent iliopsoas impingement after cementless implantation of the acetabular component. The groin pain was relieved after revision with a more anteverted acetabular component. We describe the diagnostic methods as well as the principles of the revision.
Arthroplasty, Replacement, Hip↗
Iliopsoas haematoma in Gaucher disease.
Extrapelvis or retroperitoneal haemorrhage has long been appreciated as having many causes and considerable variability in subsequent morbidity; however, to date only two cases have been reported in patients with Gaucher disease, the most common lysosomal storage disorder. It had been our assumption that these cases were unique and a consequence of severe disease in patients who had not been treated with enzyme (or other disease-specific) therapy. Herein we present three more cases (as well as our first patient), which allow one to make some generalizations. Ultrasound was used in one centre and computed tomography in the second centre to make the definitive diagnosis. The trigger for the bleeding in all cases was muscle strain after activity. All patients were young with massive hepatosplenomegaly, anaemia, thrombocytopenia, and bone pain with skeletal involvement; the last was the most obvious commonality among these patients. Differential diagnosis is complicated by exquisite groin pain that is common to both Gaucher disease and extrapelvis haemorrhage, but not necessarily.
Adolescent↗