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PubMed1980

Early soft-tissue release in congenital dislocation of the hip.

A technique is presented for gentle soft-tissue release in congenital dislocation of the hip that resists reduction even after traction. The technique involves the release of the adductor longus and iliopsoas tendon, and the opening of the anteromedial joint capsule, if necessary. It is hoped that the more frequent use of this technique will lessen the necessity for pelvic or femoral osteotomy or for a wider open reduction, thereby avoiding the problems associated with these procedures.

Female↗
PubMed2001

Iliopsoas hematoma with femoral neuropathy presenting a diagnostic dilemma after spinal decompression.

STUDY DESIGN: Case report of an iliopsoas hematoma with femoral neuropathy appearing 8 weeks after a posterior spinal decompression procedure. OBJECTIVES: To describe a potential complication and differential diagnosis for nerve root symptoms following spinal decompression. SUMMARY OF BACKGROUND DATA: Iliopsoas hematoma is usually a complication of anticoagulation, hemophilia, or trauma. It has not been described previously as a complication of posterior spinal decompression. Femoral neuropathy results from compression within the iliopsoas compartment. METHODS: A 53-year-old woman reported pain in the right side of her groin and an increasing fixed flexion deformity of the right hip 8 weeks after a posterior, midline, spinal decompression. A femoral neuropathy later developed. Magnetic resonance imaging and computed tomography were performed. RESULTS: Imaging studies demonstrated a diffusely enlarged iliopsoas. Exploration revealed a large hematoma, which was evacuated. The compartment was fully decompressed with resolution of the nerve root symptoms within 48 hours. CONCLUSIONS: Iliopsoas pathology is a rare cause of nerve root symptoms and presented diagnostic difficulties after an apparently successful spinal decompression.

Compartment Syndromes↗
PubMed1996

The snapping hip: clinical and imaging findings in transient subluxation of the iliopsoas tendon.

OBJECTIVE: To define the clinical, ultrasonographic and magnetic resonance imaging (MRI) findings in patients with painful snapping of the hip secondary to transient subluxation of the iliopsoas tendon. PATIENTS AND METHODS: Seven patients, ranging in age from 17 to 30 years, with a total of eight painful snapping hips were examined with static and dynamic ultrasonography and MRI during hip motion producing the painful snapping. The duration of symptoms, the level of disability and the response to therapy were recorded. RESULTS: Static ultrasonography showed thickening of the iliopsoas tendon (tendinitis) in two cases and a peritendinous fluid collection in two cases. In all cases dynamic ultrasonography of the iliopsoas tendon during hip motion showed distinct abnormal motion of the tendon corresponding temporally to the painful palpable and audible sensation. MRI showed normal intra-articular structures in all cases, tendinitis in two cases and iliopsoas bursitis in one case. Clinically, subluxation of the iliopsoas tendon is a chronic (mean duration of symptoms in this series, 23 months) disabling condition that may be relieved by surgical tendon release. CONCLUSIONS: Dynamic ultrasonography is useful for detecting transient subluxation of the iliopsoas tendon in patients with a painful snapping hip. MRI is useful for excluding intra-articular abnormalities in patients with this condition.

Adolescent↗
PubMed1986

Iliopsoas recession through a medial approach.

A new method of performing iliopsoas recession in patients with cerebral palsy is described. The approach to the tendon is made by means of a medial incision. The method has been used on seven hips, and the results are comparable to those obtained by a formal anterior approach.

Cerebral Palsy↗
PubMed1989

The insertion of the iliopsoas as a design favouring lateral rather than medial rotation at the hip joint.

A study of cadaveric material undertaken to investigate a possible anatomical basis for the nature of rotary influence of the iliopsoas at the hip joint shows that the winding course around the femoral neck with extension of tendon insertion towards the greater trochanter, and the spiralling course of the tendon both appear to be a design for causing external rotation during muscular contraction by a process of unwinding around the neck and untwisting of the spiral tendon under tension.

Aged↗
PubMed2005

Hamstring injuries in Australian football.

OBJECTIVE: To identify risk factors for hamstring injury in community-level Australian football players. DESIGN: Cohort study. SETTING: The preseason and 2000 season of 4 adult Victorian Amateur Football Association clubs. PARTICIPANTS: All players in the clubs who were training at the time of the baseline assessment were invited to participate (n = 148). Players who were injured and unable to participate in the baseline assessment were excluded (22 players; 15%). ASSESSMENT OF RISK FACTORS: During 3 weeks before preseason practice, each player had a series of musculoskeletal tests and completed a questionnaire. The musculoskeletal screening included flexibility tests of the hamstrings, lower extremities, quadriceps, and iliopsoas; range of motion assessments of the lumbar spine and hip rotation; and the active slump test of neural mobility. Testing was done after a brief warm up by 4 trained screeners. A questionnaire with pre-established validity and reliability included information on playing experience, injury history, and training habits. MAIN OUTCOME MEASURES: The main outcome measure was a first hamstring injury that resulted in missed participation time and/or treatment from a health professional in relation to predictive factors. Criteria defining a hamstring injury were sudden onset of posterior thigh pain, and tenderness on palpation with or without pain on stretching or contracting the hamstring muscle group. Through the season, the clubs' coaching staff collected information on exposure (hours of match and training participation). MAIN RESULTS: A total of 26 hamstring injuries occurred (incidence, 4 injuries per 1000 player hours). More injuries were sustained during competition (77%) than training. Rapid acceleration during running or sprinting was the primary mechanism of injury (81%), with the remainder occurring as the player kicked the ball. After adjustment for exposure, younger age was associated with a lower relative risk (RR) of injury (RR for age > or =23 years, 3.8; 95% CI, 1.1-14.0), as were quadriceps flexibility (RR for >51 degree knee flexion, 0.3; CI, 0.1-0.8) and active knee extension range of motion (RR for >27 degree knee flexion, 2.8; CI, 0.9-8.5; not significant). Frequency of off-season running, body height, and neural mobility were not significantly associated with hamstring injury. CONCLUSIONS: Hamstring injuries in amateur Australian football players most commonly occurred with sprinting and were more frequent in players older than 23 years or with lesser quadriceps flexibility.

Journal Article↗
PubMed1984

Walking ability after transplantation of the iliopsoas. A long-term follow-up.

Of 47 patients with spina bifida who had had transplantation of the iliopsoas more than 10 years previously, 32 (68%) were community walkers, 3 were household walkers and 12 were non-walkers. Comparison with other published reports showed that, at the very least, the patients reviewed had not had their walking ability jeopardized by the inevitable loss of hip flexor power. Furthermore, all but three of the community walkers were able to climb and descend stairs. There was a high proportion of non-walkers in those patients whose operation had been performed in the first year of life and such early surgery is no longer recommended. We also found that the pre-operative assessment of muscle power had, in some patients, been inaccurate. Finally, we found that, at review, the power of the transferred muscles was poor, suggesting that transplantation is beneficial because it achieves permanent and major reduction in hip flexor power; this usually prevents recurrent hip flexion deformity and dislocation.

Child↗
PubMed1991

Infective iliopsoas bursitis. A case report.

We report a case of infective iliopsoas bursitis, and to our knowledge a similar case has not been described. The anatomical relation between the bursa and the hip, and related pathological conditions are reviewed. The contribution of CT-guided catheterisation is emphasised as it allows aspiration of fluid, injection of radio-opaque material and lavage.

Adult↗
PubMed2000

CT of unusual iliopsoas compartment lesions.

The authors reviewed the anatomy of the iliopsoas compartment and a spectrum of unusual lesions affecting structures in this compartment, with emphasis on the role of computed tomography (CT). Lesions in the iliopsoas compartment are caused by acute infection, tumor, or hemorrhage. The knowledge of detailed clinical data can help improve the diagnostic accuracy, particularly with regard to primary iliopsoas lesions. CT is useful for delineating the source of secondary iliopsoas lesions, guiding biopsy, and performing follow-up of treated lesions. Nonenhanced CT can help detect fresh hemorrhage, fat-containing tumor, and calcification, whereas contrast material enhanced CT optimizes imaging of infection, tumor, and aneurysm.

Acute Disease↗
PubMed1998

Lumbosacral plexopathy from iliopsoas haematoma after combined general-epidural anaesthesia for abdominal aneurysmectomy.

PURPOSE: To report a case of iliopsoas haematoma after resection of an abdominal aortic aneurysm which resulted in a lumbosacral plexopathy. CLINICAL FEATURES: An 81-yr-old man presented with an abdominal aortic aneurysm for aneurysmectomy and tube grafting. An epidural catheter was placed at the L1-2 spinal level and combined epidural-general anaesthesia was provided for surgery. The surgery was complex and a suprarenal clamp was necessary to obtain proximal control. A continuous infusion of demerol through the epidural catheter was prescribed for postoperative analgesia. On the first postoperative day, examination revealed a paretic, pulseless right leg and he was returned to the operating room for femoral-femoral bypass. By the following day, the motor and sensory impairment had progressed to complete paralysis with loss of all deep tendon reflexes and absent sensation below L1, despite palpable pulses in the leg. A CT of the abdomen demonstrated a right iliopsoas haematoma. There was no evidence of either disc herniation or an epidural haematoma. A diagnosis of lumbosacral plexopathy secondary to a iliopsoas haematoma was made. CONCLUSION: Iliopsoas haematoma is a rare cause of postoperative neurological deficit following aortic vascular surgery. The haematoma results in compression of the lumbosacral neural elements and typically presents as a femoral neuropathy. The diagnosis is clinical and can be readily validated with computed tomography.

Aged↗
PubMed2005

Repetitive painful stimulation produces an expansion of withdrawal reflex receptive fields in humans.

The aims of the present study were to investigate whether temporal summation of the nociceptive withdrawal reflex depends on the stimulation site on the sole of the human foot, and to characterize the reflex receptive fields (RRF) of lower limb muscles to repetitive stimulation. The cutaneous RRFs were assessed in 15 subjects in sitting position by recording the EMG from five lower leg muscles and the kinematic responses (ankle, knee, and hip joints) to repetitive painful electrical stimulation. The stimulus consisted of a series of five stimuli (frequency: 3 Hz) delivered randomly at 10 different sites on the sole of the foot. The size of the reflexes increased generally between the first and the second stimulus, however, the increment depended on the stimulation site. In tibialis anterior, the RRF covered the distal sole of the foot and gradually expanded during the stimulus train. No expansion toward the heel area was detected. In soleus, the reflexes were facilitated after the second stimulus at all sites and remained in this state until the last stimulus. In vastus lateralis, biceps femoris, and iliopsoas a gradual expansion of the RRF was seen, resulting in RRFs covering the lateral, distal foot, and part of the proximal foot (iliopsoas). Knee and hip flexion were evoked at all sites. Ankle dorsiflexion was evoked at the distal foot, while ankle plantarflexion was evoked at the heel. The enlargement of the RRF reflects spinal temporal summation leading to gradually stronger reflex responses. The degree of temporal summation was dependent on stimulation site. The facilitation of the withdrawal reflex responses due to repetitive stimulation might have potential applications in the rehabilitation engineering field, where these reflexes could be used to assist gait of patients with central nervous system injuries.

Adult↗
PubMed2005

Gradual enlargement of human withdrawal reflex receptive fields following repetitive painful stimulation.

Dynamic changes in the topography of the human withdrawal reflex receptive fields (RRF) were assessed by repetitive painful stimuli in 15 healthy subjects. A train of five electrical stimuli was delivered at a frequency of 3 Hz (total train duration 1.33 s). The train was delivered in random order to 10 electrode sites on the sole of the foot. Reflexes were recorded from tibialis anterior, soleus, vastus lateralis, biceps femoris, and iliopsoas (IL). The RRF changes during the stimulus train were assessed during standing with even support on both legs and while seated. The degree of temporal summation was depending on stimulation site. At the most sensitive part of the RRF, a statistically significant increase in reflex size was seen after two stimuli while four stimuli were needed to observe reflex facilitation at less sensitive electrode sites. Hence, the region from which reflexes could be evoked using the same stimulus intensity became larger through the train, that is, the RRF was gradually expanding. Reflexes evoked by stimuli four and five were of the same size. No reflex facilitation was seen at other stimulus sites outside the RRF. In all muscles except in IL, the largest reflexes were evoked when the subjects were standing. In the ankle joint, the main withdrawal pattern consisted of plantar flexion and inversion when the subjects were standing while dorsi-flexion was prevalent in the sitting position. Up to 35 degrees of knee and hip flexion were evoked often leading to a lift of the foot from the floor during standing. In conclusion, a gradual expansion of the RRF was seen in all muscles during the stimulus train. Furthermore, the motor programme task controls the reflex sensitivity within the reflex receptive field and, hence, the sensitivity of the temporal summation mechanism.

Analysis of Variance↗
PubMedDate not supplied

Results of posterior iliopsoas transfer for hip instability caused by cerebral palsy.

The incidence of subluxation or dislocation of the hip in 185 cerebral palsied patients was 25.4%. Posterior iliopsoas transfer will decrease hip deformities but complications such as weakness of hip flexion or abduction contracture are to be expected in some cases. Posterior iliopsoas transfer did not give uniformly satisfactory results; 9 out of 17 patients were fair to poor even combined with innominate osteotomy and/or versus derotation osteotomy of the femur. Early prophylactic surgery of lesser extent such as adductor release is desirable since treatment of established subluxation or dislocation is often unsatisfactory.

Casts, Surgical↗
PubMedDate not supplied

Iliopsoas impingement on the acetabular component: radiologic and computed tomography findings of a rare hip prosthesis complication in eight cases.

OBJECTIVE: To describe the radiographic and computed tomography (CT) scan features of iliopsoas impingement on the acetabular component (IPI) in total hip arthroplasty. METHOD: Eight cases of iliopsoas impingement were diagnosed and confirmed by surgical revision. The plain film radiograph findings and CT scan findings were compared with those of two control populations (8 patients with painless total hip prosthesis and 16 patients with other complications confirmed by surgical revision). RESULTS: An oversized cup was found in four hips with IPI (50%) and in one hip with another complication (6%). Coronal inclination of the acetabular cup was normal in the IPI group and in the two control groups, with a similar mean cup size. All patients with IPI had an acetabular cup overhang of more than 12 mm. Conversely, in the two control groups, the overhang, present in three and two cases, respectively, was always less than 8 mm. Iliopsoas bursal effusion was present in four hips with IPI and three hips with other complications and was never present in normal prostheses. CONCLUSION: More than a 12-mm overhang of the acetabular cup is a sensitive and specific parameter for diagnosing IPI.

Acetabulum↗
PubMed1982

Ilio-psoas hematoma--its detection, and treatment with special reference to hemophilia.

Pain around the hip joint and femoral neuropathy in a patient with a bleeding coagulopathy should alert the physician to the possibility of an iliopsoas haematoma. Unfortunately this diagnosis is often missed. Clinically, reduced hip motion, a mass in the iliac fossa and alteration in the motor and sensory function of the femoral nerve may be noted. If the pain is on the right side, appendicitis must be excluded. Ultrasound is the diagnostic aid of choice, being more sensitive than computerized tomography or radioisotope investigations. Treatment should be gradual, gentle and protracted to avoid recurrent bleeding episodes.

Hematoma↗
PubMed1998

[Lower extremity deformities as an obstacle in rehabilitation of meningomyelocele patients--pathogenesis and principles of treatment].

The fate of 89 patients with meningomyelocele operated at the Institute of Orthopedics and Rehabilitation in Poznań between 1970 and 1989 due to paretic deformities of lower extremities has been traced by the authors. Deformities prevented nursing, standing or ambulating; their type and results of treatment have been related to the level of neurosegmental lesion. Modified Sharrard's classification served to group the patients. The level of lesion established during lower extremities muscles testing has been verified after neurological examination supplemented with electrophysiological tests: sensory response within L3-S2 dermatomes, afferent conduction velocity of the peroneal nerve and selected muscles of lower extremity electromyogram. Deformities due to inadequate nursing (hip and knee contractures and equinus foot) were the main obstacle in the rehabilitation in patients with spinal Th12-L2 lesion. In patients with L3-L5 lesion hip contractures were accompanied by dislocation or subluxation of the hip due to muscular imbalance. Knee contracture was less frequent in this group and foot deformities were diverse. Surgical correction of paretic deformity of the hip was the last stage of management designed to promote rehabilitation, following previous foot and knee surgery. In patients with Th12-L2 lesion recurrence of contractures made standing and walking impossible. In patients with L3-L5 neurosegmental lesion surgery for paretic dislocation or subluxation of the hip inclusive of open reduction, varus-derotation osteotomy of the proximal femur, transiliac osteotomy and iliopsoas transfer to the greater trochanter according to Mustard resulted in stable hip. Seventy percent of patients with L3-L4 lesion and all patients with L5 lesion profited from hip surgery with reduced orthotic use and effective gait.

Adolescent↗
PubMed1988

The varied clinical manifestations of iliopsoas bursitis.

Iliopsoas bursitis is often overlooked as the cause of symptoms involving the inguinal area and lower extremity. We report 8 patients with iliopsoas bursitis. All had either osteoarthritis or rheumatoid arthritis of the hip but only 3 had significant hip pain. Patients presented with an inguinal mass and hip pain (2); unilateral leg swelling (2); inguinal mass and unilateral leg swelling (1); hip pain (1); pelvic mass with bladder compression (1); and no symptoms (1). The diagnosis was entertained initially in only 2 patients. Computed tomography was useful in establishing the diagnosis.

Aged↗