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PubMedDate not supplied

Physical and functional measures related to low back pain in individuals with lower-limb amputation: an exploratory pilot study.

For this study, we compared the physical impairments and functional deficits of individuals with lower-limb amputation (LLA) for those with and without low back pain (LBP). Nineteen participants with LLA were placed into two groups based on visual analog scores of LBP. We assessed functional limitations, iliopsoas length, hamstring length, abdominal strength, back extensor strength, and back extensor endurance. Data analysis included correlations and t-tests. We found significant correlations between pain score and functional limitations, iliopsoas length, and back extensor endurance. We also detected significant differences in functional limitations, iliopsoas length, back extensor strength, and back extensor endurance between those with and without LBP. We saw significant differences in back extensor strength and back extensor endurance between those with transtibial and transfemoral amputations. Differences exist in physical measures of individuals with LLA with and without LBP. Clinicians should consider these impairments in individuals with amputation who experience LBP. Because of the participants' characteristics, these findings may be applicable to veterans with LLA.

Adult↗

PubMedDate not supplied

The surgical treatment of internal snapping hip.

BACKGROUND: Internal snapping hip is an underdiagnosed cause of hip pain that sidelines many recreational and competitive athletes. It originates from a taut iliopsoas tendon that snaps across bony prominences when the hip is extended from a flexed position. When nonoperative treatment methods fail, fractional tendon-lengthening procedures may be used. HYPOTHESIS: Surgical tendon lengthening through a true ilioinguinal approach, which has not been previously reported, will achieve good results in patients with internal snapping hip. STUDY DESIGN: Retrospective cohort study. METHODS: In 30 patients with symptoms in their anterior hip, internal snapping hip was diagnosed by history and physical examination. All patients were initially treated nonoperatively; 19 (63%) improved and did not require further intervention. Eleven patients (12 hips) whose symptoms were recalcitrant to physical therapy were offered the surgical option of iliopsoas tendon lengthening. The procedure was performed via an ilioinguinal intrapelvic approach. Patients were followed up for an average of 3 years. RESULTS: All 11 surgically treated patients (100%) had complete postoperative mitigation of their snapping hip. Nine (82%) reported excellent pain relief. Moreover, nine patients thought that they had greatly benefited from the tendon lengthening and would repeat the surgery. CONCLUSION: Although nonoperative measures are usually successful in the treatment of internal snapping hip, surgical tendon lengthening is a viable approach in cases refractory to nonoperative therapy.

Adolescent↗

PubMed2000

Iliopsoas haemophiliac pseudotumours with bowel fistulation.

Two cases of iliopsoas haemophilic pseudotumours are presented. In one patient a fistula developed between a pseudotumour and the large bowel. This resulted in an abscess involving the pseudotumour and adjacent tissues. It resolved after 5 years of therapy involving percutaneous drainage and closure of the fistula. The second patient had a massive pseudotumour that had obstructed both ureters. Later he suffered a fatal mixed Gram negative septicaemia probably related to erosion into the colon.

Abscess↗

PubMed1992

[The hip in infantile cerebral palsy, natural developmental course and treatment concepts].

Classification of cerebral palsy according to the topographical distribution of clinical phenomena permits determination of a prognosis of the natural history of CP and the probability of hip problems to some extent. In 55 patients with CP, 101 muscle release operations were performed between 1971 and 1988. Preoperatively, the diagnosis was established by the neuropediatrician, function was evaluated according to the Rancho-los-amigos system, and the X-rays of the hip were assessed according to Reimers. For the postoperative evaluation patients were grouped according to neurologic diagnosis: hemiplegia (4), diplegia (19), total body involvement (31). Patients with hemiplegia had no functional or radiological changes as a result of the operation. In diplegia functional deterioration was seen in 4 cases (21%); in 3 cases (16%) this meant loss of the ability to walk. The migration percentage was improved from 48% to 39% on average. In 19 cerebral palsy patients with total body involvement surgery was considered to be indicated on the basis of a suspected dislocation of the hip. No functional changes occurred as a result of surgery. Hip dislocation was successfully prevented in 90% of the cases. The migration percentage was improved from 73% to 33%. In another 12 patients with total body involvement, adductor and iliopsoas release was performed to allow better hygiene and care and for pain relief. These goals were achieved; neither the Rancho-Los-Amigos function classification system nor X-rays were used to evaluate the results.

Cerebral Palsy↗

PubMed1997

Iliopsoas bursitis and pseudogout of the knee mimicking L2-L3 radiculopathy: case report and review of the literature.

We report the case of a 74-year-old woman who presented with acute-onset right groin pain irradiating to the thigh anteriorly after having suffered for a few weeks from slight knee pain. As a CT scan showed multiple herniated intervertebral discs and spinal stenosis at the L3-L4 level, she was referred to a neurosurgical unit with the tentative diagnosis of L2-L3 radicular pain. Investigations (MR, myelography with CT scan) showed severe acquired lumbar canal stenosis. Decompression surgery was finally postponed because of the patient's serious cardiac medical history and she was referred to us for conservative treatment. She was found to have iliopsoas bursitis with chondrocalcinosis of the knee. Local steroid injections of the two sites abolished her symptoms. We draw attention to the possible pitfalls that the radiographic appearance and one of the multiple clinical presentations of this unrare pathology may represent. Whenever a patient comes walking with crutches, avoids putting weight on his or her leg, and radicular pain is suspected, we advise consideration of other extra-spinal causes for the pain.

Acute Disease↗

PubMedDate not supplied

Iliopsoas transfer in cerebral palsy: the long-term outcome.

Thirty-three patients with cerebral palsy had iliopsoas transfers as part of their surgery for hip instability. All had total-body involvement, spastic cerebral palsy and none could walk. At the time of surgery, eight hips were subluxated and 39 were dislocated or severely subluxated. Mean follow-up was 8 years in patients between 8-25 years old. Forty-five of the 47 hips were located. Thirty patients had an accompanying scoliosis, and, in 10 patients, the rib cage impinged on the pelvis. Hip flexion had decreased in most patients. Sitting ability had not improved in any patient, and had in fact deteriorated in 50%.

Adolescent↗

PubMed1993

Peripheral nerve injuries in athletes. Treatment and prevention.

Peripheral nerve lesions are uncommon but serious injuries which may delay or preclude an athlete's safe return to sports. Early, accurate anatomical diagnosis is essential. Nerve lesions may be due to acute injury (e.g. from a direct blow) or chronic injury secondary to repetitive microtrauma (entrapment). Accurate diagnosis is based upon physical examination and a knowledge of the relative anatomy. Palpation, neurological testing and provocative manoeuvres are mainstays of physical diagnosis. Diagnostic suspicion can be confirmed by electrophysiological testing, including electromyography and nerve conduction studies. Proper equipment, technique and conditioning are the keys to prevention. Rest, anti-inflammatories, physical therapy and appropriate splinting are the mainstays of treatment. In the shoulder, spinal accessory nerve injury is caused by a blow to the neck and results in trapezius paralysis with sparing of the sternocleidomastoid muscle. Scapular winging results from paralysis of the serratus anterior because of long thoracic nerve palsy. A lesion of the suprascapular nerve may mimic a rotator cuff tear with pain a weakness of the rotator cuff. Axillary nerve injury often follows anterior shoulder dislocation. In the elbow region, musculocutaneous nerve palsy is seen in weightlifters with weakness of the elbow flexors and dysesthesias of the lateral forearm. Pronator syndrome is a median nerve lesion occurring in the proximal forearm which is diagnosed by several provocative manoeuvres. Posterior interosseous nerve entrapment is common among tennis players and occurs at the Arcade of Froshe--it results in weakness of the wrist and metacarpophalangeal extensors. Ulnar neuritis at the elbow is common amongst baseball pitchers. Carpal tunnel syndrome is a common neuropathy seen in sport and is caused by median nerve compression in the carpal tunnel. Paralysis of the ulnar nerve at the wrist is seen among bicyclists resulting in weakness of grip and numbness of the ulnar 1.5 digits. Thigh injuries include lateral femoral cutaneous nerve palsy resulting in loss of sensation over the anterior thigh without power deficit. Femoral nerve injury occurs secondary to an iliopsoas haematoma from high energy sports. A lesion of the sciatic nerve may indicate a concomitant dislocated hip. Common peroneal nerve injury may be due to a direct blow or a traction injury and results in a foot drop and numbness of the dorsum of the foot. Deep and superficial peroneal nerve palsies could be secondary to an exertional compartment syndrome. Tarsal tunnel syndrome is a compressive lesion of the posterior tibial nerve caused by repetitive dorsiflexion of the ankle--it is common among runners and mountain climbers.(ABSTRACT TRUNCATED AT 400 WORDS)

Accessory Nerve Injuries↗

PubMedDate not supplied

[Use of botulinum toxin in the preventive and palliative treatment of the hips in children with infantile cerebral palsy].

INTRODUCTION: The bilateral spastic cerebral palsy (CP) usually produces hip abnormalities, already presents in many cases before 2 years of age, whose diagnostic requires X ray because clinical exam do not detect some of them. The prognosis of CP hip disorders with conventional treatment is bad, progressive, and limits the possibility of independent gait. Botulin toxin type A infiltrated in adductors, medial ischiotibials and iliopsoas, in addition to physiotherapy and orthosis, gives better results. PATIENTS, METHODS AND RESULTS: In our cases (98 cases, 193 hips) the natural evolution before (BT A) treatment had been of progressive lateral migration of femoral head (86% got worse, and 11,4% became luxated), and after the onset of it the progression stopped in 74% of hips and reverted in other 14%. CONCLUSIONS: It is very important to start early the BT A treatment and infiltrate systematically every 3 4 months in order to obtain good results. Stopping the treatment increase the chances of subluxation or luxation. BT A is also a good treatment for hip pain in spastic CP.

Botulinum Toxins, Type A↗

PubMed2006

[Iliopsoas bursal distension revealing complication of total hip arthroplasty: five cases].

The iliopsoas bursa is situated immediately anterior to the hip joint. Communication can develop between a hip prosthesis and the iliopsoas bursa leading to distension and formation of an inguinal mass revealing complication of total hip arthroplasty. We report five clinical cases. The five patients with a total hip arthroplasty developed a mass in the Scarpa triangle which correlated with defective prosthesis function. We chose not to dissect the cystic mass but to treat the intra-articular cause. Symptoms resolved after the intervention in all cases. This rare condition should be envisioned if an inguinal mass develops or has a functional impact, particularly on the lymphovenous circulation. Anatomic relations can be distinguished with computed tomography. Prosthetic complications include infection, loosening or wear. The work-up should include search for infection and standard x-rays of the hip joint. Before surgery, duplex Doppler should be performed systematically to search for a thromboembolic complication.

Aged↗

PubMed1992

Ultrasound, computed tomography and magnetic resonance in the investigation of iliopsoas compartment disease.

The authors reviewed the results of imaging studies performed in 30 patients with diseases involving the iliopsoas compartment (IPC) to assess the role of Ultrasound (US), Computed Tomography (CT) and Magnetic Resonance (MR) in the investigation of these deep seated and often clinically undetectable lesions. 16 (53%) patients had histologically proven benign or malignant IPC tumours with bacterial infection in 12 (40%) and haemorrhage into the IPC in 2 (7%). US correctly detected iliopsoas pathology in only 9 of 17 cases (53%) and was satisfactory only in limited situations, such as abscess formation in children and haemorrhage in haemophiliacs. CT was much more accurate (16/17, 94%) than US and correctly diagnosed 7 cases overlooked on US, while also offering greater information in 5 cases where both studies were abnormal. CT was particularly helpful for the detection of both abscess formation and calcification within mass lesion. MR was accurate in all 9 cases imaged, and was very helpful in the assessment of associated vertebral, disc or spinal canal involvement by tumour or infection. A review of the literature, and the results of this study, suggest that CT and MR often have complementary roles where IPC disease is known or suspected. The accuracy of US in IPC disease is limited, preferably being followed by CT or MR imaging.

Magnetic Resonance Imaging↗

PubMed1998

Iliopsoas bursopathies. A review of twelve cases.

Synovial cysts are far less common at the hip than at the knee and usually occur in patients whose hip cavity communicates with the iliopsoas bursa. We report 12 cases of enlargement of the iliopsoas bursa, nine men and three women, with a mean age of 48 years. The six patients with septic bursitis had severe symptoms similar to those seen in septic arthritis of the hip. Chronic pain with or without a palpable inguinal swelling was the main symptom in the six remaining patients, some of whom had compression of neighboring structures making the diagnosis more difficult. Ultrasonography is the best first-line investigation in patients with an inguinal swelling. Computed arthrotomography with examination of the synovial fluid or magnetic resonance imaging should be performed as a confirmatory diagnostic test. Our series provides evidence of the efficacy of appropriate antimicrobial therapy in septic cases and of corticosteroid injections into the bursa or hip cavity in nonseptic cases.

Adult↗

PubMedDate not supplied

Long-term results of combined operative reduction of the hip in older children.

Long-term results of open reduction, combined with femoral shortening, iliac osteotomy, reorientation of the upper femur, and medial iliopsoas transfer, are analyzed in 144 hips, according to patients' answers to follow-up questionnaires. Age at surgery ranged from 7 to 15 years with a follow-up of 9-24 years (mean 13 years). Two-thirds of patients had good results, one-fourth had fair results, and one-tenth had poor results. This was in accordance with radiologic rating in 225 hips, with a mean follow-up of 5 years. Quality of results decreased with age at surgery. The combined procedure is not advised after the appearance of pubertal signs. Since radiologic results favored Chiari's iliac osteotomy and subjective results favored the Pemberton type, individual choice is advised, according to the severity of acetabular dysplasia and the age of the patient. Redislocations, when left alone, had better results than did hips that were operated on again.

Adolescent↗

PubMedDate not supplied

Soft-tissue release for spastic hip subluxation in cerebral palsy.

Children with spastic hip subluxation secondary to cerebral palsy were treated with a standard protocol that focused on early detection of the subluxation using physical examination and anteroposterior pelvis radiographs. Using limited hip abduction of < or =30 degrees and subluxation of > or =25% migration percentage as indications, patients had open adductor and iliopsoas lengthenings with immediate postoperative mobilization and no abduction bracing. The protocol was applied to 74 children with a mean age of 4.5 years and had 147 hips surgically addressed. Of these hips initially, 20% were normal (migration percentage <25%), 52% were mildly subluxated (migration percentage 25-39%), 22% were moderately subluxated (migration percentage 40-59%), and 6% were severely subluxated (migration percentage > or =60%). At a final postoperative follow-up of 39 months, 54% of these hips were classified as good (migration percentage <25%), 34% were fair (migration percentage 25-39%), and 12% were poor (migration percentage > or =40%). Of this patient population, 69% were nonambulators and their outcomes were not statistically different from children who could walk. No child developed an abduction contracture or wide-based gait that required treatment. With early detection and applying this treatment algorithm, 80% of children with spastic hip disease should have good or fair outcomes. Longer follow-up will be required to determine how many children will need bony reconstruction to maintain stable and located hips at the conclusion of growth.

Cerebral Palsy↗