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PubMed2001

Percutaneous implantation of iliopsoas for functional neuromuscular stimulation.

Hip flexion is required for walking and stair climbing. Percutaneous electrical stimulation of the iliopsoas muscle is a potentially useful and reliable method of providing hip flexion in individuals who are paralyzed. In this study, groin, lateral abdominal, and paraspinal approaches of percutaneous electrode implantation for electrical stimulation of the iliopsoas muscle are described. The paraspinal approach using stimulation of the second and third lumbar roots gave the best hip flexion response; however, it often was accompanied by unwanted stimulation of the hip adductor and abdominal muscles. Wire breakage and electrode movement were the most common causes for failure of maintaining hip flexion. The paraspinal approach, using double helix electrodes, provided an average of 110 weeks of functional hip flexion sufficient for walking. It is feasible to implant electrodes in the iliopsoas muscle. An open technique for permanent implantation of intramuscular electrodes is being developed to selectively stimulate the iliopsoas, which will extend the range and duration of hip flexion that will allow stair climbing in individuals who are paraplegic.

Adult↗

PubMed2006

Enlarged psoas muscle and iliopsoas bursitis associated with a rapidly destructive hip in a patient with rheumatoid arthritis.

A 39-year-old man with rheumatoid arthritis developed femoral neuropathy secondary to iliopsoas bursitis. The adjacent hip joint was severely damaged. Magnetic resonance imaging showed enlargement and inflammation of the psoas muscle at the same side of iliopsoas bursitis. Iliopsoas bursitis and abnormal findings of the psoas muscle disappeared while the symptoms improved.

Adult↗

PubMedDate not supplied

MR imaging of septic sacroiliitis.

Septic sacroiliitis is difficult to diagnose, causing delayed treatment and increased morbidity. The traditional imaging techniques for diagnosis have been CT and nuclear medicine. Our purpose was to determine the ability of MR imaging to detect septic sacroiliitis, to evaluate the features of septic sacroiliitis with MR, and to compare the relative detection rate of MR, CT, and nuclear medicine. All patients with a discharge diagnosis of septic sacroiliitis who were evaluated by MR imaging of the pelvis were retrospectively evaluated. Five patients were collected with six septic sacroiliac joints, which were also evaluated with CT, 99mTc-methylene diphosphonate bone scans, and 67Ga-citrate scans. Abnormalities consistent with sacroiliitis were seen in all sacroiliac joints both prospectively (impression from the initial report) and retrospectively on MR. In addition to the nonspecific MR findings of inflammation and/or fluid in the sacroiliac joint space, bone marrow of the sacrum and/or ilium, and iliopsoas muscle, fluid/inflammation was uniquely identified tracking posterior to the iliopsoas muscle in each of these patients with septic sacroiliitis. Even in retrospect, a definite diagnosis of sacroiliitis could be made in only five of six joints by 67Ga-citrate scans, three of six joints by CT scans, and one of six joints by 99mTc-methylene diphosphonate bone scans. These results suggest MR imaging may be a sensitive modality in the early diagnosis of septic sacroiliitis.

Adult↗

PubMedDate not supplied

[Spontaneous retroperitoneal hematoma from ileopsoas muscle bleeding. A case report].

The Authors report a case of spontaneous retroperitoneal hematoma due to iliopsoas muscle bleeding. The different causes responsible of such hematomas are taken into account as well as clinical, therapeutical and pathophysiologic aspects connected with the spontaneous bleeding of the iliopsoas muscle. As in the case observed, the Authors suggest that often a careful wait-and-see approach represents the most appropriate therapeutical choice.

Aged↗

PubMed1984

Isokinetic evaluation of trunk muscles.

The purpose of this study is to identify those individuals at risk who have weak trunk muscles and are prone to back pain. The overall thrust of this research is to develop a quantitative method to assess dynamic strength of the trunk muscles. Two unique isokinetic strength testing units in sitting and standing postures have been designed. Three groups of volunteers were tested at different times and places. Quantitative measurements of the maximum strength, fatigue behavior of the abdominal and paraspinal muscles, maximum strength in different age groups and the role of the iliopsoas muscle have been performed. The study shows that women have lower maximum strength but equal or better fatigue endurance than men. There is a significant change in maximum strength with age. The maximum abdominal strength change with age showed a bimodal distribution. The iliopsoas muscle approximately doubled the maximum back strength in flexion. The test in the sitting posture was tolerated better than the test in the standing posture. Isokinetic back strength testing in the sitting posture was found to be effective and safe.

Abdominal Muscles↗

PubMed1994

Free rectus femoris muscle transfer for one-stage reconstruction of established facial paralysis.

The free vascularized rectus femoris muscle graft with a long motor nerve was used for reconstruction of unilateral established facial paralysis in one stage. The pedicle vessels were anastomosed to the recipient vessels in the ipsilateral face, and the motor nerve of the muscle, which was led through the upper lip, was sutured to the contralateral facial nerve. The advantages of this one-stage reconstruction as compared with surgery involving second-stage reconstruction are that the reconstruction can be completed in one stage and that the period required for muscle refunctioning after surgery is short. The vascular supply of the rectus femoris muscle can emanate mainly from the lateral circumflex femoral artery. In our cadaveric study, five types of variation were found for origination of a nutrient artery of the muscle. The most common type was one in which the artery derived from the descending branch of the lateral circumflex femoral artery (39 percent). The motor nerve of the rectus femoris muscle is derived from the femoral nerve under the inguinal ligament and runs downward through the intermuscular space between the sartorius muscle and the iliopsoas muscle before entering the posteromedial part of the upper third of the rectus muscle. The advantages of using the rectus muscle are as follows: (1) safety and simplicity exist with one main large arterial supply for arterial anastomosis; (2) the length of the femoral nerve (more than 20 cm) is adequate for reaching the contralateral facial nerve for suturing; (3) a simultaneous operation by two teams is possible with the patient in the supine position; (4) the force and distance of contraction are appropriate to reanimate the face; (5) the rectus muscle can be separated as a segment with appropriate lengths, size, and power for replacing lost muscles in the face; (6) the tendinous fascia in both ends provides a reliable point for anchoring sutures, which provides firmer attachment; and (7) no loss of donor leg function occurs.

Adolescent↗

PubMed2005

Iliopsoas: a new electromyographic technique and normal motor unit action potential values.

OBJECTIVE: To describe a reliable technique of needle electrode examination and present the normal values of motor unit action potential (MUAP) parameters in iliopsoas muscle. METHODS: Thirty-one normal subjects underwent quantitative electromyographic (QEMG) examination of the iliopsoas muscle, following an ultrasonographically confirmed technique of needle electrode insertion and sampling. The leg under examination was flexed, abducted and externally rotated at the hip joint and also flexed at the knee joint. A slight flexion at the hip joint was used to uncover iliopsoas from the overlying sartorius. This provides enough space at the inguinal region between the sartorius and the femoral neurovascular bundle. Mean and outlier values of MUAP parameters and polyphasia were calculated. RESULTS: Our technique was easy to perform and secure in sampling iliopsoas. The mean +/- SD values for MUAP duration, amplitude, area, area to amplitude ratio, phases and turns were 11.5 +/- 1.35 ms, 419 +/- 71.5 microV, 633 +/- 142.7 microV ms, 1.57 +/- 0.25, 3.1 +/- 0.32, and 2.9 +/- 0.44, respectively. Lower and upper outlier limits for duration, amplitude, area and area to amplitude ratio were 3.6/20.7 ms, 150/930 microV, 100/1567 microV ms, and 0.35/3.07. Mean polyphasia was 12.6% (range 0-30%). CONCLUSIONS: The suggested EMG technique helped to distinguish iliopsoas from sartorius and at the same time increased the accessibility of its anterior surface. Normal values and outlier limits of the MUAP parameters of iliopsoas have been quantitatively established. SIGNIFICANCE: This new technique and the normal MUAP values might prove helpful for the examination of iliopsoas, important in the assessment of many neuropathic and, especially, myopathic processes.

Action Potentials↗

PubMed1998

Which procedure gives best results in reconstructing dislocated hip joints in cerebral palsy?

A retrospective study of the surgical repair of dislocated or subluxed hip joints in patients with spastic cerebral palsy was carried out to determine the procedure with the lowest recurrence rate. An open reduction and a corrective femoral osteotomy were combined with different pelvic osteotomies and different interventions on the iliopsoas muscle in most cases. The radiological results in 58 hip joints of 42 patients were assessed with a follow-up time of 5.9 years on average (2.8 to 11.0 years). Although some combined procedures were carried out in only an small number of cases, we can still draw some conclusions. The results were better, if a pelvic osteotomy and an intervention on the iliopsoas muscle were performed. An additional iliopsoas transfer made the hip joints more stable over the long term than lengthening. For severely deformed acetabula the Pemberton osteotomy was superior to the Chiari osteotomy. The Salter osteotomy was a good alternative in cases with mild subluxation. With some combined procedures the redislocation rate was as high as 66%, whereas the combination of an open reduction, a femoral osteotomy, an iliopsoas transfer and a Pemberton or Salter osteotomy gave a redislocation rate of only 11%. A concentric reduction of the hip joints was necessary. Primarily noncentered joints did not improve during the later course.

Acetabulum↗

PubMed1995

[Pectineus myectomy, tenotomy of the iliopsoas and neurectomy of the joint capsule as symptomatic therapy for coxarthrosis of the dog].

Abduction and extension of the hip is reduced and painful in patients with coxarthrosis. Contracture of the pectineus and iliopsoas muscles restricts the abduction and extension of the hip, respectively. Pectineus myectomy and tenotomy of the iliopsoas muscle result in clinical improvements. This symptomatic therapy is relatively simple, with minimal invasion. Clinical results are satisfactory.

Animals↗

PubMed1990

Diagnosis of iliopsoas pyomyositis by ultrasonography and CT.

A patient with iliopsoas muscle pyomyositis was successfully treated with intravenous antibiotics alone. The diagnosis was made by ultrasonography and X-ray computed tomography after five days of spiking fevers. Ultrasonography and X-ray computed tomography revealed swelling of the muscle body but no abscess formation. We emphasize the usefulness of early diagnostic imaging to allow conservative treatment of iliopsoas muscle pyomyositis.

Child↗

PubMed2005

[Iliopsoas tendinitis--rare cause of pain following implantation of a total hip endoprosthesis].

Pain following implantation of a total hip endoprosthesis is described in the literature with an incidence of 1-17.6%, depending on the type of prosthesis. The underlying causes are numerous; the primary reasons for such pain are septic and nonseptic loosening of the prosthesis, periarticular heterotopic ossifications, or trochanteric bursitis. Less common reasons are muscular hernia, squeezing of the joint capsule, distal nerve lesions, stress fractures, compartment syndromes, or neoplasia.One can find only a few reports about tendinitis of the iliopsoas muscle as a cause for pain following implantation of an endoprosthesis in total hip arthroplasty. We now report about a female patient with therapy-resistant pain after total hip replacement, caused by tendinitis of the iliopsoas muscle. We introduce the transpositioning of this tendon from the lesser trochanter to the proximal anterior femur and bony refixation with a PDS cord as a new operative treatment.

Arthroplasty, Replacement, Hip↗

PubMed2001

[Iliopsoas impingement in 12 patients with a total hip arthroplasty].

PURPOSE OF THE STUDY: We report 12 cases of iliopsoas impingement, an under-recognized cause of hip pain in total hip arthroplasty patients. MATERIAL AND METHODS: Between January 1998 and October 2000, we diagnosed 12 cases of iliopsoas impingement among 280 total hip arthroplasty patients with hip pain (4.3%). Our population was composed of 9 women and 3 men aged 62 to 80 years (mean 72 years). Nine patients had a first intention arthroplasty and 3 had a revision prosthesis. Delay from implantation to diagnosis of impingement ranged from 6 months to 5 years. Common cases of pain after hip arthroplasty, infection, loosening, were ruled out in all cases. A standard x-ray series including an AP view of the pelvis, an AP view of the hip and a surgical false-lateral view of the hip as well as a CT scan were obtained when iliopsoas impingement was suspected. The CT series extended from the lower part of the acetabulum through the fixation screws. RESULTS: Pain had been observed immediately after implantation in 10 cases (83%) and in 2 cases (17%) 3 to 5 years later. These patients did not have to use crutches when pain started to develop. Pain projected anteriorly and was always exaggerated when moving from the sitting position to the upright position and when going up stairs. In one patient, palpation revealed a mass in the groin that corresponded to a massive iliopsoas bursitis. Two non-pathognomonic physical signs were found in all cases: groin pain induced by active flexion against force in the lateral reclining position and at hip extension, and pain in the dorsal reclining position at deflexion of the hip, starting at 45 degrees. The standard AP views showed evidence of defective anteversion of 4 press fit cups, 1 off-centered screwed cup and 3 oversized cups. The CT scan demonstrated that the impingement involved the anterior border of the cup applied against the iliopsoas tendon in 8 cases either due to anterior uncovering in a dysplasic hip or anterior cup overhang. In 4 cases the cup fixation screws protruded anteriorly in front of the ilion and came in contact with the posterior aspect of the iliopsoas muscle. A bursitis had developed in 50% of the cases. DISCUSSION: When infection and loosening have been ruled out, hip pain after total hip arthroplasty would suggest a possible impingement of the acetebular component on the iliopsoas muscle due to defective anteversion or centering, the use of oversized cups, and/or the use of fixation screws. We emphasize the importance of a correct position for the cup to avoid an overhanging anterior border and discuss the use of screwed cups for primary total hip arthroplasty and of oversized cups for revision procedures.

Aged↗

PubMed2004

Pyrexia due to pyogenic sacroiliitis with iliopsoas abscess after spinal cord injury.

STUDY DESIGN: Single case report. OBJECTIVES: To present an unusual cause of fever in a patient with spinal cord injury (SCI). SETTING: University Hospital, Belgium. METHODS: A 52-year-old man with a complete T9 paraplegia was admitted to hospital with a 7 day history of fever above 39 degrees C without pain and without gastrointestinal, urinary, or respiratory complaints. The patient had had a flap coverage for a sacral pressure ulcer 6 months prior to admission. RESULTS: Bone scintigraphy demonstrated markedly increased activity in the left sacroiliac joint. Computed tomography (CT) revealed an infection of the left sacroiliac joint with a large abscess involving the iliopsoas muscle. The responsible organism, Pseudomonas aeruginosa, was isolated from abscess liquid obtained by CT-guided aspiration. We postulated that P. aeruginosa had colonized the eschar and, due to the proximity, infected the sacroiliac joint and the adjacent iliopsoas muscle. Prompt intravenous antibiotic therapy ensured clinical improvement and radiological regression. CONCLUSION: Pyogenic sacroiliitis is a relatively rare condition that may be difficult to diagnose in patients with normal sensation, and even more so in SCI patients. As far as we know, psoas abscess associated with pyogenic sacroiliitis has never been described in SCI patients. This infectious pathology must be kept in mind in SCI patients with fever of unknown origin and with a history of sacral eschar.

Amikacin↗

PubMed1984

Functional treatment of congenital dislocation of the hip.

A prerequisite for the development of congenital dislocation of the hip is ligamentous laxity of the hip-joint, which is demonstrable shortly after birth when the hip can be easily dislocated and reduced. This situation is described as dislocatable hip. Ligamentous laxity naturally tends to disappear, and 90% of all dislocatable hips in fact stabilize spontaneously. No dislocation develops unless an exogenous factor is involved. In infants born in breech presentation the hyperextension of the knees with the resulting increased tension in the hamstrings plays a role. During or shortly after birth, the deflexion of the hip-joint causes an increased tension in the relatively shortened iliopsoas muscle, as a result of which the hip can be dislocated in postero-superior direction. By the time the infant is two months old secondary changes (more specifically restricted abduction) become more pronounced. It may therefore be stated that contracture of the iliopsoas muscle is one of the causes, and restricted abduction a consequence of congenital dislocation of the hip. The degree of dislocation is determined by a balance between the degree of ligamentous laxity and the influence of exogenous factors. When the infant starts to stand and walk, its body weight also begins to function as a deforming exogenous factor. When dislocatable hips are not treated immediately after birth, the frequency of congenital dislocation of the hip at the age of three months amounts to 1-2 per 1000 neonates. The male:female ratio is 1:4. The secondary changes in the osseous structures of the hip-joint should always be studied three-dimensionally. Apart from conventional antero-posterior pelvic roentgenograms, CT-scans can enhance spatial insight. The secondary changes manifest themselves in an enlarged neck-shaft angle, increased femoral anteversion, an increased inclination of the acetabulum and possibly also in diminished acetabular anteversion. In view of the high radiation load involved, examination by CT-scan is not yet a routine procedure in congenital hip dislocation. Radiological examination is usually confined to an antero-posterior pelvic roentgenogram on which the acetabular angle, the neck-shaft angle and the CE-angle can be measured. These are all values projected in a frontal plane. To determine the real values the degree of acetabular and femoral torsion has to be known. With the aid of the CT-scan the torsion of the acetabulum and of the femoral neck as well as their summation - the instability index - can be measured without difficulty.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗

PubMed2001

[Anterior iliopsoas impingement after total hip arthroplasty: diagnosis and conservative treatment in 9 cases].

PURPOSE OF THE STUDY: Impingement of the iliopsoas muscle due to a protruding acetabular component is an uncommon cause of pain after total hip arthroplasty. Diagnostic signs may be misleading and therapeutic management has varied, leading to divergent findings reported in the literature. The purpose of this prospective work was to determine the frequency of groin pain due to iliopsoas impingement (with or without an identified causal mechanism) in patients with painful total hip arthroplasties and to identify diagnostic criteria that can be used to determine the appropriate therapeutic strategy. MATERIAL AND METHODS: This prospective study was conducted between 1998 and 2000 and included 206 painful total hip arthroplasties. From this series, we excluded cases where pain was related to loosening (139 cases, 67%), infection (45 cases, 21.7%), bursitis on trochanteric sutures (2 cases, 1%), and aortic aneurysm with gluteal claudication and resulting from a lumbosacral disorder (10 cases, 4.8%). This left 9 cases (4.3%) with a clinical picture suggestive of iliopsoas impingement. These 9 patients (mean age 50 years, age range 38 - 65) had 8 uncemented press-fix cups and 1 cemented cup with an acetabular mesh. Mean delay to the development of pain after the arthroplasty procedure was 7.3 months (1 - 48 months). The most suggestive clinical sign was groin pain triggered by active flexion of the hip and flexion of the hip against force with a painful arc measuring 30 degrees to 70 degrees. None of these 9 patients had any sign of material loosening and puncture aspiration ruled out infection. The final diagnosis was confirmed by sedation of pain after extra-articular infiltration at the anterior border of the cup (overhanging cup in 6/9 cases) under computed tomographic guidance. RESULTS: Infiltrations with xylocaine and long-release corticosteroids led to complete sedation of pain in 4 out of 9 patients and partial sedation in 1 other. Recurrent pain led to terminal tenotomy of the iliopsoas in 4 patients, that provided total sedation in 3 and partial sedation in 1. In all, successful pain relief was achieved in 7 out of 9 cases: 4 after infiltration (repeated in 1 cases) and 3 after tenotomy. At last follow-up physical examination has not identified any loss of flexion force. DISCUSSION AND CONCLUSION: Irritation of the iliopsoas muscle can be the cause of pain in 4.3% of patients experiencing pain after total hip arthroplasty. The delay to symptom onset is variable but there appears to be a pain-free period after implantation. An anatomic element (anterior cup overhang) is not necessary for diagnosis since the infiltration test was positive in 1 out of 3 cases without any identified acetabular factor. The infiltration test is an important element for positive diagnosis and should be the first therapeutic measure taken. We achieved success in 4 out of 9 cases. Tenotomy is indicated in case of recurrence, providing complete cure in 3 out of 4 cases in our series. Cure may be achieved without changing the cup by simple infiltration or tenotomy of the iliopsoas that led to complete cure in 7 out of 9 cases in our series, even in patients with an overhanging cup (6 out of 9 cases). An elective procedure might be indicated if a specific anomaly is identified (overly long screw, cement leakage) or for a screwed cup. The infiltration test should however be performed beforehand to confirm the diagnosis.

Adrenal Cortex Hormones↗

PubMed1997

[Plasma cell leukemia with amyloid deposition and osteogenetic change at the site of an extramedullary plasmacytoma].

A 49-year-old man was admitted with swelling in the left lower extremity, and a mass in the left lower abdomen. Laboratory findings showed an increased WBC of 15,000/microliter with 41% plasma cells, and immunoglobulin (Ig) A of 2,557mg/dl with a monoclonal component. A roentgenogram and computed tomograph of the abdomen revealed that a 5 x 10 cm mass with calcification located in the iliopsoas muscle. Plasma cell leukemia with extramedullary plasmacytoma was diagnosed, and the patient was treated with high-dose dexamethasone (40 mg/day for 4 days), resulting in a good response with the disappearance of plasma cells in peripheral blood and a marked decrease in serum Ig A. However, the patient's condition deteriorated in spite of various treatments, and he died of heart failure 5 months after admission. With informed consent from relatives, a necropsy was performed and infiltration of plasma cells in the mass in the iliopsoas muscle was noted. We reported this case because plasma cell leukemia with amyloid deposition and osteogenesis at the site of extramedullary plasmacytoma is very rare.

Amyloid↗

PubMed2005

Tumour-like inflammatory abdominal conditions in children.

The presence of a tumour, poor general condition, features of anaemia, increased erythrocyte sedimentation rates and imaging suggesting malignancy were the common features in 4 different tumour-like abdominal conditions that are extremely rare in childhood. These conditions included: extensive retroperitoneal tumour with rib involvement that turned out to be an inflammatory lesion caused by Actinomyces in a 12-year-old girl; multi-loculated tumour of the mesentery/ovary caused by mesenteric lymphadenopathy in the course of a Salmonella enteritidis infection in a 2.5-year-old girl; tumour of the VII - VIII hepatic segments that turned out to be the focus of granuloma in the course of lambliasis in a 5.5-year-old boy with a history of purulent neck lymphadenopathy and a final suspicion of immunocompromise; and a multi-loculated tumour of the small pelvis and inguinal area that turned out to be an abscess of the iliopsoas muscle in a 16-year-old boy. Apart from the imaging, the lesions required cytological examination of the material harvested by fine-needle biopsies (liver tumour) or histopathological investigations (retroperitoneal tumour, mesenteric/ovarian tumour, liver tumour and--on second surgery--the pelvic tumour) and/or bacteriological examination (all cases), serological examination (liver tumour and mesenteric/ovarian tumour), protozoal investigation (liver tumour), and measurement of AFP levels (mesenteric/ovarian tumour). Surgical treatment (retroperitoneal tumour, mesenteric/ovarian tumour and tumour of the small pelvis) and guided antibiotic therapy (all cases including 15 weeks of antibiotics in the first case) allowed complete recovery in 3 patients (actinomycosis, mesenteric lymphadenopathy, abscess of the iliopsoas muscle). Antibiotic and antiprotozoal therapy cured the granulomatous hepatitis; however this patient tended to develop severe right-sided pleural/pulmonary changes (the child was referred for further diagnosis with suspicion of immunocompromise).

Actinomycosis↗

PubMed1996

A new pelvic tilt detection device: roentgenographic validation and application to assessment of hip motion in professional ice hockey players.

Professional ice hockey players often sustain hip and low back strains. We hypothesized that playing the sport of ice hockey may result in the shortening of the iliopsoas muscles, increasing the likelihood of lumbosacral strains and hip injuries. The purpose of this study was to identify whether ice hockey players demonstrate a decrease in hip extension range of motion when compared with age-matched controls. Objective data were obtained using the Thomas test with an electrical circuit device to determine pelvic tilt motion. The device was validated by obtaining X-rays in six subjects during the Thomas test. The study then examined 25 professional hockey players and 25 age-matched controls. A two-way analysis of variance was applied for statistical analysis to examine the effect of sport and side. The results demonstrated that ice hockey players have a reduced mean hip extension range of motion (p < .0001) by comparison with age-match controls. There was no difference between right and left sides, nor was there any interaction of the sport with the side of the body. Therefore, hockey players demonstrated a decreased extensibility of the iliopsoas muscles. Future research may be directed toward establishing a link between prophylactic stretching and injury rate in professional ice hockey players.

Age Factors↗