Spontaneous Iliopsoas Hematoma following Microvascular Free Tissue Transfer.

Spontaneous hematoma within the iliopsoas muscle (SIH) is a rare complication most commonly seen in coagulopathic patients. Often, patients undergoing microvascular free tissue transfer are anticoagulated for anastomotic patency. Here we describe two cases of postoperative SIH following contralateral anterolateral thigh (ALT) free tissue transfer for reconstruction of oncologic head and neck defects. Both patients described hip pain after mobilization and had a corresponding acute blood loss anemia. Diagnosis of SIH was confirmed by CT and both patients were managed conservatively. Given that anticoagulation is a common practice following head and neck free tissue transfer, surgeons should be aware of this potential complication

Clinical submission of supernumerary head of adducter brevis muscle

Adductor brevis is an important member of the adductor family occupying the medial compartment of the thigh executing the function of adduction and medial rotation. Deviations from normal anatomy are unusual and rarely reported. A survey of anatomical archives revealed occasional mention of additional bellies of adductor brevis muscle. The present study reports a double belly of adductor brevis muscle (AB) found during a cadaveric dissection class for medical students. The left sided AB displayed two bellies disposed in the same plane. This case report attempts to present the clinical applications of supernumerary bellies of this important adductor muscle of the thigh. It is feasible to categorize these muscular variations upon specialized radiological procedures such as CT and MRI scans only if the radiologist possesses satisfactory understanding of variant anatomy of this region. It is thereafter inferred that upon recognition these muscles present a fair chance of being of utilitised in reconstructions. A biomechanical overview of the present anomaly is also attempte

Effect of a rigid ankle-foot orthosis on hamstring length in children with hemiplagia

Eighteen children with hemiplegia, mean age 8 years 5 months, underwent gait analysis and musculoskeletal modelling using specially designed software. The maximum lengths of the hamstrings were determined for each child walking in and out of an ankle–foot orthosis (AFO). The muscles were deemed to be short if shorter than the normal average – 1SD. In bare feet 8 participants had short medial hamstrings with a higher proportion of these in the less involved individuals. All participants showed an increase in maximum hamstring length when wearing an AFO. In all but one child this was sufficient to restore hamstring length to within normal limits. These finding suggest that hamstring pathology in hemiplegic gait is usually secondary to more distal lower limb pathology

Occurrence and degree of iliopsoas muscle contracture in regular male squash players

Introduction: Sprints combined with changes in direction and repeated lunges are the most frequent movements during a squash game. These motions overload the iliopsoas muscle which may cause a lot of microinjuries. Accumulating microinjuries combined with a lack of stretching exercises may lead to iliopsoas contracture. Aim of the study: Assessment of the frequency and degree of iliopsoas contracture in regular squash players. Material and methods: The experimental group comprised 25 regular squash players (minimum 2 years of playing at least twice a week) and 21 non-players (control group). A modified Thomas Test was used to assess iliopsoas contracture using goniometric and linear measurements. Results: Iliopsoas contracture was observed in 96% of the squash players and 66.7% of the non-players (p = 0.0089). The degree of muscle contracture in the goniometric measurement was greater in squash players than in the non-players in both the left (p = 0.0303) and right (p = 0.0007) iliopsoas muscles. There were no statistically significant differences in the linear measurement. Conclusions: There is a positive relationship between regularly playing squash and the frequency of iliopsoas contracture occurrence being significantly greater in squash players than in non-players

Severe Lumbar Disability Is Associated With Decreased Psoas Cross-Sectional Area in Degenerative Spondylolisthesis

Study Design: Retrospective cohort. Objectives: Alterations in lumbar paraspinal muscle cross-sectional area (CSA) may correlate with lumbar pathology. The purpose of this study was to compare paraspinal CSA in patients with degenerative spondylolisthesis and severe lumbar disability to those with mild or moderate lumbar disability, as determined by the Oswestry Disability Index (ODI). Methods: We retrospectively reviewed the medical records of 101 patients undergoing lumbar fusion for degenerative spondylolisthesis. Patients were divided into ODI score ≤40 (mild/moderate disability, MMD) and ODI score \u3e40 (severe disability, SD) groups. The total CSA of the psoas and paraspinal muscles were measured on preoperative magnetic resonance imaging (MRI). Results: There were 37 patients in the SD group and 64 in the MMD group. Average age and body mass index were similar between groups. For the paraspinal muscles, we were unable to demonstrate any significant differences in total CSA between the groups. Psoas muscle CSA was significantly decreased in the SD group compared with the MMD group (1010.08 vs 1178.6 mm2, P =.041). Multivariate analysis found that psoas CSA in the upper quartile was significantly protective against severe disability (P =.013). Conclusions: We found that patients with severe lumbar disability had no significant differences in posterior lumbar paraspinal CSA when compared with those with mild/moderate disability. However, severely disabled patients had significantly decreased psoas CSA, and larger psoas CSA was strongly protective against severe disability, suggestive of a potential association with psoas atrophy and worsening severity of lumbar pathology. © The Author(s) 2018

Anthropometric Parameters as Predictors for Iliopsoas Muscle Strength in Healthy Girls and in Girls with Adolescent Idiopathic Scoliosis

In this study iliopsoas muscle strength was measured by portable dynamometer and it was explored to what extent independent predictors (age, body weight, body height and body mass index) affect iliopsoas strength in healthy subjects and in subjects with adolescent idiopathic scoliosis. The study population was consisted of 183 girls (90 healthy girls and 93 girls with adolescent idiopathic scoliosis). Student t test analysis showed no differences in maximal voluntary isometric contraction between healthy girls and girls with scoliosis. Independent variables predicted significantly iliopsoas strength in healthy group (r=0.96, p<0.01) and in scoliosis group (r=0.94, p<0.001). Separate analysis with respect to types of scoliosis demonstrated that independent variables significantly predict iliopsoas strength in right thoracic (r=0.97, p<0.01), left thoracic (r=0.98, p=0.004), right thoracic lumbar (r=0.97, p<0.01) and left lumbar (r=0.96, p<0.01) scoliosis subgroups. In healthy girls iliopsoas strength was mostly predicted by body weight, followed by body height and body mass index. In girls with scoliosis body weigth was the strongest predictor of iliopsoas strength and was followed by curvature angle degree

THE EFFECT OF TIGHT HIPS ON SQUAT TECHNIQUE

The purpose of this study was to examine if tight hips would effect a dynamic activity such as the squat. Twenty subjects with squat experience were evaluated for hip contracture, 8 subjects were found to have iliopsoas contracture and 12 were found to have rectus femoris contracture. Two mixed model repeated measures ANOVAs were completed on hip flexion angles during a squat between a group with and without hip contracture for the iliopsoas and rectus femoris. A significant difference was found for the Iliopsoas (p=.014) and rectus femoris (p=.002) for the main effect of repetition. However, the interaction was not significant for iliopsoas (p=.20) or rectus femoris (p=.10). No significant differences were found between the hip contracture groups for the iliopsoas (p=.10) or the rectus femoris (p=.68), indicating tight hips do not have an impact on squat technique

Anthropometric Parameters as Predictors for Iliopsoas Muscle Strength in Healthy Girls and in Girls with Adolescent Idiopathic Scoliosis

In this study iliopsoas muscle strength was measured by portable dynamometer and it was explored to what extent independent predictors (age, body weight, body height and body mass index) affect iliopsoas strength in healthy subjects and in subjects with adolescent idiopathic scoliosis. The study population was consisted of 183 girls (90 healthy girls and 93 girls with adolescent idiopathic scoliosis). Student t test analysis showed no differences in maximal voluntary isometric contraction between healthy girls and girls with scoliosis. Independent variables predicted significantly iliopsoas strength in healthy group (r=0.96, p<0.01) and in scoliosis group (r=0.94, p<0.001). Separate analysis with respect to types of scoliosis demonstrated that independent variables significantly predict iliopsoas strength in right thoracic (r=0.97, p<0.01), left thoracic (r=0.98, p=0.004), right thoracic lumbar (r=0.97, p<0.01) and left lumbar (r=0.96, p<0.01) scoliosis subgroups. In healthy girls iliopsoas strength was mostly predicted by body weight, followed by body height and body mass index. In girls with scoliosis body weigth was the strongest predictor of iliopsoas strength and was followed by curvature angle degree

Large‑scale analysis of iliopsoas muscle volumes in the UK Biobank

Psoas muscle measurements are frequently used as markers of sarcopenia and predictors of health. Manually measured cross-sectional areas are most commonly used, but there is a lack of consistency regarding the position of the measurement and manual annotations are not practical for large population studies. We have developed a fully automated method to measure iliopsoas muscle volume (comprised of the psoas and iliacus muscles) using a convolutional neural network. Magnetic resonance images were obtained from the UK Biobank for 5000 participants, balanced for age, gender and BMI. Ninety manual annotations were available for model training and validation. The model showed excellent performance against out-of-sample data (average dice score coefficient of 0.9046 ± 0.0058 for six-fold cross-validation). Iliopsoas muscle volumes were successfully measured in all 5000 participants. Iliopsoas volume was greater in male compared with female subjects. There was a small but significant asymmetry between left and right iliopsoas muscle volumes. We also found that iliopsoas volume was significantly related to height, BMI and age, and that there was an acceleration in muscle volume decrease in men with age. Our method provides a robust technique for measuring iliopsoas muscle volume that can be applied to large cohorts

Arthroscopic and Endoscopic Management of the Internal Snapping Hip Syndrome

Internal snapping hip syndrome or coxa saltans interna results from the iliopsoas tendon snapping over the superior pubic ramus, iliopectineal eminence, anterior hip joint, femoral head or the lesser trochanter. This condition occurs in either the native hip or a prosthetic hip joint. Conservative management is the mainstay treatment, but iliopsoas release continues to be the definitive treatment in patients with failed conservative measures. The arthroscopic iliopsoas release from the central or peripheral compartment is useful in the management of internal snapping syndrome and may have less hip flexion strength deficits postoperatively as compared to the releasing from the lesser trochanteric level. Endoscopic iliopsoas release at the lesser trochanter level is the preferred operative treatment option for internal snapping patients who have undergone a total hip replacement