Unlock Your Hip Flexors

Unlock Your Hip Flexors

Unlock Your Hip Flexors is a program that gives the user a practical, easy-to-follow, natural method of releasing tight hip Flexors. Its aim is to help the user get the desired result within 60 days at 10-15 minutes per day. Naturally, the hip flexors are not meant to be tight. When they become tight, the user needs a way to make them loosen up. Unlock Your Hip Flexor has been programmed in such a way that it will help the user in doing just that. The plan was not created to be a quick fix. In fact, it will take the user close to 60 days to solve this problem and it is hard; yet the easiest as well the only that have been known to successfully help in the loosening of tightened hip flexors. The methods employed in this program are natural ones that have been proven by many specials. The system comes with bonus E-books Unlock Your Tight Hamstrings (The Key To A Healthy Back And Perfect Posture) and The 7-Day Anti-Inflammatory Diet (Automatically Heal Your Body With The Right Foods). There various exercises that can be done at home are recorded in a video format and are so easy that you will only get a difficult one after you have agreed to proceed to the next stage. Read more...

Unlock Your Hip Flexors Summary


4.8 stars out of 136 votes

Contents: Ebooks, Training Program
Author: Mike Westerdal
Official Website: www.unlockmyhips.com
Price: $19.00

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Unlock Your Hip Flexors Review

Highly Recommended

I started using this book straight away after buying it. This is a guide like no other; it is friendly, direct and full of proven practical tips to develop your skills.

This ebook does what it says, and you can read all the claims at his official website. I highly recommend getting this book.

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Iliopsoas And Psoas Minor423

Psoas major Psoas major PSOAS MAJOR Insertion Lateral side of the tendon of the psoas major and just distal to the lesser trochanter. Nerve Femoral, L(l), 2, 3, 4. ILIOPSOAS Action With the origin fixed, flexes the hip joint by flexing the femur on the trunk, as in supine alternate-leg raising, and may assist in lateral rotation and abduction of the hip joint. With the insertion fixed and acting bilaterally, flexes the hip joint by flexing the bunk on the femur, as in a sit-up from the supine position. The psoas major, acting bilaterally with the insertion fixed, will increase the lumbar lordosis when acting unilaterally, it will assist in lateral flexion of the trunk toward the same side. ILIOPSOAS (WITH EMPHASIS ON PSOAS MAJOR) Test Hip flexion in a position of slight abduction and slight lateral rotation. The muscle is not seen in the photograph above because it lies deep beneath the sartorius, the femoral nerve, and the blood vessels contained in the femoral sheath. Pressure...

Actions Of The Hip Joint

The hip joint is a synovial, ball-and-socket joint. The ball is the head of the femur, and the socket is the acetabulum of the pelvic bone. The motions of the hip joint are as follows (Figure 35-1A) Circumduction. A combination of hip joint motions that produces a circular motion.

Structure Of The Hip Joint

The articulating surface of the pelvic bone (os coxa) is a concave socket that is composed of three fused bones, the ilium, ischium, and pubis, called the acetabulum (Figure 35-3A). The acetabulum is horseshoe-shaped fossa. The acetabulum articulates with the head of the femur. In addition, the hip joint has a wedge-shaped fibrocartilaginous ring around the periphery of the acetabulum (acetabular labrum), which increases stability by deepening the socket and increasing the concavity of the articulating surface. The wedge shape of the acetabular labrum also assists in maintaining contact of the acetabulum with the femoral head. The medial circumflex femoral artery provides the principal blood supply to the hip.

Lateral Rotators Of Hip Joint

Pelvis Rotated Right

Insertion Anterior border of the greater trochanter of the femur and hip joint capsule. Action Abducts, medially rotates and may assist in flexion of the hip joint. Weakness Lessens the strength of medial rotation and abduction of the hip joint. Note In tests of the gluteus minimus and medius, or of the abductors as a group, stabilization of the pelvis is necessary but often difficult. It requires a strong fixation by many trunk muscles, aided by stabilization on the part of the examiner. Flexion of the hip and knee of the underneath leg aids in stabilizing the pelvis against anterior or posterior tilt. The examiner's hand attempts to stabilize the pelvis to prevent the tendency to roll forward or backward, the tendency to tilt anteriorly or posteriorly, and ifpossible, any unnecessary hiking or dropping of the pelvis laterally. Any one of these six shifts in position of the pelvis may result primarily from trunk weakness alternatively, such shifts may indicate an attempt to...

Medial Rotators Of Hip Joint

Lateral Rotatio

The medial rotators of the hip joint consist of the tensor fasciae latae, gluteus minimus and gluteus medius (anterior fibers). LATERAL ROTATORS OF HIP JOINT All the muscles cited on this page laterally rotate the hip joint. In addition, the obturator externus may assist in adduction of the hip joint, and the piriformis, obturator intemus, and gemelli may assist in abduction when the hip is flexed. The piriformis may assist in extension.

One Joint Hip Flexor Stretching

Two-Joint Hip Flexor Stretching and Hip Extensor Strengthening To stretch right hip flexors, lie on back with right lower leg hanging over end of a sturdy table. Pull left knee toward chest just enough to flatten low back on table. (When there is hip flexor tightness, the right thigh will come up from table.) Keeping beck flet, stretch right hip flexors by pulling thigh downward with the right buttock muscle, trying to touch thigh to table. Keeping thigh down toward table, try to bend knee until a firm pull is felt in front of the right thigh (no more than 80 ). To stretch left hip flexors, pull right knee toward chest and apply the stretch to left thigh, as described above. (Note This can be done at the top of a flight of stairs if no sturdy table is available.)

Ligamentous Support Of The Hip Joint

The following structures provide ligamentous support to the hip joint (Figure 35-3B) Attaches to the head of the femur (fovea). The ligament courses deep to the transverse acetabular ligament to attach to the acetabular notch. The ligament of the head of the femur does not appear to play a major role in stability of the hip joint, but rather serves as a conduit for the secondary arterial supply to the head of the femur from the obturator artery. VThe hip joint is a strong joint however, with considerable force, the head of the femur can be dislocated from the acetabulum. Most commonly, the head of the femur is forced in a posterior dislocation, resulting in a flexed and internally rotated femur. When this occurs, the patient is unable to move. Occasionally, additional damage such as pelvic fractures and nerve injury occurs around the joint. Hip dislocations usually are the result of an automobile accident or a fall from a high surface.

Iliopsoas Bursitis

Iliopsoas bursitis is caused by overuse and friction as the tendon slides over the iliopectineal eminence of the pubis. It is common in sports that require extensive use of hip flexors such as soccer, ballet, jumping, hurdling, and uphill running. On physical exam, hip extension (stretching of the iliopsoas) exacerbates symptoms. There may be pain on deep palpation of the femoral triangle where the musculotendinous junction of the iliopsoas can be palpated. Pain may also be reproduced when the patient raises the heel off the table at approximately 15 degrees while supine, which emphasizes the iliopsoas since it is the only active hip flexor in this position. MRI is the diagnostic study of choice to identify iliopsoas bursitis. MRI may reveal a collection of fluid adjacent to the muscle and will rule out underlying bony pathology. The athlete can return to play once he or she is pain-free and has achieved sufficient flexibility as well as adequate hip flexor strength.

Hip joint changes

As with the groin region, with pain in the hip it must be ascertained what tissues are involved. According to Cailliet four specific structures about the hip joint may cause pain The most painful condition of the hip joint is degenerative joint disease osteoarthrosis. In athletes late degenerative changes in the hip joint is probably a risk. In runners some papers have not been able to find any increased risk for developing arthrosis. There are however, increasing indications that extensive toplevel running may be a risk factor in causing late degenerative changes in the hip joints. The same may be true for top-level soccer, but the scientific evidence is not yet conclusive. Top-level sport of the highest intensity is probably a risk factor for developing late degenerative changes in the hip. Pain in the hip joint may be an early symptom of localized changes in the joint such as low-grade arthrosis-arthritis, osteochondritis dissecans, or loose bodies. In rare cases the outer rim of...

Positioning terminology

Rotation of the lower limb occurs at the hip joint. The position Medial rotation the lower limb is rotated inwards, so that the anterior surface faces medially. This will produce internal rotation of the hip joint. Lateral rotation the lower limb is rotated outwards, so that the anterior surface faces laterally. This will produce external rotation of the hip joint.

Anatomy and neurophysiology of antegrade ejaculation

Anatomically, the sympathetic trunks are chains of interconnected ganglia that course between the medial aspect of the psoas major and the vertebral column in the retroperitoneum. The right sympathetic chain is situated posterior to the middle of the inferior vena cava (IVC) and the left chain is located posterolateral to the abdominal aorta with transverse rami connecting the two trunks. While they appear asymmetric to the great vessels, they are aligned with the embryonic vascular tree before regression of the left-sided venous system. Similarly, the lymphatic drainage of the testes appears asymmetric in the adult, but in both cases, if one considers the midline as the aorta, the sympathetic system as well as the vascular and lymphatic anatomy is similar bilaterally. The sympathetic chains are often intimately involved with lumbar vessels and the number, size, and position of paravertebral ganglia are variable. Colleselli and colleagues 18 demonstrated in a cadaver anatomical study...

Intraosseous injection

In some larger rats, chinchillas, guinea pigs, rabbits, etc., the best site is the proximal femur in the fossa between the hip joint and the greater trochanter. The area must be surgically prepared as the needle would track bacteria straight into the medullary cavity, resulting in severe osteomyelitis. A 20-21-gauge needle or a spinal needle is screwed into the bone. Apply antibiotic cream around the needle to prevent infection. Cap the needle and bandage in place. This procedure is very painful so requires heavy sedation or a general anaesthetic. The procedure should never be attempted if there is any sign of metabolic bone disease. A radiograph should be taken after the needle is placed to ensure that it is in the correct position.

Pathophysiologic Basis For Rehabilitation

Flexion-based exercises, or Williams exercises, may be effective in decreasing zygapophyseal joint compressive forces, thus alleviating the com-pressive load to the posterior disc, decompressing the intervertebral foramen, stretching hip flexors and paraspinal musculature, and strengthening core stabilizers, such as the abdominals.12 Included in flexion-based exercises are pelvic tilts, which can be performed either with bent knees, straight legs, or standing, depending on the comfort level of the patient. These exercises will help decompress the zygapophyseal joint and help mobilize the pelvis for sacroiliac joint dysfunction. When dealing with patients with idiopathic scoliosis it is widely understood that therapeutic exercises cannot prevent the progression of the curvature however, there is a clear role for rehabilitation in this setting. The fundamental goal is to prevent the progression of secondary morbidities. Exercises to restore range of motion and strength should begin...

Physiologic Factors Of Spinal Stabilization

Finally, the prime movers, including the rectus abdominis, erector spi-nae, and latissimus dorsi, are strengthened. Traditionally abdominal exercises have been emphasized as part of a low back exercise program, as well as lower extremity strengthening because of their integral association with the trunk. This is particularly important during lifting, where education in proper bending and lifting techniques is stressed to prevent new-onset low back pain. Lower extremity muscular flexibility is extremely important for optimal physiologic lumbar motion. Hip flexors and extensors attach to the pelvis and will essentially dictate lumbar positioning, which can result in excessive stress on lumbar segments and the sacroiliac joint. If a patient has tight hip flexors, this will result in extension of the lumbar spine and subsequent shear forces on the intervertebral disc. A slight alteration in the kinetic chain biomechanics will promote pain and disability. Self-stretching techniques should...

Altered muscle function

Rectus femoris Rectus femoris Sartorius Pectineus Adductor longus Sartorius Pectineus Adductor longus Grieve (1981) suggested that dysfunction often involves muscle imbalance, which may give typical clinical patterns of postural disturbance. For example, there may be tightness of the erector spinae, iliopsoas, and hamstrings, with weakness of the abdominal muscles, glutei, and anterior tibial muscles. This produces increased lumbar lordosis, and limitation of hip and knee extension. He pointed out that postural and phasic muscles are often antagonistic. Slow fibers tend to become tight and shortened fast fibers tend to weakness. Hypertrophy and atrophy can occur at the same time in antagonistic muscles. Increased activity of the more postural muscle may mechanically limit the range of movement of its antagonist, and also inhibit that more phasic muscle. To exaggerate this, a sedentary lifestyle leads to overuse of postural muscles, while phasic muscles become weak with disuse. This...

Epidemiologic Instrument WHO

At the same time, the CIDI began to be used in epidemiologic studies. Mention was made of the two North American studies that used the UM-CIDI the National Comorbidity Survey and the Ontario Mental Health Survey. In addition, the CIDI was used in a national survey of Australia (Andrews et al., 2001), a two-stage investigation in Norway (Sandanger et al., 1999a), and in a large WHO-sponsored study conducted in primary care settings located in 15 different sites (Sartorius et al., 1993).

The Surgical Management of Advanced Metastatic Inguinal Disease

Wound closure can be combined with a sartorius muscle transposition in order to cover the exposed femoral vessels. However, it is debatable as to whether the sartorius transposition reduces the lymph drainage postoperatively.3 1 Other techniques which have been described include the use of an omental flap in order to reduce the risk of lymphoedema.32

Tensor Fascia Lata Pedicled Flap

An island of skin can be harvested up to 15 cm in width. The flap can be elevated up to 8 cm above the knee. The lateral circumflex femoral artery passes between the rectus femoris and the vastus lateralis where it gives off the transverse branch which pierces the TFL muscle. The flap can then be mobilized and rotated. For groin defects extensive mobilization is not required due to the close proximity of the defect to the flap. The donor area is covered with a split skin graft. The TFL flap is well vascularized and complications are limited to either wound dehiscence or necrosis of the distal tip of the flap.

Physical activity and osteoarthritis

Long-distance running is an example of a sports activity that mainly consists of repetitive loading without traumatic injuries, and could thus serve as a model in the attempts to study the relationship between exercise and OA. Most studies on runners have failed to find a correlation between running and OA 38,39 . In a 5-year follow-up of runners, with a mean age of 65 at follow-up, both runners and controls had a significant progression of radiographic features of OA, but running did not appear to accelerate the development of OA 39 . However, one study showed more radiographic hip joint changes in a group of former national team long-distance runners compared to bobsled competitors and a reference group 40 . In a study by Konradsen etal. 38 , 2 out of 33 former longdistance runners had hip OA, compared to none of the 27 controls 38 . Thus, high-mileage running on a competitive level may increase the risk of hip OA, but the evidence is weak.

Research Evidence to Date

Conversely, a review of the medical literature indicates that hydrotherapy for more serious and prolonged conditions is not effective. For example, hydrotherapy did not reduce pain, swelling, immobility, or other problems in careful studies of patients with osteoarthritis of the hip or rheumatoid arthritis, patients after knee- or hip-joint surgery, or following ligament, cesarean, and other gynecologic surgical procedures.

Acute Hip Injuries 31 Acetabular Labral Tears

An acetabular labral tear commonly occurs with hyperextension and external rotation of the femur. There is a high incidence of acetabular labral tears in athletes who participate in sports that require frequent external rotation at the hip joint, such as soccer, hockey, golf, and ballet. Some tears have also been attributed to running and sprinting. Major trauma, such as hip dislocation, can also result in acetabular tears.

Impairment Related Functional Outcomes

Duncan and colleagues also showed the value of relating impairment groups to functional and quality of life outcomes.139 The investigators examined the cumulative probabilities of achieving a BI score over 60 or over 90 within 14 days of stroke and 1, 3, and 6 months after stroke for four impairment groups motor (M) only, motor and sensory (SM), motor and hemianopia (MH), and sensorimotor and hemianopia (SMH). The 360 patients who survived the stroke represented all eligible stroke patients from 12 hospitals in greater Kansas City. The patients were alert and had been living at home at the time of the first evaluation. The investigators employed the lower extremity portion of the Fugl-Meyer index as their measure of motor impairment, using a cutoff score of 28 points out of a possible 34 points to identify patients with less than normal hip flexor power (see Chapter 7). The level of disability correlates especially with motor function of the leg.141 Sensory and visual field function...

The Current State of Affairs Resurgence and the Need for Rethinking

The last decade has witnessed an increase in research and policy attention to stigma. Across the social and socio-medical sciences, special issues have appeared in journals (e.g., Schizophrenia Bulletin, The Lancet, Psychiatric Services), national data collections have been mounted (e.g., the General Social Survey modules in 1996, 1998, 2002, and 2006), conferences have been organized (e.g., 2001 Conference, Stigma and Global Health Developing a Research Agenda see Keusch et al., 2006), and targeted grant initiatives have become available (see Michels, Hofman, Keusch, & Hrynkow, 2006). Moreover, for the first time in U.S. history, the Surgeon General focused attention on mental illness, beginning with a review of recent evidence on stigma and concluding that stigma constitutes the foremost barrier to treatment and recovery (U.S. Department of Health and Human Services, 1999, p. 3). This report was followed, four years later, by the President's New Freedom Commission on Mental Health...

Snapping Hip Syndrome

Interior medial anterior Causes include iliopsoas tendon passing over iliopectineal eminence, acetabular labral tears, subluxation of the hip, and loose bodies. On physical exam the patient with external snapping hip syndrome may have pain or tenderness over the lateral aspect of the gluteus maximus, proximal iliotibial band, or trochanteric bursa. This patient may also have a leg length discrepancy, iliotibial band tightness on the affected side, and weakness of the external rotators and hip abductors. Patients with internal snapping hip syndrome may demonstrate an anterior pelvic tilt due to a tight iliopsoas tendon and snapping may be reproduced with extension of the flexed, abducted, and externally rotated hip. Diagnostic studies such as plain films are not necessary if the diagnosis based on history and physical is definitive, especially since the majority of plain films are within normal limits. Ultrasound can be a useful diagnostic test because it may demonstrate changes in...

Conclusion Drawing from and Reflecting Back to the Social Science Core of Theory and Research

Third, and encouragingly, there has been widening scholarly interest in stigma and its consequences across countries, adding the potential to understand larger cultural and structural influences on stigma (Keusch et al., 2006 Sartorius & Schulze, 2005). This has been accompanied by a parallel resurgence in interest from consumers and providers, and from policymakers and funders. In the preface of Reducing the Stigma of Mental Illness, Norman Sartorius, one of the preeminent psychiatrists of his generation, elaborates on the importance of taking up such challenges. He notes that, The level of our ignorance is such that it is safe to predict that much more time is necessary before we learn enough about schizophrenia to be able to prevent it . however . We know what obstacles stand in the way of recovery and rehabilitation. Among these obstacles undoubtedly the most serious and the most difficult is the stigmatization of mental illness and of all those in contact with it - the sufferers,...

History and Geography

I will give you strong proof of the hypermobility (laxity) of their constitutions. You will find the greater part of the Scythians, and all the Nomades, with marks of the cautery on their shoulders, arms, wrists, breasts, hip-joints, and loins, and that for no other reason but the hypermobility and flabbiness of their constitution, for they can neither strain with their bows, nor launch the javelin from their shoulder owing to their laxity and atony but when they are burnt, much of the laxity in their joints is dried up, and they become braced, better fed, and their joints get into a more suitable condition. . . . They afterwards became lame and stiff at the hip joint, such of them, at least, as are severely attacked with it. (Adams 1891)

Changes in Patients with Paraplegia

In a longitudinal investigation, Waters and colleagues followed 148 patients who had complete traumatic paraplegia at 1 month after SCI, examining them again 1 year later to detect any change in strength and in sensation to pinprick and light touch.99 Half the patients were victims of gunshot wounds. The sensory levels in these cases tended to improve by 1-3 dermatomes in the 1st year. No one with a neurologic level above T-9 regained any motor function and 142 remained complete. With a level at or below T-9, 38 improved by a mean of about 1 grade of strength in the hip flexors and knee extensors. With an initial level at or below T-12, 20 regained enough strength in the hip and knee muscles to walk with conventional orthoses and crutches. Only 2 of the entire group developed ankle or toe movements. Six patients converted to incomplete more than 4 months after injury, using a sacral sparing definition. lower abdominal muscles in the 1st month after SCI predicted hip flexor recovery at...

Strength And Recovery

The strength of the lower extremities determines the amount of work performed by the upper extremities for support, which, in turn, determines the rate of oxygen consumption and the practicality of ambulation.127 Waters and colleagues studied patients with traumatic SCI-induced quadriparesis and paraparesis, most of whom ambulated with orthoses and as-sistive devices. The gait velocity, oxygen cost per meter walked, and peak axial load placed on assistive devices inversely correlated with lower limb strength. Patients usually became community ambulators when strength reached 60 or greater of normal in their hip flexors, abductors, and extensors and in their knee flexors and extensors. The investigators used the Ambulatory Motor Index (AMI), a 4-point scale in which 0 is absent movement, 1 is trace or poor, 2 is movement against gravity, 3 is fair strength, and 4 is movement against some or normal resistance. Community ambulators had pelvic control with at least a 2 in the hip flexors...

Muscles Of The Lower Limb

The muscles of the gluteal region primarily act on the hip joint, producing extension, medial rotation, lateral rotation, and abduction. In addition to producing motion, the muscles of the gluteal region are important for stability of the trunk and hip joint and for locomotion. These muscles consist of the gluteus maximus, gluteus medius, gluteus minimus, piriformis, superior gemellus, inferior gemellus, obturator internus, quadratus femoris, and tensor fascia lata muscles. Thigh muscles. The deep fascia divides the thigh into anterior, medial, and posterior compartments, with common actions and innervation (Figure 34-3A). Muscles of the anterior compartment of the thigh. Consist of the psoas major, psoas minor, iliacus, sartorius, and quadriceps muscles. The quadriceps muscle group consists of the rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius muscles. Most of the muscles share common actions (extension of the knee and flexion of the hip)...

Biotransformation Of Aromatic Compounds

A microalgae, Euglena gracillis Z. also contains reductase. The following aromatic aldehydes were treated in this organism. Benzaldehyde, 2-cyanobenzaldehyde, o-, m-, and p-anisaldehyde, salicylaldehyde, o-, m-, and p-tolualdehyde, o-chlorobenzaldehyde, p-hydroxybenzaldehyde, o-ni-tro-, m-, and p-nitrobenaldeyde, 3-cyanobenzaldehyde, vanillin, isovanillin, o-vanillin, nicotine aldehyde, 3-phenylpropionaldehyde, ethyl vanillin. Veratraldehyde, 3-nitrosalicylaldehde, penyl-acetaldehyde, and 2-phenylproanaldehyde gave their corresponding primary alcohols. 2-Cyanoben-zaldehyde gave its corresponding alcohol with phthalate. m- and p-Chlorobenzaldehyde gave its corresponding alcohols and m- and p-chlorobenzoic acids. o-Phthaldehyde and p-phthalate and iso-and terephthaldehydes gave their corresponding monoalohols and dialcohols. When cinnamalde-hyde and a-methyl cinnamaldehyde were incubated in Euglena gracilis, cinnamyl alcohol and 3-phenylpropanol, and 2-methylcinnamyl alcohol, and...

Gluteal Muscles Figure 351b

Attaches proximally on the ilium behind the posterior gluteal line, the sacrum, the coccyx, and the sacrotuberous ligament distally, the muscle attaches at the iliotibial tract and the gluteal tuberosity of the femur. The gluteus maximus muscle is a powerful extensor of a flexed femur at the hip joint and a lateral stabilizer of the hip joint. The inferior gluteal nerve (L5, S1, S2) innervates this muscle. Gluteus medius muscle. Attaches proximally on the ilium between the anterior and posterior gluteal lines distally, the muscle attaches on the greater trochanter of the femur. The gluteus medius muscle abducts and medially rotates the femur at the hip joint. In addition, the gluteus medius holds the pelvis secure over the stance leg, preventing pelvic drop on the opposite swing side during gait. The superior gluteal nerve (L4, L5, S1) innervates this muscle. Gluteus minimus muscle. Attaches proximally on the ilium between the anterior and posterior gluteal...

Joints Of The Gluteal Region Big Picture

The hip joint is a synovial, ball-and-socket joint that allows for a great deal of freedom, including flexion and extension, abduction and adduction, medial and lateral rotation, and circum-duction of the femur. The role of the hip joint is to provide support for the weight of the head, arms, and trunk during static postures (standing) and dynamic movements (walking and running). In addition to the hip joint, the gluteal region also contains the sacroiliac joint and the pubic symphysis, which connect the pelvic bones together as well as connecting the pelvic bones to the spine (i.e., the sacrum).

Femoral Triangle Big Picture

The femoral triangle is an area in the inguinal region that is shaped like an upside-down triangle. The femoral triangle contains the femoral nerve, artery, and vein, and the lymphatics. The femoral triangle is an area in the inguinal region that is shaped like an upside-down triangle and is bordered by the sartorius muscle, adductor longus muscle and inguinal ligament. The femoral triangle contains the following structures from lateral to medial (Figure 36-3A) Often, the acronym NAVL is used to represent the orientation of the structures of the femoral triangle. The inferior portion of the femoral triangle communicates with a facial canal (adductor canal) that runs deep to the sartorius muscle.

Abdominopelvic Cutaneous Branches Of The Lumbar Plexus

Iliohypogastric and ilioinguinal nerves (L1). Emerge from the lateral border of the psoas major muscle and pierce the transverse abdominus muscle. The iliohypogastric and ilioinguinal nerves course anteriorly between the transverse abdominus and the internal oblique muscles, contributing to the motor innervation of the muscles of the abdominal wall (internal oblique and transversus abdominus muscles). In Genitofemoral nerve (L1 L2). Pierces the psoas major muscle and divides into two branches, the genital branch and the femoral branch. The genital branch enters the deep inguinal ring, providing motor innervation to the cremasteric muscle (male only) and sensory innervation to the skin of the anterior scrotum (or mons pubis) and the labium majus. The femoral branch passes behind the inguinal ligament to enter the femoral triangle, providing sensory innervation to the skin over the femoral triangle (superior and anterior region of the thigh).

Medial compartment of the thigh

Pectineus Pectineal line Oblique line extending Adducts and flexes Femoral n. (L2, L3) from base of lesser thigh at hip joint trochanter to linea aspera on posterior surface of proximal femur Adductor longus Body of pubis Linea aspera Adducts and medially Obturator n. (anterior rotates thigh at hip joint division) (L2-L4) Adductor brevis Body of pubis and infe- Obturator n. (anterior Adducts and medially rotates thigh at hip joint Gracilis Adducts thigh at hip joint and flexes leg at knee joint Flexes leg at knee joint and extends thigh at hip joint medially rotates thigh at hip joint and leg at knee joint

Amyotrophic Lateral Sclerosis

By involving both upper and lower mo-toneurons and bulbar control, ALS requires strategies to try to prolong self-care and maintain QOL for its victims. As patients begin to become disabled, many of their needs can be anticipated. The maximal voluntary isometric contraction of each affected muscle appears to be the most reliable technique to monitor the progress of the disease.30 The Tufts Quantitative Neuromuscular Exam (Chapter 7) is a useful tool to measure overall impairment over time.31 The strength of the flexors and extensors of the lower extremities, when less than 25 of the predicted maximal isometric contraction, make it much less likely that patients will be able to walk in the community.32 When all of the hip, knee, and ankle primary movers fall below 40 of predicted torque, patients with ALS probably cannot ambulate. Of interest, greater than 50 of predicted hip flexor strength was associated with ambulation in the home and greater than 75 knee flexor strength made it 395...

Balance Disorders Frailty and Falls in the Elderly

Years half of these elderly persons fall repeatedly.157 Approximately 5 of falls cause a fracture and another 10 result in serious injury. Falls are a strong risk factor for placement in nursing homes.158 For many geriatric patients, the intrinsic and external causes of falls interact (Table 12-3) a drug causes mild delirium, arthritis makes weight bearing on the knees painful, and residual impairments from an old mild hemiparesis combine to make the person stumble over a raised crack on a sidewalk. Risks for a serious injury from falls in disabled elderly persons differ from independent persons. A Finnish study associated single status, low body mass index, impaired visual acuity, use of long-acting benzodiazepines, and impaired gait with injuries in the disabled group compared to insomnia and diminished sensation in the feet from a peripheral neuropathy in the able group.159 Weakness of the iliopsoas was another common finding in disabled subjects.

Antero Lateral Thigh Flap Phalloplasty

Flap Phalloplasty

The anterolateral thigh flap is another good option for phallic reconstruction.33 This is a musculocutaneous (perforator) rather than a fasciocutaneous based-flap and is based on the perforator vessels through vastus lateralis and rectus femoris from the descending branch of the lateral circumflex femoral artery (Chap. 7). The ALT flap is very reliable from a vascular point of view and is commonly used in reconstructive surgery. Rubino et al. described the ALT flap in order to create a neophallus for a female to male transsexual patient which incorporated a strip of vascularized fascia lata wrapped around the prosthesis.34 For phalloplasty, a 16 x 16 cm (14 x 20 cm if incorporating neourethra) flap needs to be raised (Fig. 11.30). The dissection is a little more difficult than for the radial forearm flap because of the perforators but does not require the use of a tourniquet. Another advantage is that the vascular pedicle is sometimes long enough to reach the pubic area after...

Transversus Abdominis

Transverse Abdominis Muscle Shape

The trunk-raising movement, when properly done as a test, consists of two parts spine flexion (i.e., trunk curl) by the abdominal muscles and hip flexion (i.e., sit-up) by the hip flexors. The trunk curl is followed by the hip flexion phase, during which the hip flexors contract and shorten, lifting the trunk and pelvis up from the table by flexion at the hip joints and pulling the pelvis in the direction of anterior tilt Because the abdominal muscles do not cross the hip joints, they cannot assist with the sit-up movement If the abdominal muscles are strong enough, however, they can continue to hold the trunk curled. The hip flexion phase is included in this test because it provides resistance against the abdominal muscles. The crucial point in the test is the moment at which the hip flexion phase is initiated. At this point, the feet of some subjects may start to come up from the table. The feet may be held down if the force exerted by the extended lower extremities does not...

Chronic myotendinous groin injuries

Iliopsoas Muscle Inflammation

In the literature the three most frequently mentioned causes for chronic groin pain in athletes are (i) adductor-related groin pain, (ii) lesions to the inguinal canal and associated structures and (iii) iliopsoas-related groin pain. Adductor-related pain is a frequent cause of groin pain S, 7 . Fatigue, overuse or acute overload of the adductor muscles during sports activities may lead to injuries. The adductor muscles act as very important stabilizers of the hip joint 18 , and as such are at risk if the load on the hip joints and the pelvis is no longer balanced. Injuries influencing the stability of the hip joints and the pelvis might thus precipitate overuse problems of the adductor muscles. The iliopsoas muscle (Fig. 6.3.7) is a very important contributor to the pelvic stability constantly involved in most sports activities. The precise functions of the iliopsoas muscle apart from hip flexion are not yet fully understood, but the muscle seems to work as a pelvic stabilizer as...

Eccentric muscle contraction

Muscle Contraction Sport

Recent results suggest that the apparent suppression in motoneuron activation during maximal eccentric contraction may be partly or fully removed following intense regimes of heavy-resistance strength training 50 . Thus, maximal eccentric muscle strength was seen to increase in parallel with a partial (lateral and medial vastii) or complete (rectus femoris)

What is Pagets disease

Mitch Paget

Paget's disease is named after Sir James Paget, who described its clinical and pathologic aspects in 1876. Paget's disease is the second most common metabolic bone disease. It has been found in up to 5 of northern European adults older than 55 years. However, most affected individuals are asymptomatic. The cause is unknown, but viral infection and genetic factors are believed to be responsible. The disease causes focal enlargement and deformity of the skeleton. The pathologic lesion is abnormal bone remodeling. The disease progresses through three phases lytic, lytic-blastic, and blastic. Radiographs are characteristic and show osteosclerosis with bone enlargement. Elevated alkaline phosphatase levels are typical. The wide spectrum of clinical presentation depends on the extent and site of skeletal involvement. Paget's disease commonly affects the skull, hip joints, pelvis, and spine. Back pain in the lumbar or sacral region is common. Neurologic deficits may occur due to the...

Rationale for Treatment

The sacroiliac joint is supported by strong ligaments. No muscles cross directly over the joint to support it There would be no useful function for elastic, contractile tissue (e.g., muscle) to act on a joint that has almost no movement. Weakness or tightness of muscles elsewhere, however, can affect the sacroiliac joint. When motion is restricted in an adjacent area (e.g., the back or the hip joints), stress on the sacroiliac joints is increased during any forward-bending movement. Pour groups of muscles support the pelvis in anteroposterior alignment. The low back extensors pull upward on the pelvis posteriorly, the hamstrings pull downward posteriorly, the abdominal muscles pull upward anteriorly, and the hip flexors pull downward anteriorly. With good muscle balance, the pelvis is maintained in good alignment. With muscle imbalance, the pelvis tilts anteriorly or posteriorly. With anterior pelvic tilt, the low back arches forward into a position of lordosis. In this position,...

Pearls And Pitfalls In Release Lateral Arthroscopy Patellar

Knee Arthroscopy Position

Hip joint injuries in athletes may go unrecognized for a protracted period of time, most commonly diagnosed as a strain. With an increase in awareness of intra-articular disorders, these problems are now being diagnosed earlier. However, much remains to be understood regarding the pathogenesis and natural history of many of these lesions that may influence the results of both surgical and conservative management. Nonetheless, arthroscopy has defined numerous sources of intra-articular hip pathology. In many cases, operative arthroscopy has met with significant success. For some, arthroscopy offers a distinct advantage over traditional open techniques, but for many, arthroscopy offers a method of treatment where none existed before. With this procedure, there are three important principles that must be thoroughly considered. First, a successful outcome is dependent on proper patient selection. A technically well-performed procedure will fail when performed for the wrong reason, which...

Upper Abdominal Muscles Testing And Grading

Double Limb Lowering Test

Good (8) Grade With the arms folded across the chest, the subject is able to flex the vertebral column and keep it flexed while entering the hip flexion phase and coming to a sitting position. The strongest force against the abdominals is at the moment the hip flexors start to raise the trunk. Performing only the trunk curl is not sufficient for strength testing. When the abdominal muscles are too weak to curl the trunk, the hip flexors tilt the pelvis forward and hyper-extend the low back as they raise the trunk to a sitting position. Some people cannot perform a sit-up unless the A subject with strong abdominal muscles and paralyzed hip flexor muscles can perform only the trunk curl. Flexing the trunk toward the thighs (i.e., hip joint flexion) requires action by muscles that cross the hip joint (i.e., the hip flexors). Because the abdominal muscles do not cross the hip joint, they cannot assist in the movement. It does not matter whether the legs are extended or flexed or even held...

Surgery Hip Arthroscopy

Gluteus Medius Sciatic Nerve

The portal penetrates the sartorius and rectus femoris before entering the anterior capsule. Its course is almost tangential to the axis of the femoral nerve, lying only slightly closer at the level of the capsule. (Courtesy of Smith & Nephew Endoscopy, Andover, MA.) Portal pathway Sartorius muscle Rectus femoris muscle Figure 45-5 Anterior portal pathway. The portal penetrates the sartorius and rectus femoris before entering the anterior capsule. Its course is almost tangential to the axis of the femoral nerve, lying only slightly closer at the level of the capsule. (Courtesy of Smith & Nephew Endoscopy, Andover, MA.) Level of Sartorius1 Level of rectus femoris Measurement made at superficial branch of Sartorius, rectus femoris, and capsule.

Trendelenburg Sign And Hip Abductor Weakness

Trendelen Burg

When body weight is supported, alternately, on one leg, such as in walking, the body must be stabilized on the weight-bearing leg during each step. By reverse action (i.e., origin pulled toward the insertion), strong hip abductors can stabilize the pelvis on the femur in hip joint abduction, as shown in Figure A. The lateral trunk flexors on the left also act by pulling upward on the pelvis. Figure B shows a position of hip joint adduction that results when hip abductors are too weak to stabilize the pelvis on the femur. The pelvis drops downward on the opposite side. Strong lateral trunk flexors on the left cannot raise the pelvis on that side, in standing, without the opposite abductors providing a counter-pull on the right. burg gait is one in which the affected hip goes into hip joint adduction during each weight-bearing phase of the gait. The femur rides upward, because the acetabulum is too shallow to support the head of the femur. If the problem is bilateral, a waddling gait is...

Alcoholism and Movement Disorders

In addition to the classic postural tremor associated with alcohol withdrawal, other movement disorders can occur in the setting of alcohol abuse and withdrawal. '104' A rare, slow tremor of the lower extremities can also occur in alcoholics and is produced by the synchronous flexion- extension of the muscles of the hip girdle. yj This 3-Hz tremor is associated with alcoholic cerebellar degeneration affecting the anterior superior vermis and cerebellar hemispheres. '106' When they are supine, patients with this form of tremor may reveal a kicking movement when the legs are elevated and the knee and hip joints are flexed 90 degrees. It can be best observed when

Apparent Leglength Discrepancy Caused By Muscle Imbalance

Naturist Male Wrestling

Both hip joints are neutral between The right hip joint is adducted. The left hip joint is abducted. The position of the knees in which the patellae face slightly inward results from medial rotation at the hip joints. As a functional or apparent (i.e., not structural) malalignment, it is usually accompanied by pronation of the feet (See p. 80.) The initial problem may be at the hip or at the foot, and it may result from weakness of the hip external rotators or of the muscles and ligaments that support the longitudinal arches of the feet Whichever predisposes to the fault, the end result is usually that both conditions exist if the initial problem is not corrected. A tight tensor fasciae latae may be a contributing cause, and sitting in a reverse tailor or W position may predispose toward faulty hip, knee, and foot positions. (See figure below.) Sometimes a position of knee flexion is assumed to ease a painful low back that is otherwise pulled into a lordotic curve by tight hip...

Back Extensors Testing And Grading

Back Extensors

To avoid false interpretations of the test results, it may be necessary to perform some preliminary tests. It is not necessary to do so routinely, however, because close observation of the subject in a prone position and of the movements taking place during trunk extension will indicate if preliminary tests for length of hip flexors (see p. 377) and strength of the hip extensors (see p. 436) are needed. Grading The ability to complete the movement and hold the position with hands behind the head or behind the back may be considered as normal strength. The low back muscles are seldom weak, but if there appears to be weakness, then hip flexor tightness and or hip extensor weakness must be ruled out first. Actual weakness can usually be determined by having the examiner raise the subject's trunk in extension (to the subject's maximum range) and then asking the subject to hold the completed test position. Inability to hold this position will indicate weakness. Weakness is best described...

Variations In Length Of Posterior Muscles

Gastroc Length

The hip flexors, including the rectus femoris, tensor fasciae latae and sartorius, with attachments on the anterior, superior, and inferior spines of the ilium, and the iliopsoas, with attachment on the lumbar spine and inner surface of the ilium, exert a downward pull anteriorly. The low back muscles act with the hip flexors (especially the psoas, with its direct pull from the lumbar spine to the femur) to tilt the pelvis downward and forward (i.e., anterior tilt). They are opposed in action by the combined pull of the anterior abdominals, pulling upward anteriorly, and the hamstrings and gluteus maximus, pulling downward posteriorly, to level the pelvis from a position of anterior tilt. Normally, extension of the hip joints and extension of the lumbar spine are initiated simultaneously, not as two separate movements. If slight tightness exists in the hip flexors, there is no range of extension in the hip joint, and all the movement in the direction of raising the leg backward is...

Ruptur Thympanic Membran Cruris

Vibratori Coppia Gif

The movements of the shoulder occur at the glenohumeral, thoracoscapular, acromioclavicular, and sternoclavicular joints. The glenohumeral joint is a ball-and-socket joint. In contrast to the hip joint, which is also a ball-and-socket joint, in the glenohumeral joint the humerus sits in the very shallow glenoid socket. Therefore, the function of the joint depends on the muscles surrounding the socket for stability. These muscles and their tendons form the rotator cuff of the shoulder. For this reason, many shoulder problems are muscular, not bone or joint related, in origin.

Joseph Yu and William E Garrett Jr

Calf Muscle Tear Ultrasound

Ruptures of the medial head of the gastrocnemius muscle have been documented in patients ranging from adolescents to the elderly. The incidence is greatest in the middle-aged, as reported by Millar,3 who reported a mean age of 42 years for men and 46 for women, which suggests a degenerative process analogous to a rupture of the long head of the biceps, the rotator cuff of the shoulder, the Achilles tendon, or the attachment of the rectus femoris.4 Ruptures to the medial head of the gastrocnemius are nearly nonexistent in young tennis players with the same stresses.5 This injury seems to be most common in men. Muscles such as the gastrocnemius, the biceps femoris, and the rectus femoris are quite vulnerable to injury because they cross two joints and are subjected to excessive stretch.7 Ruptures of the medial gastrocnemius occur where the medial head of the gastrocnemius inserts into the soleus aponeurosis (Fig. 4.1). In the position of knee extension and ankle dorsiflexion, the...

Posterior Pelvic Till

Psoas Muscle Throat

Two types of posture exhibit posterior pelvic tilt, hip joint extension and weakness of the iliopsoas muscle. In the past, the words lordosis and sway-back were used interchangeably in referring to the curvature in the low back and lower thoracic areas. The postural differences between the lordosis and the sway-back postures were recognized in Posture and Pain, but the name sway-back was not applied until the third edition of Muscles, Testing, and Function, published in 1983. Separating the use of these terms also differentiated the two postures, which are, in fact, distinctly different with respect to the an-teroposterior tilting of the pelvis, position of the hip joint, and accompanying muscle imbalances. Weakness of the iliopsoas is a constant finding in the sway-back posture, in contrast to being strong in the lordotic posture. As determined by the lower abdominal muscle test, the external oblique is usually weak in both the lordotic and sway-back postures. painful or if the upper...

Special Test In Poliomyelitis Therapeutic Exercise By Kisner And Colby

Ingher RS. Iliopsoas myofascial dysfunction a treatable cause of failed low back syndrome. Arch Phys Med Rehabil 1989 70 382-385. Itoi E. Roentgenographic analysis of posture in spinal hand. 2nd ed. Philadelphia JB Lippincott, 1965. Keagy RD, Brumlik J, Berg an JJ. Direct electromyogra-phy of the psoas major muscle in man. J Bone Joint Surg Am 1966 48-A 1377. Keller RB. Nonoperative treatment of adolescent idio-pathic scoliosis. In Ban* JS, ed. The spine-instructional course lectures. Vol 30. 1989 129. Kendall HO. Some interesting observations about the after care of infantile paralysis patients. J Excep Children 1937 3 107. Kendall HO. Watch those TV. exercises. TV Guide 1963 11-31 5. spine. Clin Orthop 1976 117 56. Lafian M, Raptou AD, Johnson EW. Electromyographic study of function of iliopsoas muscle. Arch Phys Med 1965 46 676-679. Lieb FJ, Perry J. Quadriceps function. J Bone Joint Surg of the foot. J Bone Joint Surg Am 1964 46-A 469. McCreary EK....

Muscles Of The Posterior Compartment Of The Thigh

Hamstrings Muscles Posterior Thigh

Attaches proximally to the ischial tuberosity and the medial surface of the proximal tibia (pes anserinus). The semitendinosus muscle extends and medially rotates the thigh at the hip joint. In addition, the muscle flexes and medially rotates the leg at the knee joint. The tibial division of the sciatic nerve (L5-S2) innervates this muscle. Semimembranosus muscle. Attaches proximally to the ischial tuberosity and the medial tibial condyle. The semi-membranosus muscle flexes and medially rotates the leg at the knee joint and extends and medially rotates the thigh at the hip joint. The tibial division of the sciatic nerve (L5-S2) innervates this muscle. Biceps femoris muscle. Consists of two heads (long and short heads). Proximally, the long head attaches on the ischial tuberosity, and the short head attaches to the lateral lip of the linea aspera. Distally, the muscle attaches to the head of the fibula. The biceps femoris muscle flexes and medially rotates the...

Patellar Instability Or Maltracking

Femoral Neck Stress Response

Fig. 150 Resisted strength test of rectus femoris hip flexion function Fig. 150 Resisted strength test of rectus femoris hip flexion function I must stress that in this book I deal only with musculo-skeletal causes of groin and thigh pain if none of these causes fits with the symptoms, specialist advice should be sought. It is important to be systematic. In many of these conditions, associated or secondary problems from unilateral injuries are common. Many core stability problems cause tenderness at the insertion of the adductor longus muscles and around the symphysis so it is important to rule out whether these symptoms are primary or secondary. For example, a left knee injury, which causes limping or pain around that knee, may often result in contra-lateral right groin pain, due to the suddenly increased stress on that leg. The history taken from the patient must include a description of the onset, type and location of the pain, details of previous injuries to the lower limbs and...

Clinical Practice Guidelines

Physical exam at the time of admission was notable for a 2 X 2 cm purple nodule on her right breast with induration and no discharge. Tenderness to palpation over the cervical spine was noted. Neurological exam demonstrated weakness in bilateral lower extremities with 2 5 hip flexors, 4 5 quadriceps, 1 5 tibialis anterior, 1 5 extensor hallucis longus, and 2.5 gastrocnemius upper extremity strength was 5 5. Sensation was

Minimally Invasive Staging Techniques

Dslnb Penile Cancer

The MIL was proposed by Catalona in 1988 after being performed in six patients with invasive carcinoma of the penis or distal urethra.53 The aim of this approach is to remove all the lymph nodes that are the most probable location of first-line lymphatic invasion, and exclude the regions lateral to the femoral artery and caudal to the fossa ovalis. The lymph node packet can be analyzed by frozen section and if it confirms metastatic disease then a radical inguinal lymphadenectomy can be performed. The anatomic location of these lymph nodes was based on earlier lymphatic drainage studies. The medial margin of MIL was the adductor longus muscle, the lateral margin was the lateral border of the femoral artery, the superior margin was the external oblique muscle above the spermatic cord, and the inferior margin was the fascia lata just distal to the fossa ovalis. The advantage of this MIL is a smaller skin incision and a smaller node dissection resulting in reduced morbidity compared with...

Degenerative Disc Disease

Iliopsoas (sometimes, but mainly L2-L3) Iliopsoas (L2-L3) Typically, there is some limitation of neck mobility. Examination of the cranial nerves should be normal, although the jaw jerk may be increased in some cases. Weakness is common in the lower extremities, especially in the iliopsoas, hamstrings, and extensors of the feet and toes. Tone in the lower extremities is spastic, and Babinski's sign may be present. Sensory loss to light touch, vibration, and joint position is sometimes found. The major deficits in lower extremity function are determined by the degree of myelopathy. Findings in the upper extremities vary depending on the level of central canal stenosis and the degree of cervical root involvement. Patients may have mild weakness with brisk reflexes. When roots are compromised, especially in the lower cervical myotomes, atrophy, weakness, and fasciculations may be found, at times mimicking the signs of amyotrophic lateral sclerosis. Sensory loss in the upper extremities...

Learn Your Muscles and Buff That

Rectus Femoris Vastus Medialis Vastus Laterialis Vastus Intermedius Rectus Femoris Vastus Medialis Vastus Laterialis Vastus Intermedius Adductor Langus Adductor Brevis Adductor Magnus Adductor group adductor longus adductor brevis adductor magnus Quadricep group rectus femoris vastus medialis vastus lateralis vastus intermedins

Lower Motor Neuron Pool

The lumbosacral plexus is derived from the anterior primary rami of the twelfth thoracic through the fourth sacral levels and is contained within the psoas major muscle. Although many more roots contribute to the lumbosacral plexus, it is somewhat simpler than the brachial plexus. Two major nerves, the femoral nerve and the sciatic nerve, are formed from the plexus (see Fig 15-7 ).

Lateral Hamstrings Biceps Femoris

Medicin Till Ben Muskler

Action The long and short heads of the biceps femoris flex and laterally rotate the knee joint. In addition, the long head extends and assists in lateral rotation of the hip joint. Origin of Rectus Femoris Origin of Vastus Medialis Distal half of the in-tertrochanteric line, medial lip of the linea aspera, proximal part of the medial supracondylar line, tendons of the adductor longus and adductor magnus and medial intermuscular septum. Action The quadriceps extends the knee joint, and the rectus femoris portion flexes the hip joint. Note Inclining the body backward may be evidence of an attempt to release hamstring tension when those muscles are contracted. When the tensor fasciae latae is being substituted for the quadriceps, it medially rotates the thigh and exerts a stronger pull if the hip is extended. If the rectus femoris is the strongest part of the quadriceps, the patient will lean backward to extend the hip, thereby obtaining maximum action of the rectus femoris. Shortness...

Motoneuron firing frequency

The maximal firing frequency of human muscle in vivo has been examined by use of intramuscular EMG recording techniques, which allow the firing pattern of single motor units to be identified. Based on such techniques, the maximal firing frequency obtained in the rectus femoris muscle during maximal voluntary contraction (MVC) was 20 greater in trained elderly weight lifters compared to age-matched untrained individuals 98 . Furthermore, using a longitudinal study design maximal firing frequency has been found to increase after strength training of selected hand muscles 99 and leg muscles (vastus lateralis 100 , tibialis anterior 86 ). Following 12 weeks of ballistic-type resistance training Van Cutsem and coworkers reported a dramatic rise in the firing frequency of single motor units recorded in the tibialis muscle at the onset of maximal, forceful contraction. Mean firing frequencies of 98.0, 75.1 and 58.0 Hz were observed in the first three interspike intervals, respectively, which...

Clinical Instruments for Primary Care Settings

At the present time, the GHQ has been used in more primary care studies than any other instrument, and its use around the world in both epidemiologic and clinical studies far exceeds what was achieved by its predecessor, the CMI. Using ''GHQ'' for a Medline search identified 841 references, among which the following illustrate the sustained used of the GHQ (Prince and Miranda, 1977 Mari and Williams, 1984 Von Korff et al., 1987 Piccinelli et al., 1993, Schmitz et al, 1999 Furukawa et al., 2001). The GHQ was also used in the first stage of the WHO Primary Care Study mentioned earlier as having also used the CIDI (Sartorius et al., 1993). Recently, Goldberg and Simpson (1995) developed the Personal Health Questionnaire (PHQ), a 10-item instrument designed to elicit information specifically about depression according to ICD-10 (Rizzo et al., 2000).

Psoas Lumbar Plexus Block

Medial Sural Artery Perforator Flap

The lumbar plexus was previously described as being between the quadratus lumborum and psoas major muscles. Current information, however, suggests that the lumbar plexus lies within the substance of the psoas major itself.173 This has been confirmed by a combined cadaver and computed tomography study.183 Cadaveric dissections have determined that the femoral nerve lies between the lateral femoral cutaneous and obturator nerves. Although the lateral femoral cutaneous nerve is in the same fascial plane as the femoral nerve, the obturator nerve can be found in the same plane as the other two nerves or in its own muscular fold. Computed tomographic data revealed the following measurements The femoral nerve is at a depth of 9.01 2.43 cm the psoas major medial border is at 2.73 0.64 cm from the medial sagittal plane and the lateral border is at 6.41 1.61 cm from the same plane.

Muscles Of The Medial Compartment Of The Thigh

Attaches to the pectineal line of the pubis and the posterior surface of the proximal femur. The pectineus muscle adducts and flexes the thigh at the hip joint. The femoral nerve (L2 and L3) innervates this muscle, with occasional branches from the obturator nerve. Adductor longus muscle. Attaches proximally to the body of the pubis distally, the muscle attaches on the linea aspera. The adductor longus muscle adducts and medially rotates the thigh at the hip joint. The obturator nerve (L2-L4) innervates this muscle. Adductor magnus muscle. Consists of an adductor part and a hamstring part. Proximally, the adductor part attaches to the ischiopubic ramus, and the hamstring part attaches to the ischial tuberosity. Distally, the adductor part of the muscle attaches on the linea aspera, and the hamstring part attaches on the adductor tubercle. The adductor magnus muscle is the largest and deepest muscle of the muscles of the medial compartment of the thigh. It adducts and...

Physical activity and low back pain

Postures as well as reduced muscle strength in back, abdominal and thigh muscles, reduced endurance in back muscles, hypermobility in the lumbar column and hypomobility of hip joints are commonly listed, activity-related risk factors for low back pain 52 . The theoretical rationale for the role of physical activity (PA) in the causation or prevention of low back pain includes the following ideas (i) PA can induce acute and repetitive subclinical or more severe injuries in the back structures (ii) higher strength of the muscles of the back and trunk could protect the back from injury or minimize the effects of injurious events (iii) higher endurance of the trunk muscles helps to maintain motor control due to less fatigue in various tasks thus decreasing the risk of high loading of spine structures or occurrence of malfunctions and consequently development of injury (iv) better flexibility may decrease the risk of injury especially during lifting and bending activities (v) good motor...

Canine hip dysplasia a multifactorial problem

Hip dysplasia is a major congenital canine health problem. Large pedigree dogs such as labradors are more prone to it but smaller dogs and mongrels may also suffer. There is abnormal formation of the 'ball and socket' hip joint. Normally the ball, which is the head of the femur, fits snugly into the socket. Dogs with a genetic disposition are born with normal hips but as the dog grows the structure of the joint becomes deformed so that the head does not fit into the socket and the joint does not rotate smoothly. The dog becomes lame, may be unwilling to run around and may have difficulty climbing stairs. It may walk with a waddle. The ultimate result is arthritis and a painful, crippling disease.

Saphenous Nerve Block At The Knee

The saphenous nerve descends through the femoral canal to accompany the femoral artery into the adductor canal. It then becomes superficial by passing between the sartorius and gracilis muscles and passes anteroinferiorly to supply the skin and fascia of the anteromedial aspects of the knee, leg, and foot.

Femoral nerve block Anatomy

The femoral nerve (L2-4) arises from the lumbar plexus and runs between psoas and iliacus to enter the thigh beneath the inguinal ligament, 2-3 cm lateral to the femoral artery and at a slightly greater depth. Branches of the anterior division include the intermediate and medial cutaneous nerves of the thigh and the supply to the sartorius. The posterior division supplies the quadriceps and the hip and knee joints and terminates as the saphenous nerve, which supplies the skin of the medial side of the calf as far as the medial malleolus and sometimes the medial side of the dorsum of the foot.

Surgical Technique Patient Positioning

The patient is placed in the standard lateral decubitus (full flank) position. Currently, we do not elevate the kidney bridge on the table, and the table is flexed to the least degree that will allow adequate separation of the costal margin from the iliac crest, the access corridor for retroperitoneoscopic surgery (Fig. 1). The surgeon and the assistant stand facing the back of the patient. Prolonged flank position has the potential to result in significant postoperative neuromuscular complications. All extremities must be placed in neutral positions and all pressure points meticulously padded with egg crate foam head and neck, axilla, hip joint, knee, and ankle. We firmly secure the patient to the table with 3-inch adhesive cloth tape and a safety belt.

Clinical Features And Evaluation

The evaluation of a patient with hip pain focuses on whether the source of symptoms is intra-articular and thus potentially amenable to arthroscopy.2 Characteristic features of hip joint pathology are summarized in Table 45-1. In general, a history of a specific traumatic event is a better prognostic indicator than a patient who simply develops insidious onset of hip pain. Onset of symptoms in the absence of injury implies a degenerative process or predisposition to damage that is less likely to be corrected by arthroscopic intervention. Mechanical symptoms such as sharp stabbing pain, locking, or catching are also better prognostic indicators of a potentially correctable problem. The C sign is very characteristic of hip joint pathology. The patient cups the hand above the greater trochanter with the thumb over the posterior aspect and gripping the fingers into the groin. It may appear as if the patient is describing a lateral

Apophyseal Avulsion Injuries

An apophyseal avulsion fracture of the pelvis is a fracture through the physis of a secondary center of ossification. These commonly involve the anterior superior iliac spine, anterior inferior iliac spine, and ischial tuberosity apophysis. These fractures occur almost exclusively in 11- to 17-year-old patients. They are most commonly seen in soccer, track, football, and baseball. In most cases, these fractures occur during fast running, hurdling, pitching, or sprinting.15 These injuries usually do not occur due to direct trauma. They may occur as a consequence to a hip dislocation. Fractures of the anterior superior iliac spine result from the pull of the sartorius and the tensor fascia lata muscles. Fractures through the anterior inferior iliac spine result from pull of the straight head of the rectus femoris muscle. A forceful sprint or a swing of a baseball bat will typically avulse the anterior superior iliac spine. The treatment of most avulsion fractures is nonoperative. The...

Acute Medial Collateral Ligament Tear Management

If an acute MCL repair is deemed necessary, it is performed using a straight medial incision extending from the medial epi-condyle to 5 cm distal to the medial joint line. The sartorius fascia is divided and the sartorius retracted distally. Flexing the knee further retracts the sartorius and the pes anserinus components, giving visualization of the superficial MCL. If the MCL is torn distally, it is important to reflect it proximally, exposing the deep meniscocapsular ligaments. If these are torn, and they frequently are, they are repaired with simple interrupted suture. The sequence of repair thus proceeds from deep to superficial. If the posterior capsule is torn mid-substance, it is approximated with interrupted sutures. If the posterior capsule is torn from the femoral or tibial attachment, it is advanced and reattached to either the femur or the tibia, respectively, with suture anchors. Once this is accomplished, repair of the superficial MCL is addressed. Reapproximation of...

Threedimensional kinetics

Fig. 1.5.16 A complete two-dimensional analysis of one walking cycle consisting of recordings from film, force platform and EMG. From top to bottom stick-diagram of the movement, ground reaction forces (the horizontal line represents body mass), net joint moments of ankle, knee and hip joint and the total support moment of the leg, rectified EMGs from the rectus femoris, semitendinosus, vastus lateralis, soleus and tibialis anterior muscles with changes in muscle-tendon lengths superimposed on the EMGs (inflection denotes lengthening of the muscle-tendon unit). nity suffers from the lack of anthropometric data for this purpose. The formulas published by Vaughan et al. 33 are often used, but these formulas are only based on X-ray data from one subject and alternative formulas are mostly substantiated. Another complication with 3D is that calculation of joint centers is closely related to specific marker set-ups. It is necessary to place three markers on each segment in order to...

The inguinal canal and associated structures

The etiology to these lesions is sometimes a traumatic episode where the athlete overstretches the front of the groin and lower abdomen, as in a forceful sliding tackle in soccer. In other cases the athlete cannot recall any single episode precipitating the pain but recalls it as developing gradually, often in connection with overuse over a period of time. The patient will often have multiple diagnoses contributing to the groin pain. Adductor-related pain, iliopsoas-related pain, sacroiliac pain and low back pain are typically concomitant findings in these patients 11,16 . Which lesion was the primary lesion resulting in the other(s) is seldom clear it is often a question of 'the chicken or the egg'.

Surgical treatment of OA

Bi- or tricompartmental knee joint replacement is best suited for those patients with severe OA in more than one knee joint compartment. For those patients where the patellar joint contributes significantly to the symptoms, this may be the preferred treatment. Similar to unicompartmental knee arthroplasty, young age at surgery and high physical activity levels contribute significantly to the risk for subsequent wear and loosening. It is therefore often recommended that the patient should be over the age of 60 at surgery. The surgical procedure is more extensive than for unicom-partmental replacement. The results of both knee and hip joint replacements have continuously improved over the last few decades, with revision rates fairly similar for hip and knee OA, and more than 90 of the average patients having a well-functioning knee or hip at 10 years after surgery 75,108,111 . Deep infections are rare and below the 1 level, wear and loosening being responsible for the majority of...

Multiple choice questions

A adductor-related pain b stress fracture of the femoral neck c lateral hernia d snapping iliopsoas e incipient hernia. b tenderness at the insertion of the adductor longus muscle insertion at the pubic bone c tight lower leg muscles d increased range of abduction e groin pain on resisted adduction.

Inflammation in pelvic joints

Inflammatory conditions may be seen in the joints of the symphysis and sacroiliac joints. Sacroiliitis is not uncommon in outdoor winter sports. Sacroiliitis can also be a symptom in a generalized disease such as rheumatoid arthritis or Bechterew's disease. Pain and or discomfort may radiate to the groin, to the hip joint, or to the thigh. Changes in the sacroiliac joints may be present without the athlete feeling any pain. The symptoms may be vague and most pronounced in the morning. Long intervals without symptoms may be present. The diagnoses are made by clinical exami

Classical reference

FES was used to facilitate standing by stimulation of both the quadriceps and hip abductors, as well as other muscles. The swing phase in a primitive gait pattern was generated by the flexor reflex mechanisms (afferent stimulation), which gives knee and hip joint flexion and ankle dorsiflexion.

Acute myotendinous groin injuries

The iliopsoas can be strained by a forceful flexion against resistance as occurs when the ground is mistakenly kicked instead of the ball, or in eccentric contraction, e.g. when the thigh is forced into extension. The adductor muscles are usually strained in eccentric contraction, e.g. in a forceful abduction, often with some degree of hip joint rotation, as in a sliding tackle in soccer. Other muscles in the groin region such as rectus femons, sartorius, the abdominal muscles and the conjoined tendon can also be injured by a hyperextension of the muscle and tendon. Grade III a total tear of the muscle-tendon unit with a total lack of function of the muscle. Grade I and II lesions are painful and often disabling. Except for the iliopsoas lesion a discoloration and swelling can frequently be found representing local hematoma and edema. Usually a 'pull' has been felt in the muscle with a sudden sharp pain and the athlete is often unable to continue the activity. Complete muscle tear...

What radiographic hallmarks indicate a flatback syndrome

Flatback syndrome is a sagittal malalignment syndrome. Radiographically the hallmarks of flatback syndrome include a markedly positive sagittal vertical axis and decreased lumbar lordosis after a spinal fusion procedure. Classically, it has been reported after use of a straight Harrington distraction rod to correct a lumbar or thoracolumbar curvature. When the thoracic and lumbar spine is fused in a nonphysiologic alignment with loss of lumbar lordosis, the patient cannot assume normal erect posture and assumes instead a stooped forward posture. The patient attempts to compensate for this abnormal posture by hyperextending the hip joints and flexing the knee joints. These compensatory mechanisms are ultimately ineffective in maintaining the SVA in a physiologic position and result in symptoms of back pain, knee pain, and inability to maintain an upright posture. Fixed sagittal malalignment of the spine has many etiologies.

What nonspinal disorders must be ruled out during the examination of a patient with degenerative spondylolisthesis

Degenerative arthritis of the hip joint and peripheral vascular disease. Hip joint arthrosis may cause buttock and thigh pain that mimics the symptoms of spinal stenosis. Assessment of hip joint range of motion can determine whether radiographs are necessary to evaluate the hip joints. If both hip arthritis and degenerative spondylolisthesis are present, injection of the hip

What are the accepted therapies for patients with AS

Treatment of AS is based on current disease manifestations and level of symptoms. Half of patients are able to control joint and spine pain stiffness with a nonsteroidal antiinflammatory drug while half require stronger agents, such as a tumor necrosis factor a (TNF-a) inhibitor. Up to 30 of patients develop uveitis, which is treated with corticosteroid eye drops. Regular exercise and group physical therapy have been proven helpful. Total hip arthroplasty is considered for severe hip joint involvement. Spinal surgery is of value in select patients.

What are important points to assess on physical examination in the patient being evaluated for possible revision spine

A general neurologic assessment and regional spinal assessment are performed. The presence of nonorganic signs (Waddell signs) should be assessed. Global spinal balance in the sagittal and coronal planes should be assessed. The physical examination is tailored to the particular spinal pathology under evaluation. For cervical spine disorders, shoulder pathology, brachial plexus disorders, and conditions involving the peripheral nerves should not be overlooked. For lumbar spine problems, the hip joints, sacroiliac joints, and prior bone graft sites should be assessed. Examination of peripheral pulses is routinely performed to rule out vascular insufficiency. Consider degenerative neurologic or muscle-based problems, such as amyotrophic lateral sclerosis or multiple sclerosis.

What are flexion exercises Williams exercises When are they appropriate

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Examples of flexion exercises include knee-to-chest exercises (Fig. 14-1), abdominal crunches, and hip flexor stretches. Flexion exercises are commonly prescribed for facet joint pain, lumbar spinal stenosis, spondylolysis, and spondylolisthesis. Flexion exercises increase intradiscal pressure and are contraindicated in the presence of an acute disc herniation. Flexion exercises are also contraindicated in thoracic and lumbar compression fractures and osteoporotic patients.

Spinocerebellar Pathways

The dorsal spino-olivary tract ascends within the dorsal columns, synapses in the cuneatus and gracilis nuclei, and then relays impulses to the contralateral accessory olivary nucleus. These fibers arise in the spinal cord and are activated by cutaneous and group Ib receptor afferents. The function of these fibers is largely spinocerebellar. There are fibers traveling in the anterior funiculi that have a similar termination and are referred to as the anterospino-olivary tract.

Inclusion Body Myositis

Clinical Features and Associated Disorders. The clinical weakness of IBM may resemble that of PM or DM, but more typically evolves over years and resembles a limb- girdle dystrophy. Distal weakness is common and dysphagia occurs in as many as 60 percent of patients. The weakness and atrophy may be asymmetrical and involve solitary muscles such as the quadriceps, iliopsoas, biceps, or triceps. Over years, there is more symmetry and weakness of the involved muscles. IBM is suspected when a patient with the diagnosis of PM does not respond to corticosteroid therapy, has early involvement of distal muscles such as

HIV1Related Myopathies

Clinical Features and Associated Disorders. Muscle weakness is the predominant sign and symptom. 1 , W1 Patients present with slowly progressive symmetrical and predominantly proximal weakness of the upper and lower limbs. Patients have difficulty arising from a chair or climbing stairs. Myalgia is present in 25 to 50 percent of affected patients. Neurological examinations reveal symmetrical weakness of proximal muscle groups with prominent involvement of neck and hip flexors. HIV-1-associated polymyositis can occur at any stage of HIV-1 infection. Presentation is similar to sporadic polymyositis with proximal muscle weakness, myalgias, and elevated CK.

Familial Spastic Paraplegias

Information about the genetic basis for these disorders is mushrooming. It has been established that uncomplicated autosomal dominant, autosomal recessive, and X-linked FSPs are heterogeneous disorders. Because families with strong similarities in phenotype are linked to different genetic loci, there may be various points of disturbance in a common biochemical pathway that leads to degeneration of the most distal portions of the longest ascending and descending central nervous system axons, particularly the corticospinal tracts from the motor cortex to the legs, the fasciculus gracilis fibers, and the spinocerebellar fibers (,iXable,36z4 ). Genetic penetrance is age dependent and nearly complete. 17 Clinical Features and Associated Disorders. The patient generally presents with leg stiffness, weakness in the hip flexors, and impaired foot dorsiflexion in the second through fourth decades, although symptoms may be apparent in infancy or not until late...

Discriminative Touch Vibration and Conscious Sense of Joint Muscle Movement

Ipsilateral funiculus gracilis or cuneatus to synapse in the nucleus gracilis or cuneatus within the medulla. As these fibers travel in the dorsal columns they are topographically localized between the fibers transmitting vibration and those transmitting discriminative touch in the intermediate region of the dorsal columns. The second-order neurons are located within the gracilis and cuneatus nuclei. The third-order neurons are located in the VPL nucleus of the thalamus following the course of the dorsal column nuclei to the somatosensory cortex, as previously mentioned. The sensory cortex gets very precise information on the position and movements of the joints. somatosensory cortex. Like proprioceptive fibers, the first-order neurons are in the DRG, second-order neurons in the cuneatus and gracilis nuclei, and third-order neurons in the VPL nucleus of the thalamus. With regard to the cortical representation of vibratory sensation, many years ago Holmes stated that the appreciation...

Pyridoxine Vitamin B6

Figure 40-8 (Figure Not Available) Vitamin E deficiency myelopathy. Cross section of cervical spinal cord. The triple arrowheads denote light-staining symmetrical areas of degeneration involving the posterior columns. The two single arrowheads indicate involvement of the dorsal and ventral spinocerebellar tracts. In the posterior columns, the fasciculus cuneatus is affected to a greater extent than the gracilis. Microscopically, numerous swollen and dystrophic axons (spheroids) and astrocytosis are present in the posterior columns, and nerve cell loss is seen in the dorsal root ganglia (luxol-fast blue-periodic acid-SchFrom Rosenblum JL, Keating JP, Prensky AL, Nelson JS A progressive neurologic syndrome in children with chronic liver disease. N Engl J Med 1981 304 506.)

Mechanical Axis Of Femur And Rotation Action Of Adductors

Rotation of the hip joint, however, does not occur about the anatomical axis of the femur but, rather, about the mechanical axis, which passes from the center of the hip joint to the center of the knee joint and is at the intersection of the two planes represented by the solid black lines in the accompanying figure.

Muscles Of The Anterior Compartment Of The Thigh

Thigh Compartments Anatomy

Originates from two muscles, the psoas major and iliacus muscles, which join to form a common tendon. The psoas major muscle attaches along vertebrae T12-L5, discs, and the iliacus within the iliac fossa. Both the psoas and iliacus muscles join together as they course deep to the inguinal ligament and insert onto the lesser trochanter of the femur. The main action of these muscles is to flex and laterally rotate the thigh at the hip joint. Innervation to the psoas major muscle is via the anterior rami of L1, L2, and L3, whereas innervation to the iliacus is through the femoral nerve (anterior rami of L2 and L3). Sartorius muscle. Attaches proximally to the anterior superior iliac spine. The distal insertion of the sartorius muscle is medial to the tibial tuberosity, contributing to the pes anser-inus. Pes anserinus ( goose's foot ) is a term used to describe the conjoined tendons of the sartorius, gracilis, and semitendi-nosus muscles their common insertion is...

Hamstring Length Apparently Short Actually Normal

Hamstring Length Norms

Short hip flexors hold back in hyperexlension and hip joint flexion Short hip flexors hold back in hyperexlension and hip joint flexion With few exceptions, the position of anterior tilt results from shortness of the one-joint hip flexors, and the amount of flexion varies with the amount of hip flexor shortness. If it were possible to determine how many degrees of hip flexion exist by virtue of the pelvic tilt, this number could be added to the number of degrees of straight-leg raise in determining hamstring length. It is not possible, however, to measure that amount of flexion. Hence, the low back and pelvis must be flat on the table. To get the low back and sacrum flat in a subject with hip flexor shortness, the hips must be flexed, but only by the amount necessary to obtain the desired position. (See facing page.) When hip joint flexion has reached the limit of hamstring length in the straight-leg raise, the hamstrings exert a downward pull on the ischium in the direction of...

Surgical Techniques of Lymphadenectomy 981 Inguinal Lymphaden ectomy

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Node dissection the incisions can be divided into horizontal and vertical. The vascular supply to the skin of the inguinal area is such that horizontal incisions are preferred over vertical ones. The key to minimizing the morbidity following lymphadenectomy is correct tissue handling and ensuring that the skin flaps are developed in the correct plane.66 No lymph nodes are found in the layer between the skin and subcutaneous fascia. At the authors' institute a parainguinal incision, a few centimeters below the groin crease, is the preferred type of incision (Fig. 9.6). The skin should be incised until the subcutaneous fascia is identified. Then the proximal and distal skin flaps are developed. The boundaries of the dissection are as follows proximally, the inguinal ligament distally, the crossing of the sartorius muscle and the adductor longus muscle (also referred to as the entrance of Hunter's canal, where the femoral vessels go under the muscles of the leg) the medial boundary is...

Anatomy and image appearances

Acetabular Fracture

Protection of the gonads from unnecessary X-radiation is an important factor when examining the hip joints, upper femora, pelvis and lower lumbar vertebrae. Exposure of the patient to X-radiation should be made in accordance with the as low as reasonably practicable (ALARP) principle and, in the UK, Ionising Radiations (Medical Exposure) Regulations (IRMER) 2000. Different positions of the lower limb result in different anatomical projections of the hip joint. The head of the femur lies anterior to the trochanteric bone of the femur when articulating normally with the acetabulum. There is an approximate angulation anteriorly of 125-130 degrees, which is best appreciated on the true lateral projection of the hip (Rogers, 2002). Internal rotation of the hip joint by approximately 50 degrees will bring the neck of the femur parallel to the cassette and the head and trochanteric bone on the same level. In abnormal conditions of the hip joint, the position of the foot is a significant clue...

Nontrauma corrective orthopaedic surgery

A long list of non-trauma corrective orthopaedic procedures are performed throughout the world. The majority involve the replacement of joints as a result of chronic bone or joint disease, e.g. severe osteoarthritis of the hip can be corrected using the implantation of a prosthetic total hip joint replacement. These procedures, however, no longer require the aid of imaging control due to the advancements of surgical techniques.

Pelvic Bone

Iliac fossa. Concave surface on the anteromedial surface. Anterior superior iliac spine. Anterior termination of the iliac crest. Serves as an attachment site for the sartorius and tensor fascia lata muscles. Anterior inferior iliac spine. Serves as an attachment site for the rectus femoris muscle.

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