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Lower Limb Muscles
Published in Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Handbook of Muscle Variations and Anomalies in Humans, 2022
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Malynda Williams
Rectus femoris is one component of quadriceps femoris. It has a dual origin, arising from the anterior inferior iliac spine and from the area just above the acetabulum (Standring 2016). Some fibers originate from the capsule of the hip joint (Standring 2016). The muscle ends in a tendon that inserts onto the base of the patella (Standring 2016).
Surgery of the Hip
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Daud TS Chou, Jonathan Miles, John Skinner
An assistant now internally rotates the extended hip and flexes, stretching the short external rotators, making them easier to divide. This also increases the distance between the sciatic nerve and the site of division of these short muscles. Strong, stay sutures are inserted into the tendons of obturator internus and piriformis, just below their insertion into the femur. Visible vessels within the operative field are coagulated: typically these lie on the tendon of piriformis and within the substance of quadratus femoris. The short external rotators, from piriformis down to gemellus inferior, are divided as close to their insertion onto the femur as possible. If further access is required, the division can be carried on further distally. The muscles are allowed to rest over the sciatic nerve, providing some protection for it throughout the rest of the operation. This exposes the posterior capsule of the hip joint. To improve visibility, the interval between the superior part of the hip capsule and the gluteus minimus is identified and dissected free with blunt dissection or scissors. This view is maintained by inserting a Hohmann retractor in the interval to displace the gluteus minimus superiorly. The capsule is incised transversely to gain access. The visible portion of capsule can either be excised or preserved for later repair. The visible portion of the acetabular labrum is excised.
Objective structured clinical examination (OSCE)
Published in Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon, Radiology for Undergraduate Finals and Foundation Years, 2018
Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon
There is an intertrochanteric fracture of the left neck of femur.These injuries are almost always managed surgically with internal fixation.The type of surgical treatment depends on the location of the fracture in relation to the capsule of the hip joint. If the fracture is extracapsular then internal fixation of the neck of femur using either a dynamic hip screw (DHS) or internal medullary hip screw with preservation of the femoral head can be performed (see below). If the fracture is intracapsular then the blood supply to the femoral head is more likely to be compromised, with a high risk of avascular necrosis, therefore the femoral head must be replaced with a prosthesis.
Diffusion tensor imaging of the sciatic and femoral nerves in unilateral osteoarthritis of the hip and osteonecrosis of femoral head: Comparison of the affected and normal sides
Published in Modern Rheumatology, 2019
Yasushi Wako, Junichi Nakamura, Shigeo Hagiwara, Michiaki Miura, Yawara Eguchi, Takane Suzuki, Sumihisa Orita, Kazuhide Inage, Yuya Kawarai, Masahiko Sugano, Kento Nawata, Kensuke Yoshino, Yoshitada Masuda, Koji Matsumoto, Seiji Ohtori
Based on these results, we suggest that DTI may be useful to differentiate hip diseases from lumbar nerve radiculopathy and piriformis syndrome. DTI has been applied to demyelinating diseases of the peripheral nerves [10], peripheral nerve tumors [12], and the entrapment of nerves such as carpal tunnel syndrome or radicular pain originating from a lumbar lesion [6,13,25]. Eguchi et al. reported that the mean FA values in entrapped nerve roots were lower than those in intact nerve roots [6]. Wada et al. reported that lumbar herniation or/and lumbar spinal stenosis resulted in mean FA values in the sciatic nerve of the femoral head region that were lower than those in intact nerves. They also reported that the piriformis syndrome patients had lower FA values in the entrapped sciatic nerve than in the intact nerves [14]. Patients with lumbar spinal disease and piriformis syndrome may also have radicular pain corresponding to the lower leg. Saito et al. reported four cases in which it was difficult to differentiate between lumbar spinal stenosis and hip arthritis, and clinicians may misdiagnose these conditions [26]. Although clinicians try to diagnose by physical findings (ex. absence of numbness), conventional MR imaging or other imaging examinations, it is difficult to differentiate the origin of lower leg pain in patients with lumbar spinal stenosis, piriformis syndrome, and hip joint diseases. These diseases can often coexist, such as hip–spine syndrome [27] and the localization of the hip pain can be variable [19,20]. The capsule of the hip joint is innervated by the obturator, femoral, sciatic, and superior gluteal nerves [28] and the mechanisms of hip pain are not fully understood. In order to differentiate between these conditions and hip joint diseases, we suggest that DTI might be useful to evaluate the sciatic and femoral nerves.
Pericapsular nerve group block for analgesia of positioning pain during spinal anesthesia in hip fracture patients, a randomized controlled study
Published in Egyptian Journal of Anaesthesia, 2020
Alrefaey K. Alrefaey, Mohamed A. Abouelela
In contrast to the above, PENG block targets the articular branches of FN and AON between the AIIS and IPE, while LA spread, also, to the subpectineal plane is assumed to block the branches of the ON [10]. Thus articular branches to the anterior capsule of the hip joint will be completely blocked using this approach.