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Anatomy of the Anterior Abdominal Wall
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
The transversus abdominis lies deep to the internal oblique and arises from the inner surfaces of the lower eight costal cartilages, the thoracolumbar fascia, along the iliac crest and the lateral one-third of the inguinal ligament. The majority of the fibres run transversely and become aponeurotic at the lateral border of the rectus sheath where they pass behind the rectus abdominis in the upper two-thirds of the abdomen and in front of the rectus abdominis in the lower one-third of the abdomen. Above the transpyloric plane, the transversus muscle runs deep to the posterior rectus sheath before becoming aponeurotic, usually as far as the midpoint of the muscle, which is in contrast to how it is often portrayed in textbooks where it is shown to be aponeurotic lateral to the rectus muscles throughout its length. In a similar fashion to the lower fibres of the internal oblique layer, the muscle fibres arising from the inguinal ligament form an arch over the inguinal canal and fuse with the lower fibres of the internal oblique to form the conjoint tendon which is inserted onto the pubic tubercle.
Surgery of the Shoulder
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Nick Aresti, Omar Haddo, Mark Falworth
A retractor can be placed over the coracoid process to enhance the exposure and the clavipectoral fascia is then split vertically starting just lateral to the coracoid. This exposes the conjoint tendon. If required, the lateral third of the conjoint tendon can be divided to allow better exposure (by not detaching the coracoid or the tendon fully, the musculocutaneous nerve is protected from excessive traction). A self-retainer is placed between the coracoid/conjoint tendon medially and the deltoid muscle laterally. The arm is externally rotated to expose the subscapularis muscle. The upper two-thirds of the subscapularis can then be tenotomized approximately 1 cm from its insertion in the lesser tuberosity and dissected free of the underlying capsule. This plane is more easily found inferiorly and becomes easier as the dissection progresses medially. Alternatively, the subscapularis can be split horizontally and retracted, exposing the underlying capsule.
Abdominal wall, hernia and umbilicus
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
As the testis descends from the abdominal cavity to the scrotum in males it firsts passes through a defect called the deep inguinal ring in the transversalis fascia, just deep to the abdominal muscles. This ring lies midway between the anterior superior iliac spine and the pubic tubercle, approximately 2–3 cm above the femoral artery pulse in the groin. The inferior epigastric vessels lie just medial to the deep inguinal ring, passing from the iliac vessels to rectus abdominis. Muscle fibres of the innermost two layers of the lateral abdominal wall, the transversus muscle and the internal oblique muscle, arch over the deep inguinal ring from lateral to medial before descending to become attached to the pubic tubercle. These two muscles fuse and become tendinous, hence this arch is referred to as the conjoint tendon. Below this arch there is no muscle but only transversalis fascia and external oblique aponeurosis, resulting in weakness (Figure60.10).
Management of a nonathlete with a traumatic groin strain and osteitis pubis using manual therapy and therapeutic exercise: A case report
Published in Physiotherapy Theory and Practice, 2020
Kyle Feldman, Carla Franck, Christine Schauerte
The rectus abdominis, adductor longus, adductor magnus, adductor brevis, and gracilis are also reported as the sources of groin pain in at least 10% of cases (Hölmich et al., 2014; Serner et al., 2015). Typical diagnosis is based on palpation of the muscle region and resisted muscle activation (Brix, Lohrer, and Hoeferlin, 2013; Hölmich et al., 2014). When the injured muscle is unknown, “athletic pubaglia”, sometimes referred to as “groin disruption” is the medical diagnosis typically given. Athletic pubalgia is described as posterior abdominal wall weakening and the conjoined tendon separates, without evidence of a hernia on imaging or a palpable defect (Garvey and Hazard, 2014; Sheen et al., 2014). Pain occurs with exertion, Valsalva’s maneuver, resisted hip adduction, pressure, and a partial sit up, but not with coughing or sneezing (Meyers et al., 2000; Morelli and Smith, 2001). Outcomes for return to pre-injury level often require surgical repair due to poor outcomes reported with conservative management (Elattar, Choi, Dills, and Busconi, 2016; Morelli and Smith, 2001).
Everything pectoralis major: from repair to transfer
Published in The Physician and Sportsmedicine, 2020
Kamali Thompson, Young Kwon, Evan Flatow, Laith Jazrawi, Eric Strauss, Michael Alaia
The subcoracoid pectoralis major transfer begins with the patient in the beach-chair position, under general anesthesia, with an interscalene block in the cervical plexus49. The patient’s limb should be placed in the pneumatic arm hold and an anterior dissection is made for a deltopectoral approach [70]. The pectoralis major muscle insertion is exposed, sternocostal head identified and sharply detached as close to the humeral shaft as possible (lateral to intertubercular groove) [70]. The biceps tendon and axillary nerve must be protected, as well as the musculocutaneous nerve located 5–6 cm from the coracoid tip with the proximal branch 2–4 cm from coracoid [76]. Different sutures are placed on the tendon to maintain orientation after transfer [73]. The muscle is advanced behind the conjoint tendon, superficial to musculocutaneous nerve and attached to the lesser tuberosity or greater tuberosity with bone tunnels or suture anchors [73]. Following the transfer, palpation of the musculocutaneous nerve is performed to ensure the nerve has no extra tension [73]. If excessive tension is placed, the proximal nerve is released followed by tendon debulking [20].
Long-standing groin pain in an elite athlete: usefulness of ultrasound in differential diagnosis and patient education – a case report
Published in European Journal of Physiotherapy, 2018
Kingsley S. R. Dhinakar, Anjanette Cantoria Lacaste
It was postulated that the possible structures that may be involved are the insertion of the hip adductors, conjoint tendon and obturator nerve. Ultrasound examination showed a focal area of mild swelling of conjoint tendon as shown in Figure 2.