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SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
The psoas major muscle joins the iliacus muscle, which originates broadly over the inner aspect of the iliac wing of the pelvis. This becomes the iliopsoas muscle and inserts on the lesser trochanter of the femur and thus flexes the thigh at the hip joint. The action of this muscle results in the leg becoming shortened and externally rotated following a fracture of the neck of the femur.
The neurological examination
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Iliopsoas muscle: Psoas and iliacus muscles (Figure 11.2a) Innervation: Upper part of iliac fossa to lesser trochanter (iliacus). Psoas major: Lumbar nerves (L1, L2, and L3).Iliacus: Femoral nerve (L2 and L3).Function: Flexion of hip joint.Physical examination: The patient lies supine with the leg flexed at the knee and hip and tries to flex the thigh against resistance.
The normal abdominal X-ray
Published in Lt Col Edward Sellon, David C Howlett, Nick Taylor, Radiology for Medical Finals, 2017
The lower thoracic and lumbar vertebrae should also be clearly visible; if not the film may be underpenetrated. The outline of the lumbar vertebrae should be traced to assess for any abnormalities such as a fracture. While assessing the lumbar spine you may also be able to identify the outline of the iliopsoas muscles (these may enlarge in cases of retroperitoneal tumour, abscess or bleed).
Imaging changes following surgery for ischiofemoral impingement
Published in Baylor University Medical Center Proceedings, 2023
Munif Hatem, Richard Feng, Jordan Teel, Hal David Martin
Atrophy of the iliacus and psoas muscles has been reported following iliopsoas tenotomy in association with hip arthroscopy.11,12 However, these studies reported no significant difference in the mHHS relative to the amount of atrophy.11,12 In the present study, no correlation between the mHHS and the amount of iliopsoas atrophy was observed. The primary function of the iliopsoas muscle is hip flexion, and tenotomy or detachment from the LT could result in hip flexion weakness. In the present study, one patient reported hip flexion weakness in the early postoperative period, which was resolved at 4-month follow-up. Previous studies have reported improvement of hip flexor weakness by at least 8 weeks postoperatively after iliopsoas tendon release.13,14 Brandenburg et al reported a 19% reduction in seated hip flexion strength following iliopsoas tenotomy at the level of the hip joint.15 Those authors also reported no significant difference in hip flexion strength in the supine position when comparing the operated with the nonoperated side.15 The reinsertion of the iliopsoas onto the femur following the LT resection could prevent flexor weakness. While the technique for iliopsoas reinsertion following LT resection is published, clinical results on hip flexor strength are not reported.16
Treatment of idiopathic meralgia paresthetica – is there reliable evidence yet?
Published in Neurological Research, 2023
The LCN originates within the lumbosacral plexus containing L2 and L3 nerve fibers. It runs in an oblique fashion in the lateral pelvis at the lateral border of the iliopsoas muscle. It then turns ventrally beneath the iliac muscle fascia towards the anterior superior iliac spina (ASIS) and continues from medial cranial to lateral caudal beneath the inguinal ligament. Four different types of courses are described (Figure 1). The most common types are 1 and 2: In type 1, the nerve cuts through both strings of the inguinal ligament, which is where it is compressed. In Type 2I, the LCN runs below the inguinal ligament, medial to the superior anterior iliac spina, and is compressed at the sharp end of the iliac fascia in a standing position. In Type 3, the nerve is compressed at the site where it traverses the sartorius muscle. In type 4, the LCN is compressed in a groove at the superior anterior iliac spine and lateral to the insertion of the inguinal ligament [13]. The LCN usually splits into two branches on the fascia of the thigh. A cadaver study in 33 specimens revealed an average distance of 8.8 mm between the ASIS and the LCN. The distance was less than 2 cm in 76% of cases [14]. The LCN only contains sensory fibers and innervates the area of the anterolateral thigh region.
Distal Stimulation Site at the Medial Tibia for Saphenous Nerve Somatosensory Evoked Potentials (DSn-SSEPs) in Lateral Lumbar Spine Procedures
Published in The Neurodiagnostic Journal, 2021
Kathryn Overzet, Derrick Mora, Eloise Faust, Lindsay Krisko, Dyanne Welch, Faisal R. Jahangiri
In addition to direct nerve injury, excessive retraction time of the iliopsoas muscle has been reported to cause nerve injury (Houten et al. 2011). Sn-SSEP recordings can detect evidence of degraded femoral nerve function from excessive or prolonged retraction. One study reported as many as 62.7% of lateral lumbar procedure patients exhibiting adverse thigh symptoms postoperatively (Cummock et al. 2011). The most common neurological deficits reported following lateral fusion surgeries include thigh pain (20–40% of patients), numbness or dysesthetic pain (10–20% of patients), and quadriceps palsy (0.7–33.6%) (Cahill et al. 2012; Moller et al. 2011; Mummaneni et al. 2014; O’Brien 2017). Sn-SSEP monitoring during lateral lumbar surgery can be valuable in the detection of degraded femoral nerve function from excessive or prolonged retraction.