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Endometriosis of the Pelvic Nerves
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Shaheen Khazali, Marc Possover
In the first published MR description of sciatic nerve endometriosis, Pharm et al. (20) suggest that enhanced T2 weighted imaging (T2-w) contrast and strong attenuation of the surrounding fat tissue are especially useful in this scenario to visualize axonal nerve degeneration and denervated muscle, both of which appear markedly bright. Additional contrast-enhanced T1-w imaging can also be very useful to delineate small vessels around the nerves. In the case described by the authors, the main finding at MR neurography was a diffuse infiltrative lesion centered at the sciatic notch. Moreover, the sciatic nerve showed a marked and continuous brightness on T2-w distal to the lesion indicating severe axonal injury. In addition, atrophy and evidence of denervation were found in distant target muscles of the sciatic nerve and the distal lumbosacral plexus, most marked in the gluteal group and the quadratus femoris muscle (20).
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
Liu et al. (2011) suggest that absence of quadratus femoris may present as muscle weakness of hip lateral rotation. Girolami et al. (2019) describe a case of isolated sciatica in a left leg that was associated with a quadratus femoris muscle with an enlarged belly and narrow origin and insertion.
Blocks of Nerves of the Sacral Plexus Supplying the Lower Extremities
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand
A technique for blocking the nerve to the quadratus femoris muscle has been described as an alternative to surgical nerve section in adult patients with severe osteoarthritic pain of the hip.35–37 This technique consists of inserting a needle posteriorly to the greater trochanter, with the patient lying prone. The needle is advanced towards the junction of the middle with the lower third of a line extending from the sacral hiatus to the posterior superior iliac spine. This technique is not free of complications and requires as much local anesthetic as a complete sciatic nerve block. As it is of no interest in pediatric anesthesia, it will not be further discussed.
Imaging changes following surgery for ischiofemoral impingement
Published in Baylor University Medical Center Proceedings, 2023
Munif Hatem, Richard Feng, Jordan Teel, Hal David Martin
All surgical procedures were performed by the same surgeon. Patients were positioned supine on a traction table with 20° of contralateral tilt. Patients with positive intraarticular injection test preoperatively underwent intraarticular assessment and associated procedures. The LT plasty was performed endoscopically through a posterolateral approach.3 Three portals were utilized: anterolateral, auxiliary proximal, and auxiliary distal (Figure 2). The LT was reached through a window in the quadratus femoris muscle between the medial femoral circumflex artery and first perforating branch of the profunda femoris artery (Figure 3). The amount of LT to be resected was determined according to the preoperative ischiofemoral space measured on the MRI with controlled positioning of the lower limbs. The observation of hard impingement bone was also utilized as an intraoperative guide for the LT plasty.
Frequency of ischiofemoral space discrepancy when comparing magnetic resonance images of distinct institutions for the same patient
Published in Baylor University Medical Center Proceedings, 2021
Munif Hatem, RobRoy L. Martin, Scott J. Nimmons, Hal David Martin
The positioning of the patient during the imaging acquisition is variable among authors describing the normal IFS in different populations.6,8,10,11 Considering that the interpretation of the IFS assessed in hip MRI by clinicians is dependent on the lower limb positioning during MRI acquisition, including this information on the exam report would be helpful in the diagnosis and surgical planning for ischiofemoral impingement. In addition to decreased IFS, the physical examination and additional imaging findings are essential to determine whether the impingement between the lesser trochanter and ischium has clinical repercussion. The ischiofemoral impingement test, long-stride walking test, and hip-spine extension test are included in the physical examination to diagnose ischiofemoral impingement.1,4,12 Helpful findings to diagnose ischiofemoral impingement in standing radiographs include the presence of asymmetric IFS and sclerosis and cystic changes at the ischial tuberosity. The presence of signal changes at the quadratus femoris muscle and adjacent hamstring tendons is another finding supporting the diagnosis of ischiofemoral impingement (Figure 7).6,13
Extra-articular hip impingement: clinical presentation, radiographic findings and surgical treatment outcomes
Published in The Physician and Sportsmedicine, 2019
Ischiofemoral impingement was first described in 1977, identified in a series of patients with previous intertrochanteric hip fractures, with malunions resulting in a reduction of the ischiofemoral space and impingement of the quadratus femoris [24]. The ischiofemoral space is defined as the space between the lateral margin of the ischial tuberosity and the medial edge of the lesser trochanter, which is an average of 20 mm in diameter [24,25]. The quadratus femoris muscle occupies this space and can be compressed if the available space is reduced. However, even following its preliminary description, this entity was not considered as a possible cause of hip pain in an uninjured or unoperated patient for several years thereafter. More recently, it has been identified as a cause of impingement with a number of theories proposed regarding the mechanism by which this ischiofemoral space is reduced. This has included traumatic injuries (i.e. intertrochanteric fractures, or bony avulsions of the ischium or lesser trochanter [LT] in pediatric patients), as well as degenerative processes (OA with medialization of the femoral head), and finally alterations in proximal femoral morphology (coxa breva, coxa valga, excessive femoral anteversion or hip dysplasia) [24,26].