Lower Limb Muscles
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo in Handbook of Muscle Variations and Anomalies in Humans, 2022
This chapter provides evolutionary theoretical background for variations and defects of lower limb muscles; and summarizes each variation and defect found in every skeletal muscle. Gluteus maximus originates from the ilium, sacrum, coccyx, aponeurosis of erector spinae, sacrotuberous ligament, and the gluteal aponeurosis. Gluteus maximus has similar origins and attachments in the apes, but compared with humans, gluteus maximus in the apes is reduced in size and thickness and is more developed in its distal portions. Variations in the gluteal muscles including division of the muscle into multiple parts should be acknowledged when considering injections into the gluteal musculature. Piriformis may have an origin from the upper part of the pelvic aspect of the sacrotuberous ligament. Anomalous presentations of piriformis include variable insertions, the presence of accessory slips, complete absence, or splitting of the muscle belly by the peroneal portion of the sciatic nerve.
Anorectal malformation—Rectal prolapse and soiling: Case study
Victoria A. Lane, Richard J. Wood, Carlos A. Reck-Burneo, Marc A. Levitt in Pediatric Colorectal and Pelvic Surgery, 2017
This chapter explains the key principles in the management of complex pediatric colorectal diagnoses. It provides case-based presentations, radiographic images, operative images with multiple choice questions to test knowledge. The chapter presents a case study of a 3-year-old girl who is known to have undergone a primary posterior sagittal anorectoplasty (PSARP) as an infant for an anorectal malformation. She has no scars on the abdomen to suggest that she has had a previous colostomy and you therefore suspect that her original malformation was a perineal fistula or a vestibular fistula. The management this child require includes: redo primary posterior sagittal anorectoplasty, vaginal replacement, resection of pre-sacral mass and detethering of the spinal cord, intermittent catheterization to protect upper renal tracts and consideration for Mitrofanoff procedure and appendicostomy for bowel management given poor sacrum and tethered cord, and reduced capacity for voluntary bowel movements.
A-P Full Spine and Lumbar, Sacrum, and Coccyx Views
Russell L. Wilson in Chiropractic Radiography and Quality Assurance Handbook, 2020
The exposure time for the A-P full spine is the longest exposure time that one typically experiences. Radiography of the lumbar spine region will provide the greatest radiation exposure to the patient. For this reason, accurate positioning, measurements, and gonadal protection is very important. The technique is based on measurements at the umbilicus. The A-P full spine is included in the lumbar region because the basic technical factors are established to visualize the lumbar spine and pelvis. The A-P or P-A lumbopelvis view is used only by chiropractors. Patients should lock knees and remove shoes for the lumbar spine and full spine studies. They should also have their feet placed at about shoulder-width apart to minimize motion. All of the lumbar, sacrum, and coccyx views can be taken A-P or P-A. The P-A views will have more magnification but will reduce the exposure for female patients.
Analysis of magnetic resonance signal intensity changes in the sacrococcygeal region of patients with uterine fibroids treated with high intensity focused ultrasound ablation
Published in International Journal of Hyperthermia, 2020
Dandan Li, Chunmei Gong, Jin Bai, Lian Zhang
Objective To evaluate the magnetic resonance (MR) signal intensity changes in the sacrococcygeal region of patients with uterine fibroids treated with high intensity focused ultrasound (HIFU). Materials and Methods Two hundred and sixty-seven patients with uterine fibroids treated with HIFU between January and December 2016 were retrospectively reviewed. All patients underwent enhanced pre- and post-HIFU MRI. Multivariate analysis was used to assess the relationship between the factors and the signal intensity changes in the sacrum and the soft tissue adjacent to the sacrum. Results Among the 267 patients, 122 (46%) had MR signal intensity changes in the sacrum and/or the soft tissue adjacent to the sacrum after HIFU. Multivariate analysis showed that the position of the uterus, the distance from the dorsal side of the fibroid to the sacrum, and the ablation efficiency were significantly correlated with MR signal intensity changes in the sacrum and the soft tissue adjacent to the sacrum. Further analysis showed a significant relationship between the location of the MR signal intensity changes and uterine size, the enhancement degree of the uterus. Leg pain was only seen in patients with MR signal intensity changes both in the sacrum and the soft tissue adjacent to the sacrum. Conclusions The location of the uterus, the distance between the dorsal side of the fibroids to the sacrum, and ablation efficiency have a significant relationship with the MR signal intensity changes. The size of the uterus and the degree of enhancement are related to the locations of MR signal changes.
Giant cell tumor of the sacrum
Published in Baylor University Medical Center Proceedings, 2021
James Rizkalla, Brendan Holderread, Jonathan Liu, Al Mollabashy, Ishaq Y. Syed
Giant cell tumor of the sacrum is a rare primary tumor in a challenging anatomical location without clear consensus on treatment. We present a case of giant cell tumor of the sacrum and subsequent treatment with preoperative embolization, L5 to S4 laminectomy, partial sacrectomy, intraoperative thermal ablation, and L4 to pelvis stabilization and fusion.
Pathology of the Sacroiliac Joint, its Effect on Normal Gait, and its Correction.
Published in Journal of Orthopaedic Medicine, 2005
When the sacrum is loaded and the pelvis is symmetrical, the primary and secondary loading forces are in balance. Any increase in posterior pelvic rotation will increase tension on the sacrotuberous ligament and increase friction and stability in the sacroiliac joints. Dysfunction may occur when the line of gravity shifts anterior to the acetabula, causing an anterior rotation of both innominates on the sacrum on an acetabular axis. This decreases tension on the sacrotuberous ligament decreasing friction in the sacroiliac joints. The force couple is disabled and the innominates will move cephalad and laterally on the sacrum moving on an acetabular axis and subluxating at the S3 segment. This may give the appearance of a multifactorial etiology or mimic the symptoms of a herniated nucleus pulposus and has many various effects on normal gait. As dysfunction of the sacroiliac joints (SIJD) is essentially always a pathological release of the self-bracing position with anterior pelvic rotation, correction of SIJD is simply manual restoration of the innominate bones caudad and medially on the sacrum back to the position of self-bracing. Correction of this subluxation will give immediate relief to at least three out of four people with low back pain.