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Objectives: Flexibility and strength are compromised in pronated feet, which could in turn lead to alteration of the dynamic balance and muscle activity in the lower extremities. This study aimed t...

The incidence of iliopsoas tendonitis (IPT) has not previously reported following hip arthroscopy for femoroacetabular impingement with or without labral tears. (i) What is the incidence of IPT following hip arthroscopy; (ii) are there any demographic risk factors and (iii) are there any operative techniques that are risk for IPT? Retrospective study. Hip arthroscopy patients from 2005 to 2012 were included. Patients were diagnosed via physical examination findings and were excluded if they had pre-operative IPT. Records were reviewed for demographics, operative reports and operative procedures. All patients received either labral debridement, labral repair, osteoplasty or a combination of those procedures. A standardized rehabilitation protocol was used. Of 252 patients, 60 (24%) had IPT. Twenty-eight (47%) had symptom resolution with activity modification, physical therapy and NSAIDs. Thirty-two (53%) required corticosteroid injection at a mean of 25 weeks after surgery. Seven (12%) required revision arthroscopy and iliopsoas release to resolve the symptoms. There were no patient-specific risk factors, differences based on surgical technique, and number of portals did not matter. Patients should minimize exercises that activate the iliopsoas after hip arthroscopy. The cause of IPT could be related to unaddressed abnormal mechanics, tendon scarring or improper physical therapy. Further studies are needed to investigate the reasons for this, as well as specific techniques to lower its incidence. The incidence of IPT after hip arthroscopy has an incidence of 24%. Additionally, we provide readers with a rehabilitation protocol to minimize this complication. What is known about the subject This subject has not previously been described. What this study adds to existing knowledge We are the first to report IPT after hip arthroscopy.

Hip periprosthetic joint infections (PJIs) with concomitant retroperitoneal abscesses may not be common clinical situations but they can be easily misdiagnosed affecting the effectiveness of infection control and eradication interventions. We present the case of a 75-year-old female patient with a late hip PJI complicated with iliopsoas abscess that was barely discovered intraoperatively. Literature review supports our recommendation of a high index of suspicion in cases of hip PJI and even routinely imaging examination of pelvis and abdomen for retroperitoneal involvement exclusion.

Le rhabdomyosarcome est une tumeur maligne mesenchymateuse de l'enfant et de l'adolescent. Il represente 5% de l'ensemble des tumeurs solides a ces âges. Cette tumeur est rare chez l'adulte et exceptionnelle chez le sujet âge. Les localisations les plus frequentes sont la tete, le cou et l'appareil urinaire. Peu d'etudes rapportent des localisations retroperitoneales et l'atteinte primitive du muscle iliopsoas a ete exceptionnellement decrite dans la litterature. Les auteurs rapportent une nouvelle observation d'une patiente de 65 ans presentant un rhabomyosarcome alveolaire de l'iliopsoas gauche. Rhabdomyosarcoma is a malignant mesenchymal tumor in children and adolescents. It represents 5% of all solid tumors at these ages. This tumor is rare in adults and exceptional in the elderly. The most frequent localizations are the head, the neck, and the urinary tract. Few studies reported retroperitoneal emplacements, and primary involvement of the iliopsoas muscle has been described exceptionally. This paper focuses on reporting a new observation of a 65-year-old patient with alveolar rhabomyosarcoma of the left iliopsoas.

Surgical management of iliopsoas pathology that fails conservative treatment is controversial. Potential complications following iliopsoas tenotomy include recurrent painful internal snapping, postoperative pain, and hip flexor weakness. Concerns are even greater in dysplastic patients, in whom the iliopsoas may play a role as an anteromedial hip stabilizer. Although data demonstrate arthroscopic iliopsoas tenotomy for painful internal snapping as safe and effective, its use has declined for the reasons stated above. On the other hand, procedures such as capsular plication with inferior shift and anatomic labral repair, augmentation, and reconstruction have made it possible to restore the primary stabilizers in many cases of hip instability. In these cases, iliopsoas fractional lengthening (IFL) with avoidance of collateral damage to the musculature or capsule can successfully treat painful internal snapping hip. We recommend iliopsoas lengthening when (1) there is painful internal snapping, (2) IFL can be performed without collateral damage, (3) the primary soft tissue stabilizers can be restored or augmented, and (4) there is no bony morphology likely to cause continued instability.

Successful outcomes after psoas tenotomies have been reported and proposed in the setting of recalcitrant internal snapping and psoas impingement. However, case reports citing hip flexion weakness and iatrogenic instability created concern regarding the role for psoas tenotomies. Despite these concerns, some recent studies reporting improved outcomes after endoscopic psoas tenotomies breathe further life into this controversial topic. Psoas tenotomy in the setting of a borderline dysplastic hip likely carries an even greater risk for iatrogenic instability. It might be critical to evaluate for clinical signs and symptoms of instability in addition to radiographic parameters to avoid this potentially devastating complication. In addition, the traditional definition of borderline dysplasia is based on lateral acetabular coverage that might be less important than anterior acetabular coverage and femoral version when contemplating psoas tenotomies on the basis of the dynamic anterior stabilizing effect of the iliopsoas myotendinous unit. Surgeons should also be extremely cautious when considering psoas tenotomy in an athletic population with the potential for persistent weakness and limited data hinting at inferior sports specific outcomes. In the end, it is not clear whether the psoas tenotomy “drives” the improvements seen in some studies, or whether many of these patients ultimately battle their way into a minimally clinically important difference “despite” the psoas tenotomy.

Purpose To calculate the iliopsoas muscle/tendon ratio at 3 levels of arthroscopic iliopsoas tenotomy sites in fresh cadaveric specimens. Methods An anatomic study design was performed using 16 iliopsoas musculotendinous units from the level of the hip joint to their insertion on the lesser trochanter. All specimens came from 16 fresh cadaveric specimens (10 male, 6 female), with a median age of 41 years (range 31-55.25 years). Circumferential measurements of the composite musculotendinous unit and the iliopsoas tendon were then made at the lesser trochanter insertion, the site of transcapsular tenotomy, and the site of tenotomy at the level of the labrum. Anatomical variance of the iliopsoas tendon at the insertion on the lesser trochanter and muscular extension below the lesser trochanter level also were described. The difference between the median circumference of the iliopsoas musculotendinous units or the isolated tendons at the 3 levels was calculated. Results The median circumference of the iliopsoas musculotendinous unit at the level of the labrum, orbicularis zone (transcapsular tenotomy site), and the lesser trochanter was 140.9 mm (range 137.9-148.9), 136.7 mm (range 132.9-140), and 99.5 mm (range 96.5-104.8), respectively. The median circumference of the iliopsoas tendon at these same levels was 25.6 mm (range 22.7-33.7), 28.9 mm (range 25.1-32.2), and 30.9 mm (range 27.9-36.1), respectively. Accordingly, the proportions of the iliopsoas muscle/tendon at the level of the labrum, the transcapsular tenotomy site, and the lesser trochanter insertion were 18% tendon/82% muscle, 21% tendon/79% muscle, and 31% tendon/69% muscle, respectively. Conclusions The proportions of the iliopsoas muscle/tendon at the level of the labrum, the transcapsular tenotomy site and the lesser trochanter insertion were 18% tendon/82% muscle, 21% tendon/79% muscle, and 31% tendon/69% muscle, respectively. The distal muscular projection below the tendinous insertion on the lesser trochanter may maintain the functional connection of the iliopsoas between origin and insertion even after releasing the tendon. Clinical relevance This finding may have implications for a new understanding of arthroscopic tenotomy of the iliopsoas around the hip, as previously described muscle/tendon proportions were not calculated in fresh cadavers.

Chronic testicular pain is a condition commonly experienced by males. Potential causes of testicular pain can be pathology localized within the testicle or referred pain from surrounding tissues or spinal conditions. The diagnostic differential is extensive and can be seen as a diagnosis of exclusion after structural disorders specific to the testicle are ruled out. In approximately 50% of the cases, the cause of pain is undetermined. Patients with testicular and inguinal pain may undergo extensive workup that overlooks potential neuropathic and musculoskeletal causes remote to the testicle. This case study describes the application of a conservative treatment program targeting presumptive chronic genitofemoral and/or ilioinguinal nerve entrapment along the course of the inguinal canal for the treatment of chronic testicular pain. By combining sacroiliac joint osteopathic manipulation, iliopsoas stretching, and soft tissue mobilization utilizing a vacuum suction cup, the patient was symptom-free on the fourth visit after suffering from testicular pain for a year. At a one-year follow-up, the patient remains pain-free.

International audience; BACKGROUND: There is little data on major muscular hematomas and the little there is has mainly focused on patients exposed to oral anticoagulants. OBJECTIVE: To describe the clinical characteristics, management and outcomes of patients admitted to emergency department (ED) for major muscular hematoma associated with an antithrombotic agent, and to identify predictors of in-hospital mortality. PATIENTS AND METHODS: Over a three-year period, all consecutive cases of adult patients admitted to the ED of 5 tertiary care hospitals for major muscular hematoma while exposed to an antithrombotic agent were prospectively collected and medically validated. Clinical and biological data, therapeutic management of the bleeding event, and in-hospital mortality were collected from the medical records and compared across five groups of hematoma locations. Potential confounders were taken in account using a multivariate binomial regression model. RESULTS: Three hundred and seventy-five patients were included (mean age = 81.4 years): 271 were exposed to vitamin K antagonists, 58 to parenteral anticoagulants (heparin, LMWH, fondaparinux), 33 to antiplatelets, and 13 to direct oral anticoagulants. The muscular hematomas were located in the lower limbs (n = 198), the rectus sheath (n = 71), the iliopsoas (n = 45), the upper limbs (n = 33), or elsewhere (n = 28). Reversal therapy was prescribed for 48.5% of patients, red cell transfusions for 63.6%, surgery for 12.3% and embolization for 3.5%. For 84% of patients, hospitalization was required, with a median length of stay of 10 days. Overall, in-hospital mortality was 8.5%. Reversal therapy, the need for intensive care and mortality were significantly more frequent among patients with iliopsoas hematomas. The independent predictors of in-hospital mortality were: decrease in mean arterial pressure (RR = 1.84), decrease in hemoglobin level (RR = 1.37) and the iliopsoas location (RR = 3.06). CONCLUSION: Frail elderly patients with major muscular hematomas linked to antithrombotic agents risk substantial morbidity and in-hospital mortality. The iliopsoas location was the most life-threatening bleeding site. Close observation of this population is warranted to ensure better outcomes.

Iliopsoas tendon pain can be a frustrating condition for both patients and surgeons after total hip arthroplasty. It is difficult to diagnose definitively, as there is no imaging modality that offers reliable information and there are numerous causes of persistent groin pain in this patient population. The pain can ruin the results of an otherwise well-functioning total hip arthroplasty. Patients who respond best to arthroscopic iliopsoas tenotomy are those with isolated pain with hip flexion activities and reproducible pain with resisted hip flexion on examination or other provocative iliopsoas maneuvers. Patients with these symptoms in addition to more generalized pain findings (pain with weight-bearing, pain at night, pain with passive range of motion) tend not to respond as favorably to isolated iliopsoas tenotomy. In addition, optimal treatment for refractory cases has been controversial historically, as both acetabular component revision and iliopsoas tendon lengthening have been advocated. With the ever-increasing popularity of hip arthroscopy and recent clinical outcome reports, arthroscopic (or endoscopic) iliopsoas tenotomy has proven to be a very safe and effective treatment option for these patients, with one caveat: the diagnosis must be correct.

Achilles tendon rupture is a well-documented adverse effect of Fluoroquinolones; however, herein we present a case of complete iliopsoas and Achilles, and partial semimembranosus tendon rupture secondary to Levofloxacin.

Iliopsoas hematoma should be considered in the differential diagnosis of femoral neuropathy in patients who are on chronic warfarin therapy. It usually presents with groin or thigh pain, and in rare instances, large bleeding may cause hypovolaemic shock. Conservative management has a good clinical and neurological outcome in such cases.

Purpose This cadaveric study aimed at describing the anatomical variations of the iliopsoas complex. Methods The iliopsoas complex was dissected unilaterally in 28 formalin-embalmed cadavers—13 males and 15 females with a mean age of 85.6 years. The number, courses and widths of the iliacus and psoas major tendons were determined. Patients with previous hip surgery were excluded. The following measurements were taken from the mid-inguinal point: the distance to the point of union of the psoas major and iliacus tendon; and the distance to the most distal insertion of iliopsoas. Results The presence of single, double and triple tendon insertions of iliopsoas were found in 12, 12 and 4 of the 28 specimens, respectively. When present, double and triple tendons inserted separately onto the lesser trochanter. The average length of the iliopsoas tendon from the mid-inguinal point to the most distal attachment at the lesser trochanter was 122.3 ± 13.0 mm. The iliacus muscle bulk merged with psoas major at an average distance of 24.9 ± 17.9 mm proximal to the mid-inguinal point. In all cases, the lateral-most fibres of iliacus yielded a non-tendinous, muscular insertion on to the anterior surface of the lesser trochanter and the femoral shaft, rather than joining onto the main iliopsoas tendon(s). The average total width of the psoas major tendon decreased with an increasing number of tendons: 14.6 ± 2.2 mm (single tendon), 8.2 ± 3.0 mm (2 tendons present) and 5.9 ± 1.1 mm (3 tendons present) (P Conclusions The results of this study suggest that multiple tendinous insertions of iliopsoas are present as an anatomical variant in more than 50% of the population. The non-tendinous muscular insertion of the iliopsoas on to the anterior surface of the lesser trochanter and femoral shaft found represents a novel anatomical variant not previously described. Level of evidence Level V

This is a case of a 50-year-old woman diagnosed with recurrent cervical adenocarcinoma presenting with chronic and persistent low back pain. She underwent myomectomy for myoma uteri 8 years prior. Histopathology report revealed cervical cancer. She underwent chemotherapy, brachytherapy and external beam radiotherapy. All surveillance work-up, over the years, were negative until she was found to have a solitary recurrent lesion in the right iliopsoas muscle on CT scan. A multidisciplinary team of surgeons collaborated to perform wide excision of pelvic recurrence en bloc right internal hemipelvectomy, right hemicolectomy en bloc resection of external iliac artery and vein, external ilio-iliac artery interposition graft and external iliac vein–common femoral vein bypass. Final histopathologic results showed adenocarcinoma with endometrioid features with associated poorly differentiated high-grade carcinoma involving the iliopsoas, cecum and terminal ileum. Two months postoperatively, the patient is ambulating with minimal assistance.

Background This study aimed to clarify potential gender differences across a comprehensive set of anthropometric and musculoskeletal characteristics within a young soccer player population. Methods This study included 227 (121 males and 106 females with mean ages of 19.0 and 17.5 years, respectively) young elite soccer players. Anthropometric measurements were obtained. In addition, general joint laxity tests assessing the wrist, elbow, shoulder, trunk, hip, knee, and ankle were performed. Muscle flexibility tests were performed on the iliopsoas, quadriceps femoris, hamstring, gastrocnemius, and soleus muscles. Moreover, isometric knee extension and flexion strength and isometric hip abduction strength were measured. Single- and double-leg balance tests were also performed. Results Male soccer players were taller, heavier, and had lower fat mass and percent body fat, and greater skeletal muscle mass and body minerals than female soccer players. Female soccer players had significantly greater laxity in all tests for general joint laxity. Female soccer players demonstrated significantly better hamstring and soleus flexibility than male soccer players but worse iliopsoas flexibility. Consequently, no significant differences were noticed in the quadriceps and gastrocnemius muscles between the male and female soccer players. However, female soccer players demonstrated significantly weaker knee extension and flexion and hip abduction. The hamstring- quadriceps ratio was significantly lower in female soccer players. Although no significant difference exists in the center of pressure excursion in the double-leg balance test between male and female soccer players, female soccer players displayed a significantly lower center of pressure excursion in the single-leg balance test. Conclusions Young male and female soccer players demonstrate significantly different anthropometric and musculoskeletal profiles.

Background Persistent groin pain after total hip arthroplasty (THA) can result from iliopsoas impingement (IPI) on the acetabular rim. Controversy exists over the risks and benefits of tenotomy versus revision as a surgical solution. We report our limited experience with combined acetabular revision and partial iliopsoas tenotomy when other conservative treatments have failed. Methodology A total of eight patients revised for IPI by a single surgeon at a single institution were retrospectively reviewed after a minimum one-year follow-up. Preoperatively, all patients had prolonged groin pain for a mean of two years (range: 1-4 years) and had failed conservative treatment for at least six months. All patients underwent acetabular revision through a direct anterior approach (DAA) with partial psoas tendon release. No stems were revised. Dislocations, complications, and clinical outcomes are reported in this study. Results Of the eight patients, seven had a positive diagnostic challenge with an image-guided injection. All revised cups showed radiographic evidence of IPI with relative acetabular retroversion by either a cross-table lateral film or computed tomography scan. Preoperatively, the mean cup anteversion was 4 degrees (range: 0-9 degrees). Postoperatively, the mean cup anteversion was 19 degrees (range: 16-21 degrees). All cups were within the so-called safe zone. To avoid overstuffing, the mean cup size remained unchanged. There were no major postoperative complications. At a mean time to follow-up of 3.3 years, the mean Hip disability and Osteoarthritis Outcome Score for Joint Replacement was 75 points (range: 32-100 points). Conclusion IPI may be effectively managed with combined acetabular revision and tenotomy. The challenges of implant placement and positioning may be aided with intraoperative imaging through a DAA THA.

The hip flexor muscles are major contributors to lumbar spine stability. Tight hip flexors can lead to pain in the lumbar spine, and hence to an impairment in performance. Moreover, sedentary behavior is a common problem and a major contributor to restricted hip extension flexibility. Stretching can be a tool to reduce muscle tightness and to overcome the aforementioned problems. Therefore, the purpose of this systematic review with meta-analysis was to determine the effects of a single hip flexor stretching exercise on performance parameters. The online search was performed in the following three databases: PubMed, Scopus, and Web of Science. Eight studies were included in this review with a total of 165 subjects (male: 111; female 54). In contrast to other muscle groups (e.g., plantar flexors), where 120 s of stretching likely decreases force production, it seems that isolated hip flexor stretching of up to 120 s has no effect or even a positive impact on performance-related parameters. A comparison of the effects on performance between the three defined stretch durations (30–90 s; 120 s; 270–480 s) revealed a significantly different change in performance (p = 0.02) between the studies with the lowest hip flexor stretch duration (30–90 s; weighted mean performance change: −0.12%; CI (95%): −0.49 to 0.41) and the studies with the highest hip flexor stretch duration (270–480 s; performance change: −3.59%; CI (95%): −5.92 to −2.04). Meta-analysis revealed a significant (but trivial) impairment in the highest hip flexor stretch duration of 270–480 s (SMD effect size = −0.19; CI (95%) −0.379 to 0.000; Z = −1.959; p = 0.05; I2 = 0.62%), but not in the lowest stretch duration (30–90 s). This indicates a dose-response relationship in the hip flexor muscles. Although the evidence is based on a small number of studies, this information will be of great importance for both athletes and coaches.

Aims Iliopsoas pathology is a relatively uncommon cause of pain following total hip arthroplasty (THA), typically presenting with symptoms of groin pain on active flexion and/or extension of the hip. A variety of conservative and surgical treatment options have been reported. In this retrospective cohort study, we report the incidence of iliopsoas pathology and treatment outcomes. Methods A retrospective review of 1,000 patients who underwent THA over a five-year period was conducted, to determine the incidence of patients diagnosed with iliopsoas pathology. Outcome following non-surgical and surgical management was assessed. Results In all, 24 patients were diagnosed as having developed symptomatic iliopsoas pathology giving an incidence of 2.4%. While the mean age for receiving a THA was 65 years, the mean age for developing iliopsoas pathology was 54 years (28 to 67). Younger patients and those receiving THA for conditions other than primary osteoarthritis were at a higher risk of developing this complication. Ultrasound-guided steroid injection/physiotherapy resulted in complete resolution of symptoms in 61% of cases, partial resolution in 13%, and no benefit in 26%. Eight out of 24 patients (who initially responded to injection) subsequently underwent surgical intervention including tenotomy (n = 7) and revision of the acetabular component (n = 1). Conclusion This is the largest case series to estimate the incidence of iliopsoas pathology to date. There is a higher incidence of this condition in younger patients, possibly due to the differing surgical indications. Arthoplasty for Perthes' disease or developmental dysplasia of the hip (DDH) often results in leg length and horizontal offset being increased. This, in turn, may increase tension on the iliopsoas tendon, possibly resulting in a higher risk of psoas irritation. Image-guided steroid injection is a low-risk, relatively effective treatment. In refractory cases, tendon release may be considered. Patients should be counselled of the risk of persisting groin pain when undergoing THA. Cite this article: Bone Joint J 2021;103-B(2):305–308.

A 27-year-old man with a past medical history of Crohn's disease presented in the Emergency Department complaining of right hip pain that has been going on for one month. At presentation, the patient was tachycardic. Physical examination revealed a positive psoas sign. Laboratory tests showed elevated white blood cells, C-reactive protein, and erythrocyte sedimentation rate. Computed tomography of the abdomen and pelvis revealed ileo-psoas fistula and psoas abscess. This rare case aims to provide awareness that intra-abdominal pathology should always be suspected in patients with referred hip pain and Crohn's disease. A thorough physical examination including maneuvers for assessment of possible iliopsoas inflammation should be effectively performed at the bedside to determine the likelihood of the condition and proper imaging should follow to confirm the diagnosis.

Introduction The modified Thomas Test (MTT) is a method of assessing flexibility of the iliopsoas, rectus femoris and tensor fascia Latae. The aim of this study is to identify the intraand inter-rater reliability of the pass/fail scoring for the Modified Thomas Test (MTT) using digital photographs. Methods Six raters varying between 1-13years of clinical experience were used to review digital photographs of 20 semi-professional rugby players performing the /MTT. Raters were asked to score each muscle of the MTT either with 0 (fail) or 1 (pass). Digital photographs were allocated in a randomized order. Each rater reviewed each photograph three times at two week intervals. Results Cronbach's alpha (Cα) revealed a mean result of high reliability for both iliopsoas (Cα = 0.95) and rectus femoris (Cα = 1.00) flexibility. TFL flexibility values ranged from 0.64- 0.95, demonstrating some inconsistencies within some of the 6 raters. Fleiss kappa (Fк) revealed a high mean reliability result across the 3 testing sessions for both iliopsoas (Fк = 0.78) and rectus femoris (Fк = 0.80) flexibility, along with a moderate reliability mean result for TFL (Fк = 0.56). Conclusion High intra and inter rater reliability was found for iliopsoas and rectus femoris flexibility with those for TFL found to be moderately reliable.

Psoas muscle hematoma is defined as a spontaneous or traumatic retroperitoneal collection of blood involving the psoas muscle. Early symptoms of an iliopsoas hematoma include lower abdominal or severe groin pain. Although psoas hematoma is a known complication of coagulopathy, psoas hematoma caused by non-penetrating trauma is the subject of only scattered reports and its significance has not been well described in the literature, so the aim of this study was to report a case of blunt traumatic psoas hematoma with the fracture of vertebral transverse process with the presentation of gross hematuria. A 65-year-old Iranian man slipped backward to the ground, and the patient complaint of gross hematuria and difficulty in walking. There was severe left costo-vertebral angle (CVA) tenderness, and mild groin tenderness, and the lower back area was painful, and he had some pain with the flexion of the vertebral column, and there was tenderness on lumbar spine, but there was no tingling, paresthesia, and weakness in left lower extremity. Hip flexion was 3/5 in the left lower. We used some diagnostic modalities as x-ray radiography, ultrasonography, computed tomography (CT) scan with intravenous (IV) contrast, CT cystography, and intravenous pyelogram (IVP) IVP to differentiate the diagnoses and also find skeletal and other organ injuries associated with this kind of injury. We can conclude that post-traumatic psoas hematoma is a rare condition. The diagnostic modality of choice is CT scan which allows rapid identification and measurement of the hematoma. The lesion usually treated with non-operative conservative management.

Background: lower cross syndrome results from muscle strength imbalance in the lower segment. It ischaracterized by specific pattern of muscle weakness and tightness that cross between the dorsal and ventralsides of the body. In lower-crossed syndrome, the patient typically has anterior pelvic turn, elevated lumbarlordosis (swayback), and weak abdominal muscles. Inaction may also have a detrimental effect on themechanics of the body, such as immobilization, disuse or excessive postural discomfort, such as sitting atthe workstation for long periods of time and poor posture .It also involves tightness of the iliopsoas, rectusfemoris, fascia lata tensor, adductor group, gastrocnemius, and soleus. Pressure biofeedback device is usedfor the purpose of measuring and treating the transverse abdominis muscle. This study is needed becauseover time due to prolonged daily activities and lack of regular exercises in young people, this leads to muscleimbalance which leads to low back pain in this population. The goal of the study is to screen for lower crosssyndrome in asymptomatic individual.Aim and objective: To screen for lower cross syndrome in asymptomatic individual. Materials andMethods: Based on the inclusion and exclusion criteria, 300 individuals will be included in the study andthe respective evaluation procedure for lower cross syndrome will be carried out.Result: The expected results would include the data about whether lower cross syndrome would be detectedin the asymptomatic individuals. Data will be analyzed using paired T-test.Conclusion: based on the previous data of test and assessment we assume it will be beneficial in relievingthe symptoms of lower cross syndrome.

Background: Muscle length is defined as the length at which the maximum amount of force a muscle isable to produce. This length is determined by the joint angle corresponding to that muscle. Understandingthe optimal muscle length as well as its comparison between the extremities is very important as a partof examination in physiotherapy, particularly in the cases of musculoskeletal disorders. Several tests areavailable for testing the muscle length. However standardize and reliable tests have been chosen to preventthe error while testing. Many studies have shown that there was difference in the lengths of muscle of lowerextremity which was assessed in different players. However there is paucity of study on the muscle lengthof individuals who are completely normal and not the athletes.Objectives: The objective of this study is comparison between the length of iliopsoas, hamstring,gastrocnemius, rectus femoris in dominant to non-dominant extremity in young asymptomatic individualsaged between 18-25 years.Methods: Measurement of hamstring, iliopsoas, rectus femoris and gastrocnemius length will be acquiredthrough standard goniometer. The methods of assessment that will be used are; active knee extension (AKE)tests the hamstrings, Thomas and modified Thomas test to evaluate iliopsoas and rectus femoris while prone,figure-four position accompanied by dorsiflexion for gastrocnemius.Results: Once the study is completed, the parameters of outcome measure will be statistically analyzed andcalculated.Conclusion: Based on the previous data we assume that there can be a significant difference between themuscle lengths of lower limb in normal person.

The diagnosis of facioscapulohumeral muscular dystrophy (FSHD) can be challenging in patients not displaying the classical phenotype or with atypical clinical features. Despite the identification by magnetic resonance imaging (MRI) of selective patterns of muscle involvement, their specificity and added diagnostic value are unknown. We aimed to identify the radiological features more useful to distinguish FSHD from other myopathies and test the diagnostic accuracy of MRI. A retrospective cohort of 295 patients (187 FSHD, 108 non-FSHD) studied by upper and lower-limb muscle MRI was analyzed. Scans were evaluated for the presence of 15 radiological features. A random forest machine learning algorithm was used to identify the most relevant for FSHD diagnosis. Different patterns were created by their combination and diagnostic accuracy of each of them was tested. The combination of trapezius involvement and bilateral subscapularis muscle sparing achieved the best diagnostic accuracy (0.89, 95% Confidence Interval [0.85–0.92]) with 0.90 [0.85–0.94] sensitivity and 0.88 [0.80–0.93] specificity. This pattern correctly identified 91% atypical FSHD patients of our cohort. The combination of trapezius involvement, bilateral subscapularis and iliopsoas sparing and asymmetric involvement of upper and lower-limb muscles was pathognomonic for FSHD, yielding a specificity of 0.99 [0.95–1.00]. We identified MRI patterns that showed a high diagnostic power in promptly discriminating FSHD from other muscle disorders, with comparable performance irrespective of typical or atypical clinical features. Upper girdle in addition to lower-limb muscle imaging should be extensively implemented in the diagnostic workup to support or exclude a diagnosis of FSHD.

International audience; Purpose: Spinal muscles are a major component of posture in spinal pathologies and changes to the spine with aging. Specifically, spinopelvic muscles may compensate for underlying anomalies such as pelvic retroversion, knee flexion, and cervical or thoracic spinal balance abnormalities. To increase understanding between muscular characteristics and compensatory mechanisms, this study aimed to compare the volume of spinopelvic muscles in adults with a spinal deformity (ASD) to a control group of well-aligned adult subjects.Methods: Twenty-eight lumbar ASD patients [Cobb angle > 20°, > 40 years old (yo)] were prospectively included and compared to 35 normal subjects divided into 2 different groups: one group of young (Y) subjects (n = 23, 40 yo). All subjects had a fat/water separation MRI (from C7 to the knees). Volumetric 3D reconstructions of 30 spinopelvic muscles were performed and muscles volumes were compared.Results: Mean age was 60 ± 16 yo, without significant differences between the ASD and O groups (57 ± 11 yo). Age and BMI were smaller in the young group. Mean Cobb angle of the ASD group was 45 ± 11°. Comparing the ASD and O groups, total muscular volume was similar; however, erector spinae (0.24 ± 0.06 vs 0.68 ± 0.08 dm3, p = 0.001), iliopsoas (0.49 ± 0.09 vs 0.60 ± 0.09 dm3, p = 0.001) and obliquus (0.42 ± 0.08 vs 0.50 ± 0.08 dm3, p = 0.02) were significantly smaller in the ASD group. Comparing the Y and the ASD groups, total muscular volume was higher in the Y group than the ASD group (+ 3.3 dm3, p = 0.003) and erector spinae (0.24 ± 0.06 vs 0.74 ± 0.08, p = 0.0001), gluteus medius (0.51 ± 0.07 vs 0.62 ± 0.13, p = 0.01) and vastus lateralis (1.33 ± 0.21 vs 2.08 ± 0.29, p = 0.001) were significantly bigger in the Y group.Conclusion: This is the first study to compare volume of spinopelvic muscles between ASD patients and a control group without spinal deformity. Our results demonstrate that muscular degeneration has a double origin: aging and deformity. Erector spinae, iliopsoas, and obliquus are the muscles most affected by degeneration.

Iliopsoas tendon impingement after hip arthroplasty is a possible cause of painful hip and must always be considered in the differential diagnosis. In these cases, arthroscopic treatment has proven to be safe, guaranteeing superior results compared to open surgery. In this chapter Authors debate the topic of impingement of iliopsoas starting from its etiology up to arthroscopic treatment.

Background Iliopsoas hematoma occasionally occurs in patients receiving anticoagulation therapy. It may be a life-threatening complication and can cause disseminated intravascular coagulation, which could develop into abdominal compartment syndrome. The incidence of and factors associated with iliopsoas hematoma during venovenous extracorporeal membrane oxygenation (ECMO) have not been well studied. Objectives To describe the incidence of iliopsoas hematoma and associated factors among patients undergoing venovenous ECMO. Methods A retrospective cohort study was conducted at Nippon Medical School Hospital from April 2015 to October 2018. All patients (>18 years old) with iliopsoas hematoma received a diagnosis based on computed tomography. Results During the study period, 54 patients were supported with venovenous ECMO. Iliopsoas hematoma occurred in 8 of those patients (15%), none of whom had disseminated intravascular coagulopathy or abdominal compartment syndrome develop. Univariate analysis indicated that management of ECMO while the patient was awake and mobilization beyond sitting on the edge of the bed were significantly different (P < .05) in patients with and patients without iliopsoas hematoma. Mortality, however, did not differ significantly between the 2 groups. Conclusions Our findings emphasize that recognizing factors associated with iliopsoas hematoma and detecting them early are crucial during venovenous ECMO in order to treat patients with iliopsoas hematoma appropriately.

Internal snapping hip is a common clinical condition and is usually asymptomatic, but in few cases, mostly in athletes and professionals who participate in activities requiring extreme ranges of hip motion, the snap may become painful (internal snapping hip syndrome—ISHS). Traditionally, the ISHS pathogenesis was described as a snapping of the tendon over the anterior femoral head or the iliopectineal ridge, but currently the pathological mechanism is considered multifactorial. Most patients respond well to conservative treatment, but in recalcitrant cases, surgery may be indicated. Arthroscopic iliopsoas fractional lengthening can be performed in the central compartment, peripheral compartment or at the tendon’s insertion on lesser trochanter. Better results have been reported with endoscopic iliopsoas tendon release compared with open techniques, which may be related to the treatment of concomitant intra-articular pathologies. Furthermore, endoscopic treatment showed fewer complications, decreased failure rate, and postoperative pain. Sub-spine impingement is an extra-capsular cause of femoroacetabular impingement (FAI) resulting in diminished hip range of motion and groin pain during hip flexion-based activities. Arthroscopic resection of the deformed AIIS, decompression of the sub-spine region, and treatment of concomitant FAI usually result in good clinical outcome. Calcific tendinitis of the rectus femoris (CTRF) is another underreported condition because it is usually self-limiting. Endoscopic treatment of CTRF is indicated for symptomatic cases recalcitrant to conservative treatment. Recently, arthroscopically assisted reduction of developmental dislocation of the hip (DDH) via medial approach has been developed with advantage of minimally invasive surgery. In this chapter, the endoscopic techniques are outlined.

This preliminary study has investigated the outcome of physiotherapy in 10 dogs affected by a primary lesion of the iliopsoas muscle and the potential effects of sex, age, and breed on recovery. Ten dogs with primary injury of the iliopsoas muscle were retrospectively included in this study. Dogs were submitted to a rehabilitation program, characterized by a multimodal approach, including physical therapies and modalities. After recovery, patients were submitted to a further support period of rehabilitation to promote muscle strengthening and limit injury recurrence during their return to normal functional and sports activity. Border collies were highly represented. The recovery of lameness occurred after a mean of 22.6 ± 14.7 (median 18) days with a median number of five sessions. None of the examined variables affected the recovery time, except for the border collie breed, which showed a significantly faster recovery time, however, there was no difference between the breeds with regard to the number of sessions. Multimodal rehabilitation therapy may promote lameness recovery of mild-to-moderate iliopsoas lesions within 3 weeks. This preliminary study reports a clinical approach and recovery of primary iliopsoas lesions, findings that can provide clinicians with useful prognostic information for dogs involved in sports activities.

This chapter reviews mechanical in-office procedures used to treat recalcitrant tendinopathy. The background and theorized mechanisms of actions are discussed. Details of the procedures are described in a step-wise fashion. This chapter may be used as a guide to learn the ideology behind as well as how to perform these procedures. Procedures discussed in this article include: high-volume image guided injection, mechanical tendon scraping, percutaneous needle tenotomy, percutaneous ultrasonic tenotomy, biceps tendon release, and iliopsoas tendon release.

BACKGROUND: The Bernese periacetabular osteotomy (PAO) is a widely used technique for the management of acetabular dysplasia and other hip deformities in adolescents and young adults. Originally, the approach was described with a release of both origins of the rectus femoris muscle(1). In the more recently described rectus-sparing approach, both heads remain attached(2,3). It has been proposed that this modification may decrease pain, ease postoperative rehabilitation, and avoid heterotopic ossifications, without limitations of the surgical overview. DESCRIPTION: Both the original and the rectus-sparing approach are modifications of the Smith-Petersen approach. The skin incision and further dissection remain identical in both approaches for the protection of the lateral femoral cutaneous nerve, the osteotomy of the anterior superior iliac spine (or takedown of the inguinal ligament), the exposure of the iliac fossa, and the medial retraction of the abdominal and iliopsoas muscles. In both variants, the further dissection traverses the iliopectineal bursa. In contrast to the original approach, in which the rectus muscle becomes part of the medial flap after releasing both heads, the rectus-sparing approach involves the undetached rectus muscle becoming part of the lateral flap while the medial flap includes the sartorius and iliacus-iliocapsularis muscles. The anterior capsule and deep structures can be accessed through the interval between the rectus femoris and iliopsoas muscles or lateral to the rectus muscle. The remaining surgical steps are again similar in both techniques. According to preference, the surgeon starts with the pubic osteotomy or with the ischial cut first, the latter avoiding additional bleeding from the pubic osteotomy. For the ischial osteotomy, the bone is accessed by making an anteroposterior tunnel between the medial capsule and the iliopsoas tendon anteriorly and between the medial capsule and the obturator externus muscle posteriorly. While the ischial osteotomy is an incomplete separation, the pubic osteotomy is a complete separation. It sections the superior pubic ramus medial to the iliopectineal eminence, in a somewhat oblique fashion. The third and fourth cuts are made in the iliac bone in such a way as to keep the posterior column intact. By connecting the posterior iliac and ischial cuts as the last osteotomy step, the acetabulum is freed and repositioned as needed. The aim of our cadaver dissection is primarily to describe part of the rectus-sparing approach and to test this modification for eventual disadvantages over the classic approach. The remaining steps of the procedure correspond to the approach as described earlier(1,4), appreciating that several modifications of the procedure are in use. ALTERNATIVES: Nonsurgical treatment may be an alternative in borderline dysplasia; however, it needs to be reconsidered and eventually changed to surgical treatment when symptoms persist or come back. Other current techniques for surgical treatment of adolescent and adult hip dysplasia include triple and rotational or spherical osteotomies(5-7). RATIONALE: The Bernese PAO is performed through a single incision. All cuts are performed from the inner side of the pelvis, avoiding interference with the vascularity of the acetabular and periacetabular bone, which mainly comes from the outside of the pelvis(8). The procedure needs minimal hardware for fixation, and partial weight-bearing can be allowed. The PAO provides a wide range of acetabular reorientation options. Wide capsulotomy and intra-articular procedures are possible, as well as additional femoral corrections. Childbirth via natural delivery is possible even after bilateral PAO(9). Nerve injuries can be guarded against with careful surgical execution of the osteotomies(4).

Background: Scoliosis cause changes in spinal alignment, mobility, flexibility rrecruitment of Paraspinal muscles and postural reflex mechanism. Ssubjects might have hump on one side of spine,functional difficulties, and pain in multiple regions of body, change in lung function, nerve compression,dysmenorrhea and constipation in severe curves. Some studies shows mood changes, depression,handicap and social involvement. Gradually it is becoming clear that if good non operative treatmentis given, only 1 in 25, or 0.1% cases may require surgery. Hence this study is aimed at effectiveness ofphysiotherapy on spinal mobility parameters.Methods: Study was conducted at Nizam’s institute of Medical sciences, department of Physiotherapy.13 adolescent idiopathic scoliotic subjects aged between 12 to 40 years were taken into the study.Subjects had curve specific exercise for 25 weeks. Outcomes measures include 1.spinal mobility(flexion, extension, left bending right bending), 2. Flexibility of pectorals, Iliopsoas and hamstringson both sides, 3. VAS (Visual analog scale) for pain, 4. Cobb angle for curve measurement.Change inVAS scores were significant (P

Introduction: Aim of this study was to describe the clinical outcomes of 16 patients with iliopsoas (IP) impingement after primary total hip arthroplasty (THA), treated with an arthroscopic tendon release. Methods: 16 patients (11 females/5 males), with a mean age of 57.8 ± 11.1 years (age at THA: 54.4 ± 11 years) and a diagnosis of IP impingement after primary THA, were treated with the Wettstein tenotomy. Preoperatively, every patient underwent a diagnostic ultrasonography guided peritendinous injection and a computed tomography (CT) scan. Every patient was clinically evaluated using WOMAC score. Subjective pain relief and active hip flexion strength were measured. Results: No complications related to arthroscopy were detected. Every cup was prominent with a mean axial overhang of 13 ± 4.8 mm (range 5–20 mm). At a mean follow-up of 27 ± 20.1 months (range 6–48 months), the WOMAC score was 83.7 ± 10.1 points. 13 patients out of 16 (81.3%) had a complete pain relief. 14 patients out of 16 (88%) regained full active hip flexion strength at the final follow-up. 1 patient was scheduled for cup revision after 6 months, due to persistent symptomatology. No demographic data or CT measurements about cup position statistically influenced the outcome. Conclusions: When preceded by an appropriate diagnosis, arthroscopic tenotomy proved safe and effective for IP impingement, regardless the magnitude of cup protrusion.

The central nervous system of humans and animals is able to modulate the activity in the spinal cord to achieve several locomotion behaviors. Previous neuromechanical models investigated the modulation of human gait changing selected parameters belonging to the CPGs (Central Pattern Generators) feedforward oscillatory structures or to the feedback reflex circuits. CPG-based models could replicate slow and fast walking by changing only the oscillation’s properties. On the other hand, reflex-based models could achieve different behaviors mainly through optimizations of a large dimensional parameter space, but could not identify effectively individual key reflex parameters responsible for the modulation of gait characteristics. This study, investigates which reflex parameters modulate the gait characteristics through neuromechanical simulations. A recently developed reflex-based model is used to perform optimizations with different target behaviors on speed, step length and step duration in order to analyse the correlation between reflex parameters and their influence on these gait characteristics. We identified 9 key parameters that influence the target speed ranging from slow to fast walking (0.48 and 1.71 m/s) as well as a large range of step lengths (0.43 and 0.88 m) and step duration (0.51, 0.98 s). The findings show that specific reflexes during stance have a major effect on step length regulation mainly given by the contribution of positive force feedback on the ankle plantarflexors’ group. On the other hand, stretch reflexes active during swing of iliopsoas and gluteus maximus regulate all the gait characteristics under analysis. Additionally, the results show that the stretch reflex of the hamstring’s group during landing phase is responsible for modulating the step length and step duration. Additional validation studies in simulations demonstrated that the identified reflexes are sufficient to modulate gait in human locomotion. Thus, this study provides an overview of the possible reflexes to control the gait characteristics.Author summary

Electromyography (EMG)-driven musculoskeletal modeling relies on high-quality measurements of muscle electrical activity to estimate muscle forces. However, a critical challenge for practical deployment of this approach is missing EMG data from muscles that contribute substantially to joint moments. This situation may arise due to either the inability to measure deep muscles with surface electrodes or the lack of a sufficient number of EMG electrodes. Muscle synergy analysis is a dimensionality-reduction approach to decompose a large number of muscle excitations into a small number of time-varying synergy excitations along with time-invariant synergy weights that define the contribution of each corresponding synergy excitation to a specific muscle excitation. This study evaluates how accurately missing muscle excitations can be predicted using synergy excitations extracted from muscles with available EMGs (henceforth called “synergy extrapolation”). The results were reported on a gait dataset collected from a stroke survivor walking on an instrumented treadmill at self-selected and fastest-comfortable speeds. The evaluation process started with full calibration of a lower-body EMG-driven model using 16-channel EMGs (including surface and indwelling) in each leg. One indwelling EMG (either iliopsoas or adductor longus) was then treated as unmeasured at a time. The synergy weights associated with the unmeasured muscle were predicted through solving a nonlinear optimization problem where the errors between inverse dynamics and EMG-driven joint moments were minimized. We also quantitatively evaluated how synergy analysis algorithms (principal component analysis (PCA) and non-negative matrix factorization (NMF)), EMG normalization methods, and number of synergies affect the accuracy of the predicted unmeasured muscle excitation. Synergy extrapolation performance was most influenced by the choice of synergy analysis algorithm and number of synergies. PCA with 5 or 6 synergies consistently predicted unmeasured muscle excitations most accurately and with greatest robustness to choice of EMG normalization method. Furthermore, the associated joint moment matching accuracy was comparable to that produced by the full EMG-driven calibration. The synergy extrapolation method described in this study may facilitate the assessment of human neuromuscular control and biomechanics in response to surgical or rehabilitation treatment when important EMG signals are missing.

The clinical diagnosis of femoral acetabular impingement (FAI) continues to evolve as the understanding of normal and pathological hips progresses. Femoral acetabular impingement is currently defined as a syndrome in which the diagnosis consists of the combination of a previously-obtained comprehensive clinical history, followed by a consistent and standardized physical examination with specific orthopedic maneuvers. Additionally, radiographic and tomographic examinations are used for the morphological evaluation of the hip, and to ascertain the existence of sequelae of childhood hip diseases and the presence of osteoarthritis. The understanding of the femoral and acetabular morphologies and versions associated with images of labral and osteochondral lesions obtained through magnetic resonance imaging (MRI) contributes to the confirmation of this syndrome in symptomatic patients, and helps in the exclusion of differential diagnoses such as iliopsoas tendon snaps, subspine impingement, ischiofemoral impingement, and other hip joint pathologies. Resumo O diagnóstico clínico do impacto femoroacetabular continua a evoluir conforme o entendimento dos quadris normal e patológico progride. Impacto femoroacetabular é atualmente definido como uma síndrome na qual o diagnóstico se baseia no somatório de uma história clínica abrangente obtida previamente, seguida de um exame físico coerente e padronizado com manobras ortopédicas específicas. Além disso, exames radiográficos e tomográficos são usados para a avaliação morfológica do quadril, e para verificar a existência de sequelas de doenças do quadril da infância e a presença de osteoartrose. O entendimento da morfologia e versão femoral e acetabular associado às imagens de lesões labrais e osteocondrais obtidas com a ressonância magnética contribuem para a confirmação da síndrome nos pacientes sintomáticos, além de auxiliar na exclusão de diagnósticos diferenciais, como ressalto do tendão do músculo iliopsoas, impacto subespinhal, impacto isquiofemoral, e outras patologias da articulação do quadril.

Purpose To perform a systematic review of biomechanical and clinical studies to determine whether the iliopsoas is a femoral head stabilizer. Methods A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Inclusion criteria were any human clinical (Levels I-IV evidence) or laboratory studies that investigated the role of the iliopsoas as a stabilizer of the hip. Exclusion criteria included studies that investigated patients undergoing spine surgery or those with a total hip arthroplasty or hip hemiarthroplasty. Study methodologic quality for clinical-outcomes studies were analyzed using the Modified Coleman Methodology Score. Because of the heterogeneity in the participants and interventions, no quantitative assimilative meta-analysis was performed. Results Eight articles were analyzed (3 biomechanical [35 cadavers and 18 healthy subjects]; 5 clinical outcomes studies [537 subjects, 207 arthroscopic iliopsoas tenotomies]). Two in vivo biomechanical studies identified the iliopsoas as an anterior hip stabilizer. One cadaveric study identified the iliopsoas as a femoral head stabilizer at 0o-15o of hip flexion. Two clinical studies demonstrated the role of the iliopsoas as a dynamic hip stabilizer, particularly in patients with increased femoral version (greater than 15˚-25˚). Two studies reported cases of atraumatic anterior hip dislocations after arthroscopic iliopsoas tenotomies. Conclusions Evidence from biomechanical and clinical studies may suggest that the iliopsoas is a dynamic anterior femoral head stabilizer. Level of Evidence Level IV, systematic review of Level III and IV plus biomechanical studies.

A correction to this paper has been published: https://doi.org/10.1007/s00402-021-03986-x

Purpose: To evaluate the technique, results and complications of arthroscopic iliopsoas tenotomies either on native hips or total hip arthroplasty (THA). Methods: A systematic review was performed using 3 databases: PubMed, EMBASE and the Cochrane library from January 2000 to December 2018 in accordance with the PRISMA procedure. The literature search, data extraction and quality assessment were conducted by 2 independent reviewers. Surgical technique, clinical outcomes, recurrences and complication rate were evaluated. Results: Out of 115 articles reviewed, 20 articles concerned native hips and 8 articles THA. 3 levels of release were described. For native hips, the recurrence rate was higher for central compartment than peripheral or lesser trochanter releases. Complication rates were similar for hip arthroscopy but remained low in all series. Loss of strength was evaluated mainly using the MRC muscle scale. Most studies noted strength recovery. MRI analysis of muscle atrophy was greater for lesser trochanter than for central compartment release but unrelated to loss of strength. The complication rate was low for tenotomy after THA, heterotopic ossification being the most common complication. Conclusions: Central compartment releases lead to the highest rate of recurrence due to incomplete release. Peripheral releases have a potential risk of vascular injury. The lesser trochanteric approach has the disadvantage of not having direct access to the joint. The main difficulty with THA lies in the diagnosis of cup/iliopsoas impingement. Diagnostic tests with infiltration should be made before iliopsoas release to prevent its failure. Cup protrusion of over 8mm is a potential indication for acetabular revision.