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Chetwood 49 first used the gluteus maximus muscle to support the rectum further reports were made by Shoemaker 50 , Bistrom 51 , Prochiantz 52 , Hentz 53 , Skef et al. 54 , and Holschneider 55 (Fig. 31.15). Skef et al. stated that the muscle normally functions as an accessory muscle of anal continence 54 . The coccygeal fibers of the gluteus are wrapped around the anal canal with its intact neu-romuscular bundle. The pull is direct and sling-like. Shoemaker 50 reported that six out of six patients became continent, but there have been only isolated reports since then (Fig. 31.16). Kucukaydin et al. recently presented 5 patients with gluteus maximus transplant who in the follow-up period showed no continence problems. Fig. 31.16 Patient with gluteus maximus transplant (reproduced from Holschneider 55 with permission of the publishers) in the relaxed condition (A) and contracted (B) Fig. 31.16 Patient with gluteus maximus transplant (reproduced from Holschneider 55 with permission of...
Cama et al. 16 outlined some of the typical features of this syndrome (1) cutaneous signs (such flattening of the buttock and shortening of the inter-gluteal cleft secondary to lumbosacral agenesis), (2) sacrococcygeal agenesis (partial or total), (3) skeletal deformities (vertebral, rib, or even lower-limb deformities, scoliosis with or without kyphosis, hip dislocation), (4) congenital heart defects (tetralogy of Fallot), (5) ARM, (6) genitourinary disorders (renal aplasia or dysplasia, whether unilateral or bilateral, vesicoureteral reflux, ureterocele, hypospadias and malformed external genitalia) and (7) pulmonary hypoplasia. ARM is considered a frequent finding with CRS 27-48 of published CRS series of cases were associated with ARM 16, 96 . ARM can be present in CRS in different forms, whether mild or severe.
We have far more muscular strength than we normally use. The gluteus maximus can generate 1,200 kg of tension, and all the muscles of the body can produce a total tension of 22,000 kg (nearly 25 tons). Indeed, the muscles can generate more tension than the bones and tendons can withstand a fact that accounts for many injuries to the patellar and cal-caneal tendons. Muscular strength depends on a variety of anatomical and physiological factors
If the fracture components are not impacted the usual clinical presentation is that of shortening and external rotation of the affected limb. This occurs as the adductors, hamstrings and rectus femoris pull upwards on the distal fragment whilst piriformis, the gemelli, obturators, gluteus maximus and gravity produce lateral rotation. The gluteal region is limited above by the iliac crest and below by the transverse skin crease the gluteal fold. The fold occurs as the overlying skin is bound to the underlying deep fascia and not, as is often thought, by the contour of gluteus maximus. The greater and lesser Muscles of the gluteal region include gluteus maximus, gluteus medius, gluteus minimis, tensor fasciae latae, piriformis, gemellus superior, gemellus inferior, obturator internus and quadratus femoris (see Muscle index, p. 164).
If the split between the gluteus maximus and medius is carried too far proximally, then the superior gluteal nerve can be damaged. This is the nerve supply to the gluteus medius and minimus, and tensor fascia lata. Damage to the nerve causes significant hip abductor weakness with resultant gait abnormalities.
It is difficult to get lost posteriorly with this approach, but if your split is entirely through the gluteus maximus, redirect it to the proper interval between the muscles. You will know you are too far posterior because you will have difficulty seeing the greater trochanter and the vastus lateralis origin. If you are too far anterior, you will again have trouble seeing the greater trochanter. Palpation should allow you to identify the location of the trochanter, so you can redirect your dissection. If you come in anterior to the tensor fascia in the interval between the tensor fascia and the sartorius, you will know it because the sartorius fibers are distinctive and the muscle is in a discrete tendon sheath. (This is not a problem as you are just doing an anterior approach.) The sartorius tends to be a round muscle, whereas the tensor fascia tends to be a triangular-shaped, flat muscle. FIGURE 30 3 The gap between those muscles is developed. Deep to the gluteus maximus, you will...
Niques with the gold standard of open surgical repair. Whatever modality is used, the underlying question should address whether any treatment is needed. For example, based on the natural history and rupture risk, most surgeons will consider treatment for an aneurysm of the abdominal aorta greater than 5 cm, but this decision may be modified in a high-risk patient. Similarly, an active middle-aged person with lifestyle-limiting buttock, and thigh claudication secondary to aortoiliac occlusive disease should be approached differently from an elderly patient who is bedridden.
Localisation The origin of the main pain should be clearly defined, is the pain coming truly from the back Couldn't it be buttock pain or loin pain If it is back pain, is lumbar spinal, sacral-spinal or lumbo-sacral spinal pain (Merskey et al., 1994). This precision is important since each condition suggests different diagnostics. If more than one pain is present, a link between them should not be presumed before a clear history has been drawn for each of them. If pain is clearly in the leg, could it be so
A Lawyer's Son in Fetter-lane, having eleven Fistu-laes in his Leg, and Thigh for about a Twelve-month, had been under the hands ofseveral Surgeons who at length despairing of his cure, let him off. The Boy calling to mind, that some fouryears before,I had cured him of two Ulcers in his Leg (for this accident was since, and hapned (sic) by a Contusion from a Cart-wheel, hurting his thigh and Leg, from whence afterwards Apostemations and Fistulaes were produced) desired his Father to send to me, I accordingly went but found him so discarned, that he was almost a Skeleton, having for twelve weeks been detained by a Diarrhaea. From his Ulcers, and Fis-tulaes flowed a filthy matter, stinking beyond all comparison, his Heel stuck to his Buttock, and his Knee disjoynted for the head of the Tibia met not with the Os Femoris (which overhung it) by above an Inch, the Ligaments being all eaten asunder, by the matter there contained. I told his Father, I had considered, the circumstances he lay...
Frequently, no distinction is made between postoperative pain, pain associated with the device, referred pain, pain related to stimulation, neuropathic pain and psychological pain. In one study, placement in the upper buttock reduced the rate of revision surgery but not pain 95 . The symptoms of pain should always be thoroughly analyzed in order to treat it. - Device complications such as pain at the implant site 22 , device rejection 143 , early pulse generator failure 147 , stimulation-dependent pain in leg or buttock 22 and current-related problems.
The dorsal surface of the sacrum is convex and irregular, with ridges and grooves. In the mid-line, there is the median sacral crest, consisting of three or four tubercles (rudimentary spinous process). At the inferior pole, the sacral hiatus is due to the failure of the fusion of the laminae of the fifth sacral vertebra. Laterally, the sacral crest just lateral to the sacral grooves comprises a row of four small tubercles representing the fusion of the articular processes. It forms the medial aspect of the posterior foramina. The lateral foramina correspond to the fusion of the transverse processes and are the site of insertion of the gluteus maximus muscle. The dorsal sacral foramina transmit the small dorsal rami of the sacral spinal nerves from the sacral canal to the deep back muscle compartment. The foramina are closed by a thin membrane. Small bony projections may be formed on the medial aspects of the foramina and are associated with muscle attachment points. The posterior...
A paper by Dyck (1999) summarizes the characteristic features it typically strikes elderly diabetic individuals between 36 and 76 years (median 65 years). The duration of diabetes has a median of 4.1 years (range 0-36 years), HbA1c has a median value of 7.5 (range 5-12). The CSF protein can be moderately elevated and a mild pleocytosis may occur. All except one patient of this series had type II diabetes. A clinical feature is severe weight loss before the neurologic disease. Pain is the dominant symptom, radiating into the hip or anterior thigh, and weakness and atrophy occur. Hip flexors, gluteal muscles, and quadriceps showed weakness, and adductors can be involved, demonstrating clearly that
For the superficial gluteal muscles, see figure 10.34. Figure 10.31 Deep Gluteal Muscles. For the superficial gluteal muscles, see figure 10.34. used to hang a ham for curing. They flex the knee and, aided by the gluteus maximus, they extend the hip during walking and running. The pit at the rear of the knee, called the popliteal fossa, is bordered by the biceps tendon on the lateral side and the tendons of the semimembranosus and semitendinosus on the medial side. When wolves attack large prey, they often attempt to sever the hamstring tendons, because this renders the prey helpless. Hamstring injuries are common among sprinters, soccer players, and other athletes who rely on quick acceleration.
The sacral plexus pain resembles sciatic nerve injury. Depending on the lesion of the sacral plexus, motor symptoms are concentrated in L5, S1, resulting in weakness of the sciatic nerve muscles. Proximal muscles that exhibit weakness include the gluteus maximus muscle, but the gluteus medius muscle is usually spared. Sensory symptoms may also involve proximal areas, such as the distributions for the pudendal nerve and the posterior cutaneous nerve of the thigh. Sphincter involvement can occur.
The internal iliac vein follows the course of the internal iliac artery and its distribution. Its tributaries drain the gluteal muscles the medial aspect of the thigh the urinary bladder, rectum, prostate, and ductus deferens in the male and the uterus and vagina in the female.
On the lateral side the fascia lata is condensed to form the iliotibial tract (Fig. 47.4). The tract is attached above to the iliac crest and receives the insertions of tensor fasciae latae and three-quarters of gluteus maximus. These muscles are also enveloped in deep fascia. The ili-otibial tract inserts into the lateral condyle of the tibia.
Admitted to hospital severely shocked, the whole of the right side of his pelvis and much musculature including the psoas and gluteal muscles were missing the urethra was torn across (Fig. 3.5). After resuscitation and surgery he developed various complications but ultimately walked with sticks. The second patient sustained a similar injury but avulsion took place at the hip joint, removing only part of the acetab-ulum and the ischium although the gluteal muscles were avulsed, there was no urethral injury. Wound contamination required a temporary colostomy he left hospital with a lower limb prosthesis after 3 months.
When you are fully bent over forward, as in touching your toes, the erector spinae is fully stretched. Because of the length-tension relationship explained in chapter 11, muscles that are stretched to such extremes cannot contract very effectively. Standing up from such a position is therefore initiated by the hamstring muscles on the back of the thigh and the gluteus maximus of the buttocks. The erector spinae joins in the action when it is partially contracted. Gluteus maximus Figure 10.17 Neck, Back, and Gluteal Muscles. The most superficial muscles are shown on the left, and the next deeper layer on the right. Erector spinae Gluteus medius Gluteus maximus Figure 10.17 Neck, Back, and Gluteal Muscles. The most superficial muscles are shown on the left, and the next deeper layer on the right. Standing too suddenly or improperly lifting a heavy weight, however, can strain the erector spinae, cause painful muscle spasms, tear tendons and ligaments of the lower back, and rupture...
The rate of isolation of these organisms varies in each infection entity (Table 4) (156). BLPB were present in 288 (44 ) of 648 patients with skin and soft tissue infections, 75 harbored aerobic and 36 had anaerobic BLPB. The infections in which BLPB were most frequently recovered were vulvovaginal abscesses (80 of patients), perirectal and buttock abscesses (79 ), decubitus ulcers (64 ), human bites (61 ) and abscesses of the neck (58 ). The predominant BLPB were Staphylococcus aureus (68 of patients with BLPB) and the B. fragilis group (26 ).
Fibers come from the lower part of the lumbosacral plexus, roots S1-3. The fibers descend together with the inferior gluteal nerve through the greater sciatic notch, below the piriformis muscle. A branch leaves to the perineum and scrotum. The sensory area includes the lower buttock, parts of the labia or scrotum, dorsal side of the thigh and proximal third of the calf. The autonomic field is a small area above the popliteal fossa. Paresthesias and numbness over the lower part of the buttock and posterior Symptoms thigh. Bicycle riding Colorectal tumors Fall on the buttocks Gymnastic exercises on buttocks Hemangiopericytoma Iatrogenic injection in buttock Ischemia of lower extremity Sedentary occupation Venous malformation Wounds of the dorsal thigh Fibers from L3 to S3 und S4 leave the pelvis through the sciatic foramen. The Anatomy nerve passes below the piriform muscle (or pierces it), into the gluteal region and moves first laterally, then caudally. It continues between the...
Trendelenburg's sign, indicating weakness of the hip abductors (gluteus medius muscle). A Standing on both feet the pelvis remains in horizontal position. B When the patient stands on his left leg, his pelvis tilts to the right side. This patient had a left gluteus medius nerve lesion, caused by an iliac aneurysm. Note that the greater gluteal muscles are not affected
The first case is a 42-year-old man with a history of 5 years of recurrent bipolar aphthosis, skin pustulosis, ocular lesions, and articular involvement. After 3 years of remission, he developed large and extensive ulcerations on the legs, buttock, and back. Biopsy of the lesion showed vasculitis. Local treatment with injection of triamcinolone acetonide induced new ulcerations after each injection. Cyclosporin was the only successful treatment. He developed a central nervous system involvement secondary to cyclosporin.
The sacral plexus has nerves that provide genital innervation and also has motor nerves to the posterior hip, thigh, and anterior and posterior leg. The pudendal nerve innervates the penis and scrotum in males, the clitoris, labia, and distal vagina in females, and the muscles of the pelvic floor in both sexes. The sacral plexus also has the superior and inferior gluteal nerves that innervate the gluteal muscles and the tibial nerve and the common fibular nerve. These last two nerves are grouped together as the sciatic nerve, a large nerve of the posterior thigh. The tibial nerve innervates the hamstring muscles, the muscles of the calf, and the muscles originating on the foot. The common fibular nerve innervates the short head of the biceps femoris muscle, the muscles on the lateral side of the leg and the anterior surface of the leg. Cutaneous branches innervate the skin and muscular branches take motor information to the muscles. Label these nerves and color them in.
In this infant who was a breech presentation note the edema, bruising, and ecchymosis. In breech presentations the perineum, buttocks, and thighs may be severely bruised. Figure 4.29. This infant is another example of a breech presentation. Note the extended legs and the equivalent of a caput over the right buttock, which was the presenting part.
Discoloration with gangrene of the right buttock following umbilical artery catheter placement. Figure 7.43. Discoloration with gangrene of the right buttock following umbilical artery catheter placement. Figure 7.44. The same infant 10 days later showed marked improvement of the buttock. Figure 7.44. The same infant 10 days later showed marked improvement of the buttock. Figure 7.45. Gangrene of the left buttock following umbilical artery catherization. The umbilical artery catheter was positioned in the iliac artery radiographical-ly. There is a well-known association between injection of medications into the umbilical artery and necrosis and gangrene of the buttock and sciatic nerve palsy. Figure 7.46. The same infant with unilateral gangrene of the buttock also had a sciatic nerve palsy as a result of the umbilical catheter being positioned in the iliac artery. Note the foot drop. Figure 7.46. The same infant with unilateral gangrene of the buttock also had a sciatic...
A careful history and physical examination will frequently provide the clinician with considerable information. In general, risk factors for aortoiliac occlusive disease parallel those seen for other atherosclerotic lesions (elderly, male, diabetes, hypertension, tobacco abuse). In contrast, however, nearly half of all patients with limited, localized aortoiliac disease are women. Women patients tend to have more focal disease, are active smokers and present at a younger age than their male counterparts. Male patients are somewhat older and tend to have diffuse atherosclerotic disease. Patients with localized, segmental disease typically present with varying degrees of claudication. Frequently, this may involve the proximal thigh, buttock or hip. The classic Leriche syndrome describes the patient with thigh or buttock claudication associated with impotence, wasting of the thigh musculature and diminution of the femoral pulses. However, as mentioned previously, many of these patients...
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