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PubMed1996

Hematomas within the iliopsoas muscles in hemophilic patients: the Latin American experience.

The majority of bleeding episodes in patients who have hemophilia occur within the musculoskeletal system, primarily in the joints, but approximately 30% occur within the muscles. Iliopsoas muscle bleeding episodes are often large in volume, causing muscular function inhibition, angular deformities, and nerve involvement. Recurrent hemorrhages are common (14.2%) and neural involvement is as high as 37%. Three hundred patients are being observed in the authors' hemophilia center, 63 of whom have suffered 127 hemorrhages. Absolute bed rest and long term factor replacement are the mainstay of therapy. The experiences of physicians in other countries are appendixed to this article.

Hematoma↗

PubMed2003

Ultrasound-guided botulinum toxin injection technique for the iliopsoas muscle.

Intramuscular botulinum toxin A injections are beneficial for the treatment of functional shortening of the iliopsoas muscle, but it is difficult to achieve precise needle positioning and injection. As a solution to this we present an ultrasound-guided injection technique for the iliopsoas muscle using an anterior approach from the groin. The procedure was performed 26 times in 13 patients (seven males, six females; mean age 11 years, SD 9 years 8 months; age range 4 to 31 years), 10 times bilaterally. Indications were functional iliopsoas shortening due to cerebral palsy (17 hips), hereditary spastic paraplegia (four hips), and Perthes disease (five hips). In all cases the iliopsoas muscle was identified easily by ultrasound; the placement of the injection needle and injection into the site of interest were observed during real time. No complications were encountered. Botulinum toxin A (BTX-A) injections have become established as a standard procedure for the treatment of functional shortening of different muscles in persons with spasticity or dystonia (Kessler et al. 1999, Bakheit et al. 2001, Kirschner et al. 2001). Optimal needle placement is essential to avoid severe side effects and to assess lack of response to the drug or incorrect region of injection. While injection into superficial, very palpable muscles is quite easy, the approach to other muscles such as the iliopsoas muscle may be more difficult and the placement of the needle for an optimal injection site is harder to control. As a solution to this, we present an ultrasound-guided injection technique. The main indications for BTX-A injections in the iliopsoas muscle are dynamic hip flexion deformities mostly due to spastic conditions which may compromise walking (increased anterior pelvic tilt during the whole gait cycle, decreased hip extension at terminal stance, increased peak hip flexion during swing; Molenaers et al. 1999. Another indication might be decentration of the femoral head (as part of an injection programme which also includes other muscles like the adductors and the medial hamstrings) for pain relief, reducing care difficulties and, possibly, prevention of further decentration (Porta 2000, Foster et al. 2001, Deleplanque et al. 2002, Lubik et al. 2002). In Perthes disease, BTX-A injections in the iliopsoas muscle and the adductors may prevent a fixed deformity, which is a negative prognostic factor.

Adult↗

PubMed1997

Traumatic injury of the iliopsoas muscle in three dogs.

Three dogs with injuries of the iliopsoas muscle were examined. All dogs had a history of trauma. On physical examination, discomfort on hyperextension of the hip joints was detected. Palpation and stretching of the affected muscle by simultaneous internal rotation and extension of the hip joint elicited signs of pain. Abnormalities were not detected on pelvic radiography. On the basis of clinical signs and lack of radiographic abnormalities, a presumptive diagnosis of a strain injury of the iliopsoas muscle was made. Ultrasonography confirmed the presumptive diagnosis and provided further information about the location and extent of the injury. Traumatic injury to the iliopsoas muscle should be included as a differential diagnosis for lameness of the pelvic limb in dogs, and ultrasonography can be of value in the diagnosis of muscle injuries in dogs.

Animals↗

PubMedDate not supplied

CT-guided needle biopsy of deep pelvic lesions by extraperitoneal approach through iliopsoas muscle.

We report our experience with computed tomography (CT)-guided coaxial needle biopsy of deep pelvic lesions by an extraperitoneal approach through the iliopsoas muscle, using a curved needle for difficult-to-reach lesions. We reviewed the records of all patients with pelvic masses who underwent CT-guided percutaneous biopsy via iliopsoas muscle between January 1999 and December 2001. Direct anterior or posterior approach to the lesion was obstructed by bowel, bladder, vessels, or bones in all patients. An 18-gauge guide needle was advanced through the iliopsoas muscle and a 22-gauge Chiba needle was used to perform the biopsy. A custom-tailored curved 22-g needle was used in 17 procedures when the location of the iliac vessels and the slope of the iliac wing obstructed a straight path to the lesion. Fifty-three patients underwent 57 CT-guided needle biopsies during the study period. The lesions comprised obturator (n = 25), internal iliac (n = 11), anterior external iliac (n = 4), and common iliac nodes (n = 4); soft tissue masses along pelvic side-wall (n = 6); adnexal lesions (n = 5); a loculated fluid collection, and a perirectal node. All lesions were safely accessed, and major vessels and viscera were avoided in all cases. Of the 57 biopsies, 53 (93%) yielded diagnostic specimens. No major complications were encountered. CT-guided coaxial needle biopsy by an anterolateral approach through the iliopsoas muscle, with the use of a curved needle in selected cases is safe and effective for obtaining samples from deep pelvic lesions.

Adult↗

PubMed1994

[Pyomyositis of iliopsoas muscle with infection of renal cyst: a case report].

We report a case of pyomyositis of iliopsoas muscle with infection of renal cyst. A 50-year-old woman was admitted to our hospital complaining of left lumbago, and we suspected that she had a left ureteral stone at first. Ultrasonogram and intravenous pyelography showed bilateral multilocular renal cyst and enlargement of the left iliopsoas muscle. Finally she was diagnosed with left pyomyositis of iliopsoas muscle with infection of renal cyst by ultrasonogram, computerized tomography scan and magnetic resonance imaging. She had no complaints after she had received antibiotic therapy for a week.

Bacterial Infections↗

PubMed2002

Anticoagulant-related iliopsoas muscle bleeding leading to fatal exsanguination: report of two autopsy cases.

Two cases of massive iliopsoas muscle bleeding leading to fatal exsanguination are presented. Both patients (two women, 61 and 74 years old, respectively) received oral anticoagulation with phenprocoumon. The intramuscular bleeding occurred spontaneously in women of relatively good physical condition. Intriguingly, phenprocoumon concentrations were within the therapeutic range (1.55 microg/ml and 1.26 microg/ml, respectively) as detected by toxicologic analysis. These cases demonstrate that severe bleeding in the iliopsoas muscle has to be considered in all patients receiving anticoagulant medication, even in those who have coagulation parameters within the therapeutic range. Especially in older patients with a high degree of comorbidity or in patients receiving analgesic drugs, the potential of fatal outcome of iliopsoas muscle bleeding seems to be of clinicopathologic relevance.

Aged↗

PubMed1984

The iliopsoas muscle pedicle bone graft: an experimental study of femoral head vascularity after subcapital fractures and hip dislocations.

Distal iliopsoas muscle pedicle bone graft was investigated in dogs to determine whether a collateral blood supply to the femoral head can develop after displaced femoral neck fractures and dislocation of the hip joint. Microangiography performed in cadavers showed good vascularity of the muscle pedicle graft and similar studies in dogs showed that when transferred to the anterior femoral neck, the iliopsoas muscle pedicle graft healed with an ingrowth of vessels across the graft site. Microangiographic and histologic studies in dogs showed that the procedure could maintain the vascularity and viability of the grafted femoral head. Consequently, an iliopsoas muscle pedicle bone graft can provide a vascular supply to a compromised femoral head and may be applied in both the prevention and treatment of avascular necrosis of the injured femoral head.

Angiography↗

PubMed2004

[Pyogenic sacroiliitis complicated by iliopsoas muscle abscess].

Both pyogenic sacroiliitis and iliopsoas muscle abscess are uncommon infectious entities, and their coexinstence has been reported in very few patients. We present here the case of a woman who developed a large iliopsoas abscess as a consequence of a pyogenic sacroiliitis, initially misdiagnosed as a common sciatica and treated with corticosteroids. The patient was cured by the surgical drainage of the abscess and a long-lasting antibiotic treatment. We discuss diagnostic difficulties linked to the two infectious entities, their possible pathogenic connections, the role of imaging procedures, and therapeutic options. We conclude that pyogenic sacroiliitis and the potential evolution to an iliopsoas abscess must be taken into consideration in the differential diagnosis of lower back pain, especially if fever is a concomitant sign.

Aged↗

PubMed2003

Age-related changes of element contents in human tendon of the iliopsoas muscle and the relationships among elements.

To elucidate compositional changes of the tendons with aging, the authors investigated age-related changes of element contents in the tendon of the iliopsoas muscle by inductively coupled plasma-atomic emission spectrometry. The subjects consisted of 14 men and 14 women, ranging in age from 4 to 102 yr. The insertion tendons of the iliopsoas were removed from the cadavers after ordinary dissection and also surgically from patients with congenital dislocation of the hip. It was found that both Mg and P in the tendon of the iliopsoas muscle increased significantly with aging, but the other elements, such as S, Ca, Na, Zn, Fe, and Si, hardly changed with aging. With regard to the relationship among element contents, extremely significant correlations were found between P and S contents, between Mg and Na contents, and between S and Zn contents. In addition, very significant correlations were found between Si and either S or Zn contents. However, there was no significant correlation between Ca and P contents. These results revealed that with regard to age-related changes of element contents and the relationships among element contents, the tendon of the iliopsoas muscle was different from the Achilles tendon, in which both Mg and P decreased significantly with aging and there were significant correlations each other among the contents of S, Mg, and P.

Adolescent↗

PubMed1991

Abscess of the iliopsoas muscle diagnosed by magnetic resonance imaging and ultrasonography.

We have reported a case of abscess of the iliopsoas muscle, in which a limp and hip pain pointed toward pathology of the hip. The diagnosis in such cases may be difficult unless there is close attention to the clinical history and a good physical examination is obtained. One ultrasonographic examination of the hip in such a patient, subtle differences between the iliopsoas muscles should alert the radiologist to examine the psoas muscle. Ultrasonography is instrumental in demonstrating the solid or cystic nature of the iliopsoas mass, while MRI depicts the extent and proximity of adjacent organs. Once an iliopsoas abscess is diagnosed, treatment includes parenteral antibiotics and drainage.

Abscess↗

PubMed1979

Posterior iliopsoas muscle transfer in myelodysplasia.

A Sharrard posterior iliopsoas muscle-transfer procedure was done in forty-two hips of twenty-four children with myelodysplasia. Folow-up ranged from twenty-nine months to approximately ten years. An over-all success rate of 50 per cent was achieved which included all hips operated on for potential and existing instability. The success rate for surgery in hips with an existing instability was 29.6 per cent. Factors predisposing to a poor result were: age more than five years old, dysplastic acetabulum (index more than 30 degrees), prior hip surgery, and inequality of limb length. This operation is recommended primarily for hips not previously operated on in children less than five years old who have a normal acetabular index. If the child is more than five years old or if acetabular dysplasia exists, reconstruction of the acetabulum should precede or accompany the tendon transfer for best results. Iliopsoas muscle transfer is unlikely to be successful if used as a salvage procedure.

Acetabulum↗

PubMed1988

Complex repetitive discharges in the iliopsoas muscle.

A prospective electromyographic investigation of lower limb muscles in patients with different neurogenic disorders showed that complex repetitive discharges (CRD) were observed predominantly and often only in the iliopsoas muscle. Analysis of the EMG findings in acute and chronic lesions shows that CRD are a feature of a chronic proximal motor axon lesion. Furthermore, the frequently focal occurrence of CRD in the iliopsoas muscle in clinically distal diabetic polyneuropathies suggests that this muscle and its nerves represent a locus minoris resistentiae.

Acute Disease↗

PubMed1983

CT in idiopathic pyogenic myositis of the iliopsoas muscle. A report of 2 cases.

Pyogenic myositis of the iliopsoas muscle may occur as a primary clinical entity of an idiopathic nature, or more commonly secondarily to an adjacent disease process. We report 2 cases of idiopathic pyogenic infection caused by Staphylococcus aureus. This disease entity is rare in temperate climates. CT combined with clinical and biochemical information enabled the correct diagnosis, and appropriate treatment could thus be started.

Abscess↗

PubMed1997

Metric features of the iliopsoas muscle in late fetuses and adults.

Differences in structure of iliopsoas muscle were documented in studies performed on 12 human fetuses, aging 37 to 40 weeks of gestational life and on 20 adult individuals. Results of measurements performed on the muscle were compared between fetuses of the perinatal age and adult individuals. Indirectly, the comparison allowed to draw conclusions as to changes in the muscle structure which take place in between the two developmental stages. The process was monitoring applying the metric techniques of studies and statistical interpretation of the results.

Adult↗

PubMed1985

Iliopsoas muscles: MR study of normal anatomy and disease.

Magnetic resonance (MR) imaging was performed on 15 healthy subjects to define the appearance of the iliopsoas muscle and on 15 patients with iliopsoas disease. Seven patients had tumorous involvement of the muscles, five had inflammatory disease, one had retroperitoneal hemorrhage, one had iliopsoas bursitis, and one had bilateral hypertrophy. MR imaging permitted delineation of the muscles and depiction of the disease condition. Transverse MR images alone almost always provided the necessary data to determine the origin and extent of disease. Sagittal images were occasionally useful in defining the extension of disease into the spine. T1-weighted images provided optimal contrast between the muscles and adjacent tissues, while T2-weighted images were more useful for depicting disease within the muscles themselves.

Abscess↗

PubMedDate not supplied

[Usefulness of CT in the evaluation of hematoma of the iliopsoas muscle in hemophiliacs].

Four iliopsoas hematomas in hemophiliacs are reported, evaluating the diagnostic role of CT. The specificity of the method is stressed in showing the morphological and densitometric patterns, which allow to localize the hematoma, to state the originating structures, and to follow its evolution. Comparing the obtained results to those found in literature, the authors suggest the use of CT in any hemophiliac in which a retroperitoneal hematoma is suspected.

Adolescent↗

PubMed2003

[Impingement of the iliopsoas muscle after revision of a loosened acetabular cup with an acetabular reinforcement ring].

Impingement of the iliopsoas muscle due to a protruding acetabular component is an uncommon cause of pain after total hip arthroplasty. We report the case of a 59 year old female patient who developed groin pain one year after revision arthroplasty and reconstruction of the acteabular defect with an acetabular reinforcement ring due to a loosened cup. THERAPY AND FOLLOW UP: After revision of the right hip via an anterior approach we used bone cement to smooth the anterior edge of the acetabular reconstruction ring and created a smooth rim for the iliopsoas tendon. At follow up 2 years later the patient was satisfied with the result, she complained about very rare recurrent groin pain, without any need for further treatment.

Acetabulum↗

PubMed1997

[Post traumatic myositis ossificans of the iliopsoas muscle. Apropos of a case with review of the literature].

A case of traumatic myositis ossificans of the iliopsoas muscle in a 13 year old ballet dancer is presented. A history of multiple minor injuries to the region of the left hip in addition to the radiographic appearance of calcification were indicative of ectopic bone formation. The lesion was explored surgically because of the clinical symptoms of the coexistant femoral hernia as well as to obtain biopsy material to exclude a soft tissue tumor. Histological examination demonstrated the zoning effect of myositis ossificans with patterns varying from a cellular central zone to a peripheral one of fairly well oriented bone. The patient remains symptom-free and no radiographic evidence of recurrence was observed four years postoperatively.

Adolescent↗