Strain Assessment of Deep Fascia of the Thigh During Leg Movement
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Iliopsoas Tendonitis/Bursitis Exercises
ILIOPSOAS TENDONITIS / BURSITIS What is the Iliopsoas and Bursa? The iliopsoas is a muscle that runs from your lower back through the pelvis to attach to a small bump (the lesser trochanter) on the top portion of the thighbone near your groin. This muscle has the important job of helping to bend the hip—it helps you to lift your leg when going up and down stairs or to start getting out of a car. A fluid-filled sac (bursa) helps to protect and allow the tendon to glide during these movements. The iliopsoas tendon can become inflamed or overworked during repetitive activities. The tendon can also become irritated after hip replacement surgery. Signs and Symptoms Iliopsoas issues may feel like “a pulled groin muscle”. The main symptom is usually a catch during certain movements such as when trying to put on socks or rising from a seated position. You may find yourself leading with your other leg when going up the stairs to avoid lifting the painful leg. The pain may extend from the groin to the inside of the thigh area. Snapping or clicking within the front of the hip can also be experienced. Do not worry this is not your hip trying to pop out of socket but it is usually the iliopsoas tendon rubbing over the hip joint or pelvis. Treatment Conservative treatment in the form of stretching and strengthening usually helps with the majority of patients with iliopsoas bursitis. This issue is the result of soft tissue inflammation, therefore rest, ice, anti- inflammatory medications, physical therapy exercises, and/or injections are effective treatment options. -
Plantar Fascia-Specific Stretching Program for Plantar Fasciitis
Plantar Fascia-Specific Stretching Program For Plantar Fasciitis Plantar Fascia Stretching Exercise 1. Cross your affected leg over your other leg. 2. Using the hand on your affected side, take hold of your affected foot and pull your toes back towards shin. This creates tension/stretch in the arch of the foot/plantar fascia. 3. Check for the appropriate stretch position by gently rubbing the thumb of your unaffected side left to right over the arch of the affected foot. The plantar fascia should feel firm, like a guitar string. 4. Hold the stretch for a count of 10. A set is 10 repetitions. 5. Perform at least 3 sets of stretches per day. You cannot perform the stretch too often. The most important times to stretch are before taking the first step in the morning and before standing after a period of prolonged sitting. Plantar Fascia Stretching Exercise 1 2 3 4 URMC Orthopaedics º 4901 Lac de Ville Boulevard º Building D º Rochester, NY 14618 º 585-275-5321 www.ortho.urmc.edu Over, Please Anti-inflammatory Medicine Anti-inflammatory medicine will help decrease the inflammation in the arch and heel of your foot. These include: Advil®, Motrin®, Ibuprofen, and Aleve®. 1. Use the medication as directed on the package. If you tolerate it well, take it daily for 2 weeks then discontinue for 1 week. If symptoms worsen or return, then resume medicine for 2 weeks, then stop. 2. You should eat when taking these medications, as they can be hard on your stomach. Arch Support 1. -
Pelvic Anatomyanatomy
PelvicPelvic AnatomyAnatomy RobertRobert E.E. Gutman,Gutman, MDMD ObjectivesObjectives UnderstandUnderstand pelvicpelvic anatomyanatomy Organs and structures of the female pelvis Vascular Supply Neurologic supply Pelvic and retroperitoneal contents and spaces Bony structures Connective tissue (fascia, ligaments) Pelvic floor and abdominal musculature DescribeDescribe functionalfunctional anatomyanatomy andand relevantrelevant pathophysiologypathophysiology Pelvic support Urinary continence Fecal continence AbdominalAbdominal WallWall RectusRectus FasciaFascia LayersLayers WhatWhat areare thethe layerslayers ofof thethe rectusrectus fasciafascia AboveAbove thethe arcuatearcuate line?line? BelowBelow thethe arcuatearcuate line?line? MedianMedial umbilicalumbilical fold Lateralligaments umbilical & folds folds BonyBony AnatomyAnatomy andand LigamentsLigaments BonyBony PelvisPelvis TheThe bonybony pelvispelvis isis comprisedcomprised ofof 22 innominateinnominate bones,bones, thethe sacrum,sacrum, andand thethe coccyx.coccyx. WhatWhat 33 piecespieces fusefuse toto makemake thethe InnominateInnominate bone?bone? PubisPubis IschiumIschium IliumIlium ClinicalClinical PelvimetryPelvimetry WhichWhich measurementsmeasurements thatthat cancan bebe mademade onon exam?exam? InletInlet DiagonalDiagonal ConjugateConjugate MidplaneMidplane InterspinousInterspinous diameterdiameter OutletOutlet TransverseTransverse diameterdiameter ((intertuberousintertuberous)) andand APAP diameterdiameter ((symphysissymphysis toto coccyx)coccyx) -
The Cyclist's Vulva
The Cyclist’s Vulva Dr. Chimsom T. Oleka, MD FACOG Board Certified OBGYN Fellowship Trained Pediatric and Adolescent Gynecologist National Medical Network –USOPC Houston, TX DEPARTMENT NAME DISCLOSURES None [email protected] DEPARTMENT NAME PRONOUNS The use of “female” and “woman” in this talk, as well as in the highlighted studies refer to cis gender females with vulvas DEPARTMENT NAME GOALS To highlight an issue To discuss why this issue matters To inspire future research and exploration To normalize the conversation DEPARTMENT NAME The consensus is that when you first start cycling on your good‐as‐new, unbruised foof, it is going to hurt. After a “breaking‐in” period, the pain‐to‐numbness ratio becomes favourable. As long as you protect against infection, wear padded shorts with a generous layer of chamois cream, no underwear and make regular offerings to the ingrown hair goddess, things are manageable. This is wrong. Hannah Dines British T2 trike rider who competed at the 2016 Summer Paralympics DEPARTMENT NAME MY INTRODUCTION TO CYCLING Childhood Adolescence Adult Life DEPARTMENT NAME THE CYCLIST’S VULVA The Issue Vulva Anatomy Vulva Trauma Prevention DEPARTMENT NAME CYCLING HAS POSITIVE BENEFITS Popular Means of Exercise Has gained popularity among Ideal nonimpact women in the past aerobic exercise decade Increases Lowers all cause cardiorespiratory mortality risks fitness DEPARTMENT NAME Hermans TJN, Wijn RPWF, Winkens B, et al. Urogenital and Sexual complaints in female club cyclists‐a cross‐sectional study. J Sex Med 2016 CYCLING ALSO PREDISPOSES TO VULVAR TRAUMA • Significant decreases in pudendal nerve sensory function in women cyclists • Similar to men, women cyclists suffer from compression injuries that compromise normal function of the main neurovascular bundle of the vulva • Buller et al. -
Thieme: an Illustrated Handbook of Flap-Raising Techniques
4 Part 1 Flaps of the Upper Extremity Chapter 1 dyle are palpated and marked. A straight line is The Deltoid Fasciocutaneous Flap marked to connect these two landmarks. The groove between the posterior border of the del- toid muscle and the long head of triceps is pal- pated and marked. The intersection of these two lines denotes approximately the location of the vascular pedicle, as it emerges from under- The deltoid free flap is a neurovascular fascio- neath the deltoid muscle. This point may be cutaneous tissue, providing relatively thin sen- studied with a hand-held Doppler and marked sate tissue for use in soft-tissue reconstruction. if required. The deltoid fasciocutaneous flap was first de- Depending on the recipient area, the patient scribed anatomically and applied clinically by is positioned either supine, with the donor Franklin.1 Since then, the deltoid flap has been shoulder sufficiently padded with a stack of widely studied and applied.2–5 This flap is sup- towels, or in the lateral decubitus position. Myo- plied by a perforating branch of the posterior relaxants are required in muscular individuals, circumflex humeral artery and receives sensa- so as to ease retraction of the posterior border tion by means of the lateral brachial cutaneous of the deltoid muscle, especially if a long vascu- nerve and an inferior branch of the axillary lar pedicle is required for reconstruction. nerve. This anatomy is a constant feature, thus making the flap reliable. The ideal free deltoid Neurovascular Anatomy flap will be thin, hairless, of an adequate size, and capable of sensory reinnervation. -
Wound Classification
Wound Classification Presented by Dr. Karen Zulkowski, D.N.S., RN Montana State University Welcome! Thank you for joining this webinar about how to assess and measure a wound. 2 A Little About Myself… • Associate professor at Montana State University • Executive editor of the Journal of the World Council of Enterstomal Therapists (JWCET) and WCET International Ostomy Guidelines (2014) • Editorial board member of Ostomy Wound Management and Advances in Skin and Wound Care • Legal consultant • Former NPUAP board member 3 Today We Will Talk About • How to assess a wound • How to measure a wound Please make a note of your questions. Your Quality Improvement (QI) Specialists will follow up with you after this webinar to address them. 4 Assessing and Measuring Wounds • You completed a skin assessment and found a wound. • Now you need to determine what type of wound you found. • If it is a pressure ulcer, you need to determine the stage. 5 Assessing and Measuring Wounds This is important because— • Each type of wound has a different etiology. • Treatment may be very different. However— • Not all wounds are clear cut. • The cause may be multifactoral. 6 Types of Wounds • Vascular (arterial, venous, and mixed) • Neuropathic (diabetic) • Moisture-associated dermatitis • Skin tear • Pressure ulcer 7 Mixed Etiologies Many wounds have mixed etiologies. • There may be both venous and arterial insufficiency. • There may be diabetes and pressure characteristics. 8 Moisture-Associated Skin Damage • Also called perineal dermatitis, diaper rash, incontinence-associated dermatitis (often confused with pressure ulcers) • An inflammation of the skin in the perineal area, on and between the buttocks, into the skin folds, and down the inner thighs • Scaling of the skin with papule and vesicle formation: – These may open, with “weeping” of the skin, which exacerbates skin damage. -
Anatomy and Physiology of Erection: Pathophysiology of Erectile Dysfunction
International Journal of Impotence Research (2003) 15, Suppl 7, S5–S8 & 2003 Nature Publishing Group All rights reserved 0955-9930/03 $25.00 www.nature.com/ijir Chapter 2 Anatomy and Physiology of erection: pathophysiology of erectile dysfunction Reporters and participants of the 1st Latin American Dysfunction Consensus Meeting International Journal of Impotence Research (2003) 15, Suppl 7, S5–S8. doi:10.1038/sj.ijir.3901127 Anatomy deep dorsal vein, the circumflex veins, the emissary veins, the cavernous veins and the crural veins). The lacunar spaces drain into small venules, which flow The penis, the male genital organ, has two func- together into a subalbugineal plexus, which in turn, tions: sexual and urinary. It is located above the emerges as emissary veins4,5 (Figure 1). scrotum, and it is linked to the pubic symphysis by two ligaments. It has a three-cylinder shape, integrated by two CROSS-SECTIONAL SECTION OF THE PENIS vascular tissue bodies (corpora cavernosa) (CC) and Superficial dorsal vein the corpus spongiosum (CS). The CCs have two Dorsal artery of penis Dorsal nerve of portions: a fixed posterior one, or perineal, and one penis that is anterior or free. At its base, the ischiopubic Deep dorsal vein Colles’ fascia rami are fixed, surrounded by the ischiocavernous muscles. The CS, in turn, stems from the perineum, Buck’s fascia Circumflex Vein surrounded by the bulbocavernous muscle. The Corpus urethra runs most of its length. At the distal end, cavernosum Tunica albuginea the CS dilates into a structure known as glans, Cavernous artery where the urethra opens to the outside of the Corpus spongiosum Urethral artery body through the meatus.1,2 Urethra Adapted and Modified from the 2ndBrazilian Consensus on Erectile Dysfunction2 The penis has an epidermal layer, underneath which is located the superficial fascia (Colles’), Figure 1 Cross-sectional section of the penis. -
Skin Grafting for Penile Skin Loss
Demzik et al. Plast Aesthet Res 2020;7:52 Plastic and DOI: 10.20517/2347-9264.2020.93 Aesthetic Research Review Open Access Skin grafting for penile skin loss Alysen Demzik1, Charles Peterson2, Bradley D. Figler1 1Department of Urology, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599, USA. 2University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA. Correspondence to: Dr. Bradley D. Figler, Department of Urology, University of North Carolina-Chapel Hill, 2105 Physician’s Office Building, 170 Manning Drive, Chapel Hill, NC 27599, USA. E-mail: [email protected] How to cite this article: Demzik A, Peterson C, Figler BD. Skin grafting for penile skin loss. Plast Aesthet Res 2020;7:52. http://dx.doi.org/10.20517/2347-9264.2020.93 Received: 24 Apr 2020 First Decision: 11 Aug 2020 Revised: 1 Sep 2020 Accepted: 17 Sep 2020 Published: 12 Oct 2020 Academic Editor: Marlon E. Buncamper Copy Editor: Cai-Hong Wang Production Editor: Jing Yu Abstract Penile skin grafting is an effective technique for managing skin deficiency resulting from a variety of causes. A thorough understanding of penile anatomy and the pathophysiology of the underlying condition being treated are essential. We provide an overview of penile anatomy as well as the pathophysiology of conditions that may lead to penile skin deficiency, as a result of either the underlying condition or its management. The conditions discussed include lichen sclerosus, buried penis, hidradenitis suppurativa, lymphedema, necrotizing fasciitis, cancer, and trauma. We also discuss surgical technique for penile skin grafting with an emphasis on technical considerations unique to the penis. -
The Fascia Lata of the Thigh – More Than a “Stocking”: a Magnetic Resonance Imaging, Ultrasonography and Dissection Study
The Fascia Lata of the Thigh – More Than a “Stocking”: A Magnetic Resonance Imaging, Ultrasonography and Dissection Study. Willem Fourie. School of Anatomical Sciences, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa. Phone: +27 (0)11 763 6990. Fax: +27 (0)866 180 179. E-mail: [email protected] BACKROUND: Regional descriptions of the thigh mostly exclude detailed descriptions of the fascia lata and its relationships to underlying muscles. It is cursorily described as “a strong, dense, broad single layer of deep fascia investing the thigh muscles like a stocking”. This “stocking” contributes to increased compartment pressure when the muscles contract, aiding venous return. With recent growing understanding of the role of deep fascia, it seems like the fascia lata may not solely be for compartmentalisation, containment and aiding venous return. OBSERVATIONS: During dissections of cadaver thighs, we observed that the fascial relations to underlying muscles differ from textbook descriptions, forming a separate fascia covering some muscles, while acting as an epimysial cover to others in the same region. Furthermore, in an ultrasonography (US) pilot study, some regions of the upper thigh appeared as a triple layer of fascia covering muscles. Both these observations contradicted the general descriptions in literature. AIMS: 1. To investigate the above observations further. 2. Comparing dissection observations and living subjects using magnetic resonance imaging (MRI) and ultrasonography (US). METHODS: Detailed dissection of eight cadaver thighs compared to observations from MRI and US of four living subjects’ thighs. Observations were done at the same four levels on all the thighs. RESULTS: While vastus lateralis observations corresponded to textbook descriptions, US showed the fascia lata as a triple layer in places. -
Hamstring Muscle Injuries
DISEASES & CONDITIONS Hamstring Muscle Injuries Hamstring muscle injuries — such as a "pulled hamstring" — occur frequently in athletes. They are especially common in athletes who participate in sports that require sprinting, such as track, soccer, and basketball. A pulled hamstring or strain is an injury to one or more of the muscles at the back of the thigh. Most hamstring injuries respond well to simple, nonsurgical treatments. Anatomy The hamstring muscles run down the back of the thigh. There are three hamstring muscles: Semitendinosus Semimembranosus Biceps femoris They start at the bottom of the pelvis at a place called the ischial tuberosity. They cross the knee joint and end at the lower leg. Hamstring muscle fibers join with the tough, connective tissue of the hamstring tendons near the points where the tendons attach to bones. The hamstring muscle group helps you extend your leg straight back and bend your knee. Normal hamstring anatomy. The three hamstring muscles start at the bottom of the pelvis and end near the top of the lower leg. Description A hamstring strain can be a pull, a partial tear, or a complete tear. Muscle strains are graded according to their severity. A grade 1 strain is mild and usually heals readily; a grade 3 strain is a complete tear of the muscle that may take months to heal. Most hamstring injuries occur in the thick, central part of the muscle or where the muscle fibers join tendon fibers. In the most severe hamstring injuries, the tendon tears completely away from the bone. It may even pull a piece of bone away with it. -
Back of Thigh
Back of thigh Dr Garima Sehgal Associate Professor King George’s Medical University UP, Lucknow DISCLAIMER: • The presentation includes images which have been taken from google images or books. • The author of the presentation claims no personal ownership over these images taken from books or google images. • They are being used in the presentation only for educational purpose. Learning Objectives By the end of this teaching session on back of thigh – I all the MBBS 1st year students must be able to: • Enumerate the contents of posterior compartment of thigh • Describe the cutaneous innervation of skin of back of thigh • Enumerate the hamstring muscles • List the criteria for inclusion of muscles as hamstring muscles • Describe the origin, insertion, nerve supply & actions of hamstring muscles • Describe origin, course and branches of sciatic nerve • Write a short note on posterior cutaneous nerve of thigh • Write a note on arteries and arterial anastomosis at the back of thigh • Discuss applied anatomy of back of thigh Compartments of the thigh Cutaneous innervation of back of thigh 1 4 2 3 Contents of Back of thigh Muscles: Hamstring muscles & short head of biceps femoris Nerves: Sciatic nerve & posterior cutaneous nerve of thigh Arterial Anastomosis: The Posterior Femoral Cutaneous Nerve (n. cutaneus femoralis posterior) Dorsal divisions of – S1, S2 & Ventral divisions of S2, S3 Exits from pelvis through the greater sciatic foramen below the Piriformis. Descends beneath the Gluteus maximus with the inferior gluteal artery Runs down the back of the thigh beneath the fascia lata, to the back of the knee and leg Posterior Femoral Cutaneous Nerve contd…. -
L2 Hip Flexors | Iliopsoas
International Standards for the Classification of Spinal Cord Injury Motor Exam Guide Grades 0, 1 & 2 Patient Position: The shoulder is in neutral rotation, neutral flexion/extension, and adducted. The elbow is in full extension. The forearm is in full pronation and the wrist in neutral flexion- extension. The MCP joint is stabilized. An alternate position is with the shoulder in internal rotation, adducted, and neutral flexion/extension. The elbow is in 90° of flexion, the forearm and wrist are in neutral flexion /extension, and the MCP joint is stabilized. Examiner Position: Stabilize the dorsal wrist and hand by pressing down lightly on the back of the hand. Be sure that the MCP joints are stabilized to prevent hyperextension. Palpate the abductor digiti minimi muscle and observe the muscle belly for movement. Instructions to Patient: “Move your little finger away from your ring finger.” Action: The patient attempts to abduct the little finger through the full range of motion. T1 Common Muscle Substitution Finger extension can mimic 5th finger abduction. Proper positioning and stabilization will minimize this error. L2 Hip Flexors | Iliopsoas Grade 3 Patient Position: The hip is in neutral rotation, neutral adduction/abduction, with both the hip and knee in 15° of flexion. Examiner Position: Support the dorsal aspect of the distal thigh and leg. Do not allow flexion beyond 90° when examining acute thoraco-lumbar injuries due to the kyphotic stress placed on the lumbar spine. Instructions to Patient: “Lift your knee towards your chest as far as you can, trying not to drag your foot on the exam table.” Action: The patient attempts to flex hip to 90° of flexion.