DOCSLIB.ORG

The Pyramidalis–Anterior Pubic Ligament–Adductor Longus Complex (PLAC) and Its Role with Adductor Injuries: a New Anatomical Concept

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Pyramidalis–Anterior Pubic Ligament–Adductor Longus Complex (PLAC) and Its Role with Adductor Injuries: a New Anatomical Concept The pyramidalis-anterior pubic ligament-adductor longus complex (PLAC) and its role with adductor injuries a new anatomical concept Schilders, Ernest; Bharam, Srino; Golan, Elan; Dimitrakopoulou, Alexandra; Mitchell, Adam; Spaepen, Mattias; Beggs, Clive; Cooke, Carlton; Holmich, Per Published in: Knee Surgery, Sports Traumatology, Arthroscopy DOI: 10.1007/s00167-017-4688-2 Publication date: 2017 Document version Publisher's PDF, also known as Version of record Document license: CC BY Citation for published version (APA): Schilders, E., Bharam, S., Golan, E., Dimitrakopoulou, A., Mitchell, A., Spaepen, M., ... Holmich, P. (2017). The pyramidalis-anterior pubic ligament-adductor longus complex (PLAC) and its role with adductor injuries: a new anatomical concept. Knee Surgery, Sports Traumatology, Arthroscopy, 25(12), 3969-3977. https://doi.org/10.1007/s00167-017-4688-2 Download date: 08. Apr. 2020 Knee Surg Sports Traumatol Arthrosc DOI 10.1007/s00167-017-4688-2 HIP The pyramidalis–anterior pubic ligament–adductor longus complex (PLAC) and its role with adductor injuries: a new anatomical concept Ernest Schilders1,2,3 · Srino Bharam3,4 · Elan Golan5 · Alexandra Dimitrakopoulou2,6 · Adam Mitchell7 · Mattias Spaepen8 · Clive Beggs2 · Carlton Cooke9 · Per Holmich10,11 Received: 29 April 2017 / Accepted: 16 August 2017 © The Author(s) 2017. This article is an open access publication Abstract Results The pyramidalis is the only abdominal muscle Purpose Adductor longus injuries are complex. The anterior to the pubic bone and was found bilaterally in all confict between views in the recent literature and various specimens. It arises from the pubic crest and anterior pubic nineteenth-century anatomy books regarding symphyseal ligament and attaches to the linea alba on the medial border. and perisymphyseal anatomy can lead to difculties in MRI The proximal adductor longus attaches to the pubic crest and interpretation and treatment decisions. The aim of the study anterior pubic ligament. The anterior pubic ligament is also is to systematically investigate the pyramidalis muscle and a fascial anchor point connecting the lower anterior abdomi- its anatomical connections with adductor longus and rec- nal aponeurosis and fascia lata. The rectus abdominis, how- tus abdominis, to elucidate injury patterns occurring with ever, is not attached to the adductor longus; its lateral tendon adductor avulsions. attaches to the cranial border of the pubis; and its slender Methods A layered dissection of the soft tissues of the internal tendon attaches inferiorly to the symphysis with fas- anterior symphyseal area was performed on seven fresh-fro- cia lata and gracilis. zen male cadavers. The dimensions of the pyramidalis mus- Conclusion The study demonstrates a strong direct con- cle were measured and anatomical connections with adduc- nection between the pyramidalis muscle and adductor longus tor longus, rectus abdominis and aponeuroses examined. tendon via the anterior pubic ligament, and it introduces the 1 * Ernest Schilders Fortius Clinic, 17 Fitzhardinge Street, W1H 6EQ London, [email protected] UK 2 Srino Bharam School of Sport, Leeds Beckett University, Leeds, [email protected] West Yorkshire, UK 3 Elan Golan Orthopaedics, Lennox Hill Hospital, New York, NY, USA [email protected] 4 Mount Sinai School of Medicine, New York, NY, USA Alexandra Dimitrakopoulou 5 Orthopaedics, Maimonides Medical Center, Brooklyn, NY, USA [email protected] 6 The Wellington Hospital, The London Hip Arthroscopy Adam Mitchell Centre, London, UK [email protected] 7 Radiology, Fortius Clinic, London, UK Mattias Spaepen 8 [email protected] Radiology, GZA, Antwerpen, Belgium 9 Clive Beggs Leeds Trinity University, Leeds, West Yorkshire, UK [email protected] 10 Sports Orthopedic Research Center ‑ Copenhagen (SORC‑C), Carlton Cooke Department of Orthopedic Surgery, Copenhagen University [email protected] Hospital, Amager-Hvidovre, Copenhagen, Denmark 11 Per Holmich Aspetar Orthopaedic and Sports Medicine Hospital, Sports [email protected] Groin Pain Center, Doha, Qatar Vol.:(0123456789)1 3 Knee Surg Sports Traumatol Arthrosc new anatomical concept of the pyramidalis–anterior pubic books [4, 8, 13, 15–17, 22, 29, 33] and one cadaver study ligament–adductor longus complex (PLAC). Knowledge of in 2007 [25] which found the pyramidalis to be the only these anatomical relationships should be employed to aid abdominal muscle encountered anterior to the pubic in image interpretation and treatment planning with proxi- symphysis. mal adductor avulsions. In particular, MRI imaging should The pyramidalis muscles are paired and lie between the be employed for all proximal adductor longus avulsions to anterior surface of the rectus abdominis and the posterior assess the integrity of the PLAC. surface of the rectus sheath. The muscle exhibits a mixed fbre-type composition [18]. The function of the pyramidalis Keywords Adductor longus avulsions · Anterior pubic muscle is to tension the linea alba [8, 18] and stretch the ligament · Pyramidalis–anterior pubic ligament–adductor abdominal aponeurosis [17] to assist the rectus abdominis longus complex (PLAC) · Pyramidalis · Groin pain in so as to give greater power to the oblique and transverse athletes · Rectus abdominis · Adductor injuries · Groin muscles [4]. anatomy Adductor longus injuries are complex, and MRI inter- pretation can be difcult. The aim of the study is to sys- tematically investigate and describe the anatomy anterior to Introduction the pubic symphysis and pubic bones with special focus on the pyramidalis muscle and its anatomical connections with The symphyseal and perisymphyseal area has become of adductor longus and rectus abdominis, to elucidate injury increasing interest for hip surgeons, sports physicians and patterns occurring with adductor avulsions. radiologists dealing with hip impingement and complex pain The pyramidalis muscle is the only muscle lying anterior syndromes of the inguinal/adductor and lower abdominal to the pubic symphysis and pubic bones. The pyramidalis area. An anatomical explanation has been sought for ingui- muscle has a strong direct anatomical connection with the nal, adductor related and pubic pain experienced by athletes adductor longus. There is no signifcant connection between [32]. the rectus abdominis and the adductor longus. Several anatomy studies have been performed to examine the adductor tendons [11, 30, 31] and the connection with the distal rectus sheath [23, 25, 27]. Some studies suggest Materials and methods that a direct anatomical connection exists between the cau- dal rectus abdominis muscle and the proximal origin of the Dissection technique and observations adductor longus [6, 14, 19, 20, 34]. It has been the frst author’s clinical observation that ath- Two orthopaedic surgeons (ES, SB) with a vast experience letes with traumatic adductor longus avulsions often pre- in athletic groin injuries worked jointly to systematically sent with associated unilateral abdominal pain and lower dissect the anterior pubic soft tissues in seven fresh-frozen abdominal haematomas. When examined on MRI scans or cadaveric male pelvises [median age 67 years (60–79)]. intraoperatively, it is the frst author’s experience that in Standard surgical dissection techniques were used to per- such patients, it is the pyramidalis muscle, and not the rec- form a meticulous layer-by-layer dissection from the skin tus abdominis, that remains attached to the adductor longus down to the anterior pubic bone with macroscopic fndings preventing caudal and lateral retraction. discussed and reported. All specimens dissected included If correct, this fnding demonstrates that there is a direct the pelvis to mid-diaphyseal femur. The skin and subcuta- anatomical connection between the pyramidalis muscle and neous fat were excised from the level of anterior superior the adductor longus muscle, suggesting that the role of the iliac spines (ASIS) to mid-thigh exposing the anterior rec- pyramidalis in this type of injury may have been underes- tus sheath, external oblique fascia and fascia lata. Care was timated. The involvement of the pyramidalis in groin pain taken to preserve the integrity of the fbres of the individual or pubic-related pain in athletes has not previously been fascial plains. The linea alba was inspected for anatomical reported. Indeed, in a study reviewing 347 abdominal mus- variation (i.e. fat or cord-like). cle strains in professional baseball, no injuries to the pyrami- The fbre orientation of the anterior rectus sheath, exter- dalis were reported [7]. nal oblique fascia, anterior pubic ligament and fascia lata There are conficting views in the literature with regard was noted, with a window subsequently made in the anterior to the anatomical position of the rectus abdominis: several rectus fascia adjacent to the linea alba, allowing access to imaging and anatomy studies [6, 11, 20] reported the rec- the deeper fascia anterior to the pyramidalis muscle. The tus abdominis muscle to lie anterior to the pubic symphy- fbre orientation of this fascia was also recorded, with all sis. This description lies in direct contrast to the fndings such fascial fbre orientations noted based on orientation in of numerous eighteenth- and nineteenth-century anatomy a frontal plane. 1 3 Knee Surg Sports Traumatol Arthrosc The fascia was then completely excised from the level of signifcant. The rationale was to assess symmetry of the ASIS to mid-thigh
Load more

Recommended publications
  • Anterior Abdominal Wall (Continue)
    Anterior rami (T7 – L1) . T7-T11 called intercostal nerves. T12 called subcostal nerve. L1 through lumber plexus i.e. ilio inguinal & ilio hypogastric nerves T7……. Epigastrum T10……Umblicus L1…Above inguinal ligament & symphysis pubis. Arterial: Upper mid line: superior epigastric artery (internal thoracic artery). Lower mid line: inferior epigastric artery (external iliac artery). Flanks: supplied by branches from intercostal artery, lumbar artery & deep circumflex iliac artery. Venous: all venous blood collected into a plexus of veins that radiate from umbilicus toward: : Above : to lateral thoracic vein then to axillary vein. Below : to superficial epigastric & greater saphenous veins then to femoral vein. Lymphatic Of Anterior abdominal Wall: Above umbilicus : drain into anterior axillary lymph nodes. Below umbilicus: drain in to superficial inguinal nodes 1)External oblique muscle. 2) Internal oblique muscle. 3) Transversus abdominis 4)Rectus abdominis. 5) Pyramidalis. Origin: The outer surface of lower 8 ribs then directed forward & downward to its insertion. Upper four slip interdigitate with seratus anterior muscle. Lower four slip interdigitate with latissimus dorsi muscle . Insertions: As a flat aponeurosis into: * Xiphoid process. * Linea alba * Pubic crest. * Pubic tubercle. * Anterior half of iliac crest . Internal Oblique Muscle: Origin : * Lumber fascia * Anterior 2/3 of iliac crest. * Lateral 2/3 of inguinal ligament. Insertion: The fibers passes upward & foreword & inserted to lower 3 ribs & their costal cartilages, xiphoid process, linea alba & symphysis pubis. Conjoint Tendon: Form from lower tendon of internal oblique joined to similar tendon from transversus abdominis . Its is attached medially to linea alba ,pubic crest & pectineal line but has a lateral free border. The spermatic cord, as it passes below this muscle, it gains a muscular cover called " Cremaster muscle " which composed of muscle & fascia.
    [Show full text]
  • The Pyramidalis–Anterior Pubic Ligament–Adductor Longus Complex (PLAC) and Its Role with Adductor Injuries: a New Anatomical Concept
    The pyramidalis-anterior pubic ligament-adductor longus complex (PLAC) and its role with adductor injuries a new anatomical concept Schilders, Ernest; Bharam, Srino; Golan, Elan; Dimitrakopoulou, Alexandra; Mitchell, Adam; Spaepen, Mattias; Beggs, Clive; Cooke, Carlton; Holmich, Per Published in: Knee Surgery, Sports Traumatology, Arthroscopy DOI: 10.1007/s00167-017-4688-2 Publication date: 2017 Document version Publisher's PDF, also known as Version of record Document license: CC BY Citation for published version (APA): Schilders, E., Bharam, S., Golan, E., Dimitrakopoulou, A., Mitchell, A., Spaepen, M., Beggs, C., Cooke, C., & Holmich, P. (2017). The pyramidalis-anterior pubic ligament-adductor longus complex (PLAC) and its role with adductor injuries: a new anatomical concept. Knee Surgery, Sports Traumatology, Arthroscopy, 25(12), 3969- 3977. https://doi.org/10.1007/s00167-017-4688-2 Download date: 03. okt.. 2021 Knee Surg Sports Traumatol Arthrosc DOI 10.1007/s00167-017-4688-2 HIP The pyramidalis–anterior pubic ligament–adductor longus complex (PLAC) and its role with adductor injuries: a new anatomical concept Ernest Schilders1,2,3 · Srino Bharam3,4 · Elan Golan5 · Alexandra Dimitrakopoulou2,6 · Adam Mitchell7 · Mattias Spaepen8 · Clive Beggs2 · Carlton Cooke9 · Per Holmich10,11 Received: 29 April 2017 / Accepted: 16 August 2017 © The Author(s) 2017. This article is an open access publication Abstract Results The pyramidalis is the only abdominal muscle Purpose Adductor longus injuries are complex. The anterior to the pubic bone and was found bilaterally in all confict between views in the recent literature and various specimens. It arises from the pubic crest and anterior pubic nineteenth-century anatomy books regarding symphyseal ligament and attaches to the linea alba on the medial border.
    [Show full text]
  • Anatomy of Abdominal Incisions
    ANATOMY FOR THE MRCS but is time-consuming. A lower midline incision is needed for an Anatomy of abdominal emergency Caesarean section (where minutes may be crucial for baby and mother). The surgeon must also be sure of the pathol- incisions ogy before performing this approach. Close the Pfannenstiel and start again with a lower midline if the ‘pelvic mass’ proves to be Harold Ellis a carcinoma of the sigmoid colon! There are more than one dozen abdominal incisions quoted in surgical textbooks, but the ones in common use today (and which the candidate must know in detail) are discussed below. The midline incision (Figures 1–4) Opening the abdomen is the essential preliminary to the per- formance of a laparotomy. A correctly performed abdominal The midline abdominal incision has many advantages because it: exposure is based on sound anatomical knowledge, hence it is a • is very quick to perform common question in the Operative Surgery section of the MRCS • is relatively easy to close examination. • is virtually bloodless (no muscles are cut or nerves divided). • affords excellent access to the abdominal cavity and retroperi- toneal structures Incisions • can be extended from the xiphoid to the pubic symphysis. Essential features If closure is performed using the mass closure technique, pros- The surgeon needs ready and direct access to the organ requir- pective randomized clinical trials have shown no difference in ing investigation and treatment, so the incision must provide the incidence of wound dehiscence or incisional hernia com- sufficient room for the procedure to be performed. The incision pared with transverse or paramedian incisions.1 should (if possible): The upper midline incision is placed exactly in the midline • be capable of easy extension (to allow for any enlargement of and extends from the tip of the xiphoid to about 1 cm above the scope of the operation) the umbilicus.
    [Show full text]
  • Anatomy and Physiology of the Abdominal Wall 0011 CHAPTER Internal Oblique Some Inferior fi Bers Form the Cremaster Muscle at the Level of the Inguinal Canal
    Handbook of Complex Abdominal Wall Anatomy and physiology of the abdominal wall 0011 CHAPTER Álvaro Robín Valle de Lersundi, MD, PhD Arturo Cruz Cidoncha, MD, PhD 11.1..1. Anatomy of the abdominal wall 1.1.1. Introduction The abdominal wall is delimited by muscle structures than can be classifi ed in 5 ana- tomical areas: lateral, anterior, posterior, diaphragmatic and perineal (Table 1.1). We will describe the fi rst four due to their relevance in surgical repair of complex abdom- inal wall. These groups of muscles are enclosed by several bone structures: last ribs, chondrocostal joints, xyphoid, pelvis and costal apophysis of lumbar vertebrae. Layers of the anterior and lateral abdominal wall include skin, subcutaneous tissue, super- fi cial fascia, deep fascia, muscles, extraperitoneal fascia and peritoneum. Table 1.1. Muscular limits of the abdominal wall ∙ Quadratus lumborum POSTERIOR ∙ Psoas ∙ Iliac muscle ∙ External oblique LATERAL ∙ Internal oblique ∙ Transversus abdominis ∙ Rectus abdominis ANTERIOR ∙ Piramidalis CONTENTS SUPERIOR ∙ Diaphragm 1.1. Anatomy of the abdominal INFERIOR ∙ Perineal muscles wall 1.1.2. Muscles of the abdominal wall 1.2. Physiologyygy Muscles of the anterolateral wall Rectus abdominis The rectus abdominis (m. rectus abdominis) is a long and thick muscle that is extended from the anterolateral thorax to the pubis close to the midline (Figure 1.1). 1 Figure External oblique 1.1. Rectus abdominis The external oblique muscle (m. obliquus externus abdominis) is the most superfi cial and thickest of the three lateral abdominal wall muscles (Figure 1.2). Figure 1.2. External oblique muscle Handbook of Complex Abdominal Wall Handbook of Complex Cranially, the rectus abdominis muscles originates from 3 dig- itations that insert on the 5th-7th costal cartilages, the xyphoid process and costoxyphoid ligament.
    [Show full text]
  • Anterior Abdominal Wall
    Abdominal wall Borders of the Abdomen • Abdomen is the region of the trunk that lies between the diaphragm above and the inlet of the pelvis below • Borders Superior: Costal cartilages 7-12. Xiphoid process: • Inferior: Pubic bone and iliac crest: Level of L4. • Umbilicus: Level of IV disc L3-L4 Abdominal Quadrants Formed by two intersecting lines: Vertical & Horizontal Intersect at umbilicus. Quadrants: Upper left. Upper right. Lower left. Lower right Abdominal Regions Divided into 9 regions by two pairs of planes: 1- Vertical Planes: -Left and right lateral planes - Midclavicular planes -passes through the midpoint between the ant.sup.iliac spine and symphysis pupis 2- Horizontal Planes: -Subcostal plane - at level of L3 vertebra -Joins the lower end of costal cartilage on each side -Intertubercular plane: -- At the level of L5 vertebra - Through tubercles of iliac crests. Abdominal wall divided into:- Anterior abdominal wall Posterior abdominal wall What are the Layers of Anterior Skin Abdominal Wall Superficial Fascia - Above the umbilicus one layer - Below the umbilicus two layers . Camper's fascia - fatty superficial layer. Scarp's fascia - deep membranous layer. Deep fascia : . Thin layer of C.T covering the muscle may absent Muscular layer . External oblique muscle . Internal oblique muscle . Transverse abdominal muscle . Rectus abdominis Transversalis fascia Extraperitoneal fascia Parietal Peritoneum Superficial Fascia . Camper's fascia - fatty layer= dartos muscle in male . Scarpa's fascia - membranous layer. Attachment of scarpa’s fascia= membranous fascia INF: Fascia lata Sides: Pubic arch Post: Perineal body - Membranous layer in scrotum referred to as colle’s fascia - Rupture of penile urethra lead to extravasations of urine into(scrotum, perineum, penis &abdomen) Muscles .
    [Show full text]
  • Low Back & Hip Unit 4
    LOW BACK & HIP UNIT MODULE 4 1 __________________________________________________________________ Welcome to Beyond Trigger Points Seminars, Low Back and Hip Unit Module 4 on the Thoracolumbar Erector Paraspinals, Abdominals and Serratus Posterior Inferior. This is Cathy Cohen. By the end of this lesson, you will be able to identify the trigger points and the dysfunctions occurring in these very important structural muscles. Our other learning objective is to differentiate between a somatovisceral versus a viscerosomatic effect. First, let's be clear on how these muscles are named. Collectively the muscle group along the spine is referred to as the paravertebral muscles. Our book labels the superficial group as the erector spinae and the deep group as the paraspinal muscles. So again, the superficial group we'll refer to as the erector spinae and the deep group as the paraspinal muscles. When I was developing my true beginner’s status in this profession, I made a bet with a chiropractor. My perception of the relative thickness between the superficial and the deep paraspinal muscles differed from his knowing. During a camping trip in the Shenandoah Valley, Virginia, I thought I had the perfect opportunity to win my bet. A farmer had donated a pig to roast and my fellow campers agreed to let me butcher the pig’s tenderloin. Those are the muscles along the pig’s spine. Well, just as my chiropractor friend said, the long fibered superficial muscles are relatively thinner than the short fatter diagonal muscles of the deep group. I lost ten dollars that day. On page 24 of the student study guide, the actions to list for the deep thoracolumbar paraspinals are: 1.
    [Show full text]
  • Adductor Release for Athletic Groin Pain
    40 Allied Drive Dedham, MA 02026 781-251-3535 (office) www.bostonsportsmedicine.com ADDUCTOR RELEASE FOR ATHLETIC GROIN PAIN THE INJURY The adductor muscles of the thigh connect the lower rim of the pelvic bone (pubis) to the thigh-bone (femur). These muscles exert high forces during activities such as soccer, hockey and football when powerful and explosive movements take place. High stresses are concentrated especially at the tendon of the adductor longus tendon where it attaches to the bone. This tendon can become irritated and inflamed and be the source of unrelenting pain in the groin area. Pain can also be felt in the lower abdomen. THE OPERATION Athletic groin pain due to chronic injury to the adductor longus muscle-tendon complex usually can be relieved by releasing the tendon where it attaches to the pubic bone. A small incision is made over the tendon attachment and the tendon is cut, or released from its attachment to the bone. The tendon retracts distally and heals to the surrounding tissues. The groin pain is usually relieved since the injured tendon is no longer anchored to the bone. It takes several weeks for the area to heal. Athletes can often return to full competition after a period of 8-12 weeks of rehabilitation, but it may take a longer period of time to regain full strength and function. RISKS OF SURGERY AND RESULTS As with any operation, there are potential risks and possible complications. These are rare, and precautions are taken to avoid problems. The spermatic cord (in males) is close to the operative area, but it is rarely at risk.
    [Show full text]
  • EMG Evaluation of Hip Adduction Exercises for Soccer Players
    Downloaded from http://bjsm.bmj.com/ on November 8, 2017 - Published by group.bmj.com Original article EMG evaluation of hip adduction exercises for soccer players: implications for exercise selection in prevention and treatment of groin injuries Andreas Serner,1,2 Markus Due Jakobsen,3 Lars Louis Andersen,3 Per Hölmich,1,2 Emil Sundstrup,3 Kristian Thorborg1 1Arthroscopic Centre Amager, ABSTRACT potential in both the prevention and treatment of Copenhagen University Introduction Exercise programmes are used in the groin injuries. Hospital, Copenhagen, Denmark prevention and treatment of adductor-related groin Currently, no studies have been able to demon- 2Aspetar Sports Groin Pain injuries in soccer; however, there is a lack of knowledge strate a reduction in the number of groin injuries in – Centre, Aspetar, Qatar concerning the intensity of frequently used exercises. soccer.12 14 Various explanations for this have been – Orthopaedic and Sports Objective Primarily to investigate muscle activity of proposed, such as insufficient compliance,12 14 over- Medicine Hospital, Doha, Qatar 12 3 adductor longus during six traditional and two new hip optimistic effect sizes and inadequate exercise National Research Centre for 12 the Working Environment, adduction exercises. Additionally, to analyse muscle intensity. Physical training has proven effective in Copenhagen, Denmark activation of gluteals and abdominals. the treatment of long-standing adductor-related groin Materials and methods 40 healthy male elite soccer pain,15 which is supported
    [Show full text]
  • Morphometric Measurement of Adductor Longus and Its Clinical Application: a Cadaveric Study
    Original Research Article DOI: 10.18231/2394-2126.2018.0062 Morphometric measurement of adductor longus and its clinical application: A cadaveric study Navneet Kour1, Vanita Gupta2,*, Gaurav Agnihotri3, Shalika Sharma4, Vikrant Singh5 1,5Assistant Professor, 2Professor, 3,4Associate Professor, 1,2,3,4Dept. of Anatomy, Acharya Shree Chander College of Medical Sciences, Jammu, Jammu & Kashmir, India 5Lecturer, Dept. of Gaestrointestinal Surgery, Government Medical College, Jammu, Jammu & Kashmir, India *Corresponding Author: Email: [email protected] Received: 17th January, 2018 Accepted: 15th March, 2018 Abstract Objectives: A profound knowledge of the anatomical organization of adductor muscle compartment is necessary to understand their functions, and to assist in the development of accurate clinical and biomechanical models. This study aims at providing appropriate morphometric measurements of adductor longus muscle. Materials and Methods: The present study was conducted on 50 lower limbs. All limbs were fully dissected and measurements were taken with help of a steel tape. Results: We found Adductor longus muscle in all the 50 dissected lower limbs (100%). The range of length and width of proximal aponeurosis varied from 4.1- 6.8cm and 0.8 -2.5cm respectively. The range of length of fleshy part (muscular belly) varied from 14.4 – 20.7cm. The range of length and width of distal aponeurosis varied from 9.8 – 13.9cm and 2.1 – 4.8cm respectively. Conclusion: Our results would aid educational anatomy dissections, surgical interventions
    [Show full text]
  • Defining the Location of the Adductor Canal Using Ultrasound
    REGIONAL ANESTHESIA AND ACUTE PAIN Regional Anesthesia & Pain Medicine: first published as 10.1097/AAP.0000000000000539 on 1 March 2017. Downloaded from BRIEF TECHNICAL REPORT Defining the Location of the Adductor Canal Using Ultrasound Wan Yi Wong, MMed, MBBS,* Siska Bjørn, MS,† Jennie Maria Christin Strid, MD,† Jens Børglum, MD, PhD,‡ and Thomas Fichtner Bendtsen, MD, PhD† represents an injection into the true adductor canal. Lund et al in- Background and Objectives: The precise location of the adductor ca- troduced a more proximal approach at the midthigh level, defined nal remains controversial among anesthesiologists. In numerous studies of by anatomical surface landmarks as the midpoint between the an- the analgesic effect of the so-called adductor canal block for total knee terior superior iliac spine (ASIS) and the base of patella. This ap- arthroplasty, the needle insertion point has been the midpoint of the thigh, proach has become the well-known “ACB.”6,9–11 determined as the midpoint between the anterior superior iliac spine and It is a common notion that the AC is located in the middle of “ ” base of patella. Adductor canal block may be a misnomer for an approach the thigh and that an injection at the midthigh is indeed an injection “ that is actually an injection into the femoral triangle, a femoral triangle into the middle of the AC. However, an injection at the midthigh ” block. This block probably has a different analgesic effect compared with can be into the AC or in the femoral triangle (FT), depending on an injection into the adductor canal.
    [Show full text]
  • 1 Anatomy of the Abdominal Wall 1
    Chapter 1 Anatomy of the Abdominal Wall 1 Orhan E. Arslan 1.1 Introduction The abdominal wall encompasses an area of the body boundedsuperiorlybythexiphoidprocessandcostal arch, and inferiorly by the inguinal ligament, pubic bones and the iliac crest. Epigastrium Visualization, palpation, percussion, and ausculta- Right Left tion of the anterolateral abdominal wall may reveal ab- hypochondriac hypochondriac normalities associated with abdominal organs, such as Transpyloric T12 Plane the liver, spleen, stomach, abdominal aorta, pancreas L1 and appendix, as well as thoracic and pelvic organs. L2 Right L3 Left Visible or palpable deformities such as swelling and Subcostal Lumbar (Lateral) Lumbar (Lateral) scars, pain and tenderness may reflect disease process- Plane L4 L5 es in the abdominal cavity or elsewhere. Pleural irrita- Intertuber- Left tion as a result of pleurisy or dislocation of the ribs may cular Iliac (inguinal) Plane result in pain that radiates to the anterior abdomen. Hypogastrium Pain from a diseased abdominal organ may refer to the Right Umbilical Iliac (inguinal) Region anterolateral abdomen and other parts of the body, e.g., cholecystitis produces pain in the shoulder area as well as the right hypochondriac region. The abdominal wall Fig. 1.1. Various regions of the anterior abdominal wall should be suspected as the source of the pain in indi- viduals who exhibit chronic and unremitting pain with minimal or no relationship to gastrointestinal func- the lower border of the first lumbar vertebra. The sub- tion, but which shows variation with changes of pos- costal plane that passes across the costal margins and ture [1]. This is also true when the anterior abdominal the upper border of the third lumbar vertebra may be wall tenderness is unchanged or exacerbated upon con- used instead of the transpyloric plane.
    [Show full text]
  • Chapter 9 the Hip Joint and Pelvic Girdle
    The Hip Joint and Pelvic Girdle • Hip joint (acetabular femoral) – relatively stable due to • bony architecture Chapter 9 • strong ligaments • large supportive muscles The Hip Joint and Pelvic Girdle – functions in weight bearing & locomotion • enhanced significantly by its wide range of Manual of Structural Kinesiology motion • ability to run, cross-over cut, side-step cut, R.T. Floyd, EdD, ATC, CSCS jump, & many other directional changes © 2007 McGraw-Hill Higher Education. All rights reserved. 9-1 © 2007 McGraw-Hill Higher Education. All rights reserved. 9-2 Bones Bones • Ball & socket joint – Sacrum – Head of femur connecting • extension of spinal column with acetabulum of pelvic with 5 fused vertebrae girdle • extending inferiorly is the coccyx – Pelvic girdle • Pelvic bone - divided into 3 • right & left pelvic bone areas joined together posteriorly by sacrum – Upper two fifths = ilium • pelvic bones are ilium, – Posterior & lower two fifths = ischium, & pubis ischium – Femur – Anterior & lower one fifth = pubis • longest bone in body © 2007 McGraw-Hill Higher Education. All rights reserved. 9-3 © 2007 McGraw-Hill Higher Education. All rights reserved. 9-4 Bones Bones • Bony landmarks • Bony landmarks – Anterior pelvis - origin – Lateral pelvis - for hip flexors origin for hip • tensor fasciae latae - abductors anterior iliac crest • gluteus medius & • sartorius - anterior minimus - just superior iliac spine below iliac crest • rectus femoris - anterior inferior iliac spine © 2007 McGraw-Hill Higher Education. All rights reserved. 9-5 © 2007 McGraw-Hill Higher Education. All rights reserved. 9-6 1 Bones Bones • Bony landmarks • Bony landmarks – Medially - origin for – Posteriorly – origin for hip hip adductors extensors • adductor magnus, • gluteus maximus - adductor longus, posterior iliac crest & adductor brevis, posterior sacrum & coccyx pectineus, & gracilis - – Posteroinferiorly - origin pubis & its inferior for hip extensors ramus • hamstrings - ischial tuberosity © 2007 McGraw-Hill Higher Education.
    [Show full text]