DOCSLIB.ORG

Pelvis, Hip and Groin 235

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pelvis, Hip and Groin 235 Pelvis, Hip and Groin 235 Pelvis, Hip and Groin 15 Wayne Gibbon and Ernest Schilders CONTENTS Box 15.2. Conventional radiography ● 15.1 Introduction 236 The value of conventional radiographs resides is their ability to rapidly, simply and inexpen- 15.2 Anatomical Considerations 237 sively demonstrate acute bony injury, late stress 15.3 Osteitis Pubis 242 injury to bone, arthropathy and coincidental 15.3.1 Symphyseal Stress Injury 242 osseous condition e.g. primary and secondary 15.3.2 “True” Osteitis Pubis 246 bone tumours and skeletal infection 15.4 Pubic Osteomyelitis 248 ● Stress radiographs are of limited value for 15.5 Stress Fractures 249 assessing pelvic instability 15.6 Hip Joint Dysfunction 251 15.7 Sacroiliac Joint Dysfunction 252 15.8 Entheseal Injury 252 Box 15.3. Computed tomography 15.9 “Sportsman’s Hernia” 256 ● 15.10 Parasymphyseal Muscle Tears 256 The indications for CT in athletes with pelvic, hip and groin pain are limited but include bony 15.11 Iliopsoas Tendinopathy 258 abnormalities at complex anatomical sites such 15.12 Nerve Entrapment 259 as the sacroiliac joints, diagnostic confi rmation 15.13 A Unifying Concept for of specifi c local conditions e.g., myositis ossifi - Groin Pain in Athletes 260 cans circumscripta and causes of referred pain 15.14 Conclusion 261 to region e.g., lumbar spondylolysis Things to Remember 261 References 262 Box 15.4. Ultrasound ● Sonography is able to demonstrate acute and Box 15.1. Magnetic resonance imaging chronic tendon injury, defi ne the extent of muscle tears and correlate imaging abnormali- ● This is probably the fi rst line investigation for ties with site of anatomical tenderness most causes of pelvic, hip and groin pain in ● athletes due to its high anatomical detail and Ultrasound is also useful in studies requiring a ability to demonstrate a wide range of osseous dynamic component e.g., Valsalva Manoeuvre and soft-tissue pathologies for functionally assessing hernias, conditions where Colour or Power Doppler imaging may ● Conventional MR imaging acts as a “water map” be helpful e.g., hip synovitis and for guiding a for demonstrating bone marrow and soft-tissue range of percutaneous diagnostic and thera- edema whereas fat-suppressed contrast enhanced peutic procedures studies demonstrate hyperaemia and therefore acts as a surrogate market for infl ammation ● Intra-articular contrast may be helpful in dem- W. Gibbon, MD, PhD, Professor onstrating conditions such as hip labral tears E. Schilders, MD 18th Seventh Ave, St. Lucia, Brisbane Q 4067, Australia 236 W. Gibbon and E. Schilders Table 15.1. The differential diagnosis of groin pain 15.1 1. Muscle tear Introduction a) Adductor group – adductor longus – adductor brevis – gracilis Chronic hip, groin and pelvic pain are major causes b) Rectus femoris of morbidity in professional and elite athletes and c) Rectus abdominis these problems are often inter-related. Groin injuries d) Oblique/tranversalis (inferior portions) are the commonest cause of chronic injury in a wide d) Hamstring group range of sports, especially football. Depending on e) Sartorius f) Ilio-psoas which published data is chosen they constitute up to 2. Tendinitis or tear 27% of injuries in soccer (Ekstrand and Gillquist a) Adductor origin – adductor longus 1983), 12% in American Football (Moretz et al. 1978), – adductor brevis 11.3% in rugby (Hornof and Napravnik 1969) and – gracilis 6.6% in Australian-rules football (Seward et al. 1993). b) Rectus femoris c) Ilio-psoas In soccer players, groin injuries tend to be associated 3. Bone or apophysis avulsion with a prolonged recovery and 50% of players with a) Adductor origin groin pain will have symptoms that persist for more b) Anterior inferior iliac spine/apophysis than 20 weeks after initial injury (Nielsen and Yde c) Ischial apophysis d) Anterior superior iliac spine/apophysis 1989). Therefore, as they constitute 55% of overuse e) Lesser trochanter/apophysis injuries, the impact on a team’s performance is great 4. Bursitis (Fifa 1992). a) Ilio-pectineal Great diagnostic diffi culties exist refl ecting the fact b) Ilio-psoas that the causes of groin pain are protean (Table 15.1) 5. Pubic symphysitis/osteitis pubis 6. Pubic osteomyelitis and also possibly refl ecting clinical prejudice. In one 7. Stress fracture study reviewing the case-notes of 189 athletes with a) Inferior pubic ramus chronic groin pain, 27% were found to have multiple b) Parasymphyseal pathologies (Lovell 1995). One possible explana- c) Femoral neck tion for the diagnostic confusion could be that there 8. Entrapment neuropathy a) Ilio-inguinal nerve neuralgia may indeed be more than one diagnosis in many b) Obturator neuralgia athletes. However, this confusion could also be due c) Genito-femoral causalgia to the fact that many of the diagnoses are anatomi- 9. Hip pathology cally and/or biomechanically linked. Consequently, a) Osteoarthrosis adequate treatment requires the addressing of more b) Slipped capital femoral epiphysis Holmich 10. Inguinal lymphadenitis than one of these clinical conditions ( et 11. Hernia al. 1999) and, therefore, medical imaging has a most a) Direct inguinal important role in patient management, i.e. in defi n- b) Indirect inguinal ing as precisely as possible the underlying injury and c) Femoral disease processes. d) Obturator e) Spigelian The problem of groin pain in athletes is not a 12. Genito-urinary new one. Pierson (1929) was probably the fi rst to a) Orchitis describe chronic stress injury to the symphysis pubis b) Prostititis or “osteitis pubis” in 1929. He termed the condition c) Scrotal trauma/haematocele osteochondritis of the symphysis pubis which indeed d) Low renal calculus 13. Haematoma better refl ects the articular nature of the injury. Spi- a) Direct blow nelli described osteitis pubis in athletes as early as b) Tear of inferior epigastric artery (Rectus sheath) 1932 (Spinelli 1932). This condition has also been 14. Referred pain termed dynamic osteopathy (Losada and Saldias a) Spine – spondylolysis 1968) and tenosteochondrosis of the pubis, refl ecting – Scheuermann’s disease – high lumbar disc prolapse the dynamic nature of the condition and the inter- b) Sacro-iliac joint – instability relationship of bone, joint and tendon aetiological – sacro-iliitis components (Rosenklint and Anderson 1969). – osteoarthrosis Subchondral trabecular fracture as a cause for groin 15. Acute abdominal/pelvic viscus infl ammation 16. Idiopathic pain in athletes was reported by Williams in 1978. Pelvis, Hip and Groin 237 Pubic symphyseal osteomyelitis was fi rst described in noses made by 5 specialists (general surgeon, ortho- an athlete in Adams and Chandler (1953) and the paedic surgeon, urologist, nuclear medicine physi- differentiation between infl ammatory osteitis pubis cian and radiologist), in 21 athletes complaining of and low grade pubic osteomyelitis has remained a unexplained chronic groin pain. These investigators diagnostic problem in athletes ever since. found that in 90% of cases more than one diagnosis Probably the fi rst description of adductor muscle was made and in 14% of cases the specialists made injuries in athletes was in ten-pin bowlers in Hoon four or more different diagnoses for each patient. (1959). Wiley was the fi rst investigator in the English The authors concluded that “the fi nal diagnosis (and literature to associate traumatic osteitis pubis with treatment) often refl ects the specialty of the doctor abnormalities of the gracilis tendon origin in 1983. and as a result alternative causes of groin pain are This single case report described the signifi cant histo- overlooked”. Further clinical investigation in ath- pathological fi ndings seen in the excised tissue at the letes, who are not cured by hernia repair, will pro- gracilis enthesis. These included a mixture of viable duce an alternative treatable diagnosis in more than and non-viable bone fragments, extensive fi brosis and 80% of cases, most of which are subsequently cured an absence of infection, suggesting a chronic traction by addressing the more latterly diagnosed condition. phenomenon at the osseotendinous junction inferior Conversely, adductor origin symptoms often subside margin of the symphysis pubis. Although this was the following hernia repair. Therefore, the mechanism for fi rst record of the condition in the English literature, adductor origin injury appears to be linked in some it had been described 20 years earlier in the German way to that of the “pre-hernia complex”. It could be literature (Schneider 1963). Wiley in his report also implied from these results that the actual diagnosis commented on the fact that avulsion of the gracilis made in athletes with groin pain refl ects clinical prej- tendon origin is associated with concurrent avulsion udice (Fredberg and Kissmeyer-Nielsen 1996) of the ligamentous support of the inferior region of and that greater recognition of the interlinked nature the symphysis and avulsion of bony fragments at the of the different conditions is required. edge of the pubis (Wiley 1983). This infers a rela- tionship between the stability of the symphysis and tendinous avulsion. Pelvic adductor syndrome as a cause of groin pain in footballers was fi rst postulated in Reideberger et al. (1967), rectus abdominis ten- 15.2 dinopathy in Martens et al. (1987) and adductor Anatomical Considerations longus tendinopathy in Akermark and Johansson (1992). There are a signifi cant number of errors is the clas- Carnevale (1954) described a condition, he sical description of the soft tissue attachments to termed inguinocrural pain in footballers, which was the pubic bodies (Fig. 15.1). In only 3% of groins probably an early description of the “sportsman’s does a conjoint tendon representing the fused infero- hernia”, i.e. an imminent, but non-palpable, direct medial aponeuroses of internal oblique and transver- inguinal hernia. This has subsequently been thought sus abdominis actually insert into the pubic tubercle to be a common cause of unexplained chronic groin and adjacent pubic crest as is classically described.
Load more

Recommended publications
  • The Structure and Function of Breathing
    CHAPTERCONTENTS The structure-function continuum 1 Multiple Influences: biomechanical, biochemical and psychological 1 The structure and Homeostasis and heterostasis 2 OBJECTIVE AND METHODS 4 function of breathing NORMAL BREATHING 5 Respiratory benefits 5 Leon Chaitow The upper airway 5 Dinah Bradley Thenose 5 The oropharynx 13 The larynx 13 Pathological states affecting the airways 13 Normal posture and other structural THE STRUCTURE-FUNCTION considerations 14 Further structural considerations 15 CONTINUUM Kapandji's model 16 Nowhere in the body is the axiom of structure Structural features of breathing 16 governing function more apparent than in its Lung volumes and capacities 19 relation to respiration. This is also a region in Fascla and resplrstory function 20 which prolonged modifications of function - Thoracic spine and ribs 21 Discs 22 such as the inappropriate breathing pattern dis- Structural features of the ribs 22 played during hyperventilation - inevitably intercostal musculature 23 induce structural changes, for example involving Structural features of the sternum 23 Posterior thorax 23 accessory breathing muscles as well as the tho- Palpation landmarks 23 racic articulations. Ultimately, the self-perpetuat- NEURAL REGULATION OF BREATHING 24 ing cycle of functional change creating structural Chemical control of breathing 25 modification leading to reinforced dysfunctional Voluntary control of breathing 25 tendencies can become complete, from The autonomic nervous system 26 whichever direction dysfunction arrives, for Sympathetic division 27 Parasympathetic division 27 example: structural adaptations can prevent NANC system 28 normal breathing function, and abnormal breath- THE MUSCLES OF RESPIRATION 30 ing function ensures continued structural adap- Additional soft tissue influences and tational stresses leading to decompensation.
    [Show full text]
  • Synovial Joints Permit Movements of the Skeleton
    8 Joints Lecture Presentation by Lori Garrett © 2018 Pearson Education, Inc. Section 1: Joint Structure and Movement Learning Outcomes 8.1 Contrast the major categories of joints, and explain the relationship between structure and function for each category. 8.2 Describe the basic structure of a synovial joint, and describe common accessory structures and their functions. 8.3 Describe how the anatomical and functional properties of synovial joints permit movements of the skeleton. © 2018 Pearson Education, Inc. Section 1: Joint Structure and Movement Learning Outcomes (continued) 8.4 Describe flexion/extension, abduction/ adduction, and circumduction movements of the skeleton. 8.5 Describe rotational and special movements of the skeleton. © 2018 Pearson Education, Inc. Module 8.1: Joints are classified according to structure and movement Joints, or articulations . Locations where two or more bones meet . Only points at which movements of bones can occur • Joints allow mobility while preserving bone strength • Amount of movement allowed is determined by anatomical structure . Categorized • Functionally by amount of motion allowed, or range of motion (ROM) • Structurally by anatomical organization © 2018 Pearson Education, Inc. Module 8.1: Joint classification Functional classification of joints . Synarthrosis (syn-, together + arthrosis, joint) • No movement allowed • Extremely strong . Amphiarthrosis (amphi-, on both sides) • Little movement allowed (more than synarthrosis) • Much stronger than diarthrosis • Articulating bones connected by collagen fibers or cartilage . Diarthrosis (dia-, through) • Freely movable © 2018 Pearson Education, Inc. Module 8.1: Joint classification Structural classification of joints . Fibrous • Suture (sutura, a sewing together) – Synarthrotic joint connected by dense fibrous connective tissue – Located between bones of the skull • Gomphosis (gomphos, bolt) – Synarthrotic joint binding teeth to bony sockets in maxillae and mandible © 2018 Pearson Education, Inc.
    [Show full text]
  • Peripartum Pubic Symphysis Diastasis—Practical Guidelines
    Journal of Clinical Medicine Review Peripartum Pubic Symphysis Diastasis—Practical Guidelines Artur Stolarczyk , Piotr St˛epi´nski* , Łukasz Sasinowski, Tomasz Czarnocki, Michał D˛ebi´nski and Bartosz Maci ˛ag Department of Orthopedics and Rehabilitation, Medical University of Warsaw, 02-091 Warsaw, Poland; [email protected] (A.S.); [email protected] (Ł.S.); [email protected] (T.C.); [email protected] (M.D.); [email protected] (B.M.) * Correspondence: [email protected] Abstract: Optimal development of a fetus is made possible due to a lot of adaptive changes in the woman’s body. Some of the most important modifications occur in the musculoskeletal system. At the time of childbirth, natural widening of the pubic symphysis and the sacroiliac joints occur. Those changes are often reversible after childbirth. Peripartum pubic symphysis separation is a relatively rare disease and there is no homogeneous approach to treatment. The paper presents the current standards of diagnosis and treatment of pubic diastasis based on orthopedic and gynecological indications. Keywords: pubic symphysis separation; pubic symphysis diastasis; pubic symphysis; pregnancy; PSD 1. Introduction The proper development of a fetus is made possible due to numerous adaptive Citation: Stolarczyk, A.; St˛epi´nski,P.; changes in women’s bodies, including such complicated systems as: endocrine, nervous Sasinowski, Ł.; Czarnocki, T.; and musculoskeletal. With regard to the latter, those changes can be observed particularly D˛ebi´nski,M.; Maci ˛ag,B. Peripartum Pubic Symphysis Diastasis—Practical in osteoarticular and musculo-ligamento-fascial structures. Almost all of those changes Guidelines. J. Clin. Med.
    [Show full text]
  • 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)
    [Show full text]
  • 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.
    [Show full text]
  • Diaphragm and Intercostal Muscles
    Diaphragm and intercostal muscles Dr. Heba Kalbouneh Associate Professor of Anatomy and Histology Skeletal System Adult Human contains 206 Bones 2 parts: Axial skeleton (axis): Skull, Vertebral column, Thoracic cage Appendicular skeleton: Bones of upper limb Bones of lower limb Dr. Heba Kalbouneh Structure of Typical Vertebra Body Vertebral foramen Pedicle Transverse process Spinous process Lamina Dr. Heba Kalbouneh Superior articular process Intervertebral disc Dr. Heba Inferior articular process Dr. Heba Facet joints are between the superior articular process of one vertebra and the inferior articular process of the vertebra directly above it Inferior articular process Superior articular process Dr. Heba Kalbouneh Atypical Vertebrae Atlas (1st cervical vertebra) Axis (2nd cervical vertebra) Dr. Heba Atlas (1st cervical vertebra) Communicates: sup: skull (atlanto-occipital joint) inf: axis (atlanto-axial joint) Atlas (1st cervical vertebra) Characteristics: 1. no body 2. no spinous process 3. ant. & post. arches 4. 2 lateral masses 5. 2 transverse foramina Typical cervical vertebra Specific to the cervical vertebra is the transverse foramen (foramen transversarium). is an opening on each of the transverse processes which gives passage to the vertebral artery Thoracic Cage - Sternum (G, sternon= chest bone) -12 pairs of ribs & costal cartilages -12 thoracic vertebrae Manubrium Body Sternum: Flat bone 3 parts: Xiphoid process Dr. Heba Kalbouneh Dr. Heba Kalbouneh The external intercostal muscle forms the most superficial layer. Its fibers are directed downward and forward from the inferior border of the rib above to the superior border of the rib below The muscle extends forward to the costal cartilage where it is replaced by an aponeurosis, the anterior (external) intercostal membrane Dr.
    [Show full text]
  • Applied Anatomy of the Hip RICARDO A
    Applied Anatomy of the Hip RICARDO A. FERNANDEZ, MHS, PT, OCS, CSCS • Northwestern University The hip joint is more than just a ball-and- bones fuse in adults to form the easily recog- socket joint. It supports the weight of the nized “hip” bone. The pelvis, meaning bowl head, arms, and trunk, and it is the primary in Latin, is composed of three structures: the joint that distributes the forces between the innominates, the sacrum, and the coccyx pelvis and lower extremities.1 This joint is (Figure 1). formed from the articu- The ilium has a large flare, or iliac crest, Key PointsPoints lation of the proximal superiorly, with the easily palpable anterior femur with the innomi- superior iliac spine (ASIS) anterior with the The hip joint is structurally composed of nate at the acetabulum. anterior inferior iliac spine (AIIS) just inferior strong ligamentous and capsular compo- The joint is considered to it. Posteriorly, the crest of the ilium ends nents. important because it to form the posterior superior iliac spine can affect the spine and (PSIS). With respect to surface anatomy, Postural alignment of the bones and joints pelvis proximally and the PSIS is often marked as a dimple in the of the hip plays a role in determining the femur and patella skin. Clinicians attempting to identify pelvic functional gait patterns and forces associ- distally. The biomechan- or hip subluxations, leg-length discrepancies, ated with various supporting structures. ics of this joint are often or postural faults during examinations use There is a relationship between the hip misunderstood, and the these landmarks.
    [Show full text]
  • Role of Greater Sciatic Notch in Sexing Human Hip Bones
    International Journal of Recent Trends in Science And Technology, ISSN 2277-2812 E-ISSN 2249-8109, Volume 7, Issue 3, 2013 pp 119-123 Role of Greater Sciatic Notch in Sexing Human Hip Bones Rajashree Sheelawant Raut 1*, Prakash B. Hosmani 2, P. R. Kulkarni 3 1Assistant Professor, Department of Anatomy, B. J. Government Medical College, Pune, Maharashtra, INDIA. 2Associate Professor, Department of Anatomy, Dr. V. M. Government Medical College, Solapur, Maharashtra, INDIA. 3 Professor and Head, Department of Anatomy, Government Medical College, Latur, Maharashtra, INDIA. *Corresponding Address: [email protected] Research Article Abstract: Identification of the deceased person from bones is the in archaeological collections that they cannot be used for most critical problem faced by anatomist, forensic science experts sex determination. When pubic material is not preserved, & anthropologists. Skeletal remains have been used for sexing the sex determinations must be made using other less individual as bones of the body are last to perish after death. Hip bone, especially t he greater sciatic notch is valuable in deformed diagnostic features. The greater sciatic notch is especially bones because it is highly sexually dimorphic, is resistant to valuable in such situations because it is highly sexually damage, and thus can often be scored in poorly preserved dimorphic, is resistant to damage, and thus can often be skeletons. In present study one hundred and eighty three adult hip scored in poorly preserved skeletons[3]. Many attempts bones of known sex (125 male and 58 female) are studied for have been made to describe sex differences in the sciatic various parameters of greater sciatic notch.
    [Show full text]
  • How to Perform a Transrectal Ultrasound Examination of the Lumbosacral and Sacroiliac Joints
    DIAGNOSTIC IMAGING How to Perform a Transrectal Ultrasound Examination of the Lumbosacral and Sacroiliac Joints Erik H.J. Bergman, DVM, Diplomate ECAR, Associate Member LA-ECVDI*; Sarah M. Puchalski, DVM, Diplomate ACVR; and Jean-Marie Denoix, DVM, PhD, Agre´ge´, Associate Member LA-ECVDI Authors’ addresses: Lingehoeve Veldstraat 3 Lienden 4033 AK, The Netherlands (Bergman); Uni- versity of California, Davis, One Shields Avenue, School of Veterinary Medicine, Davis, CA 95616 (Puchalski); E´ cole Nationale Ve´te´rinaire d’Alfort, 7 Avenue du Ge´ne´ral de Gaulle, 94700 Maisons- Alfort, France (Denoix); e-mail: [email protected]. *Corresponding and presenting author. © 2013 AAEP. 1. Introduction have allowed for identification of these structures 5 There is increasing interest in pathology of the and the inter-transverse joints. These authors urge lumbosacral and sacroiliac joints giving rise to stiff- caution in the interpretation of lesions identified on ness and/or lameness and decreased performance radiography in the absence of other diagnostic im- in equine sports medicine.1–3 Pain arising from aging and clinical examination. Nuclear scintigra- these regions can be problematic alone or in con- phy is an important component of work-up for junction with lameness arising from other sites sacroiliac region pain, but limitations exist. Sev- 9,10 (thoracolumbar spine, hind limbs, or forelimbs).4 eral reports exist detailing the anatomy and tech- Localization of pain to this region is critically impor- nique findings in normal horses11,12 and findings in tant through clinical assessment, diagnostic anes- lame horses.13 Patient motion, camera positioning, thesia, and imaging. and muscle asymmetry can cause errors in interpre- In general, diagnostic imaging of the axial skele- tation.
    [Show full text]
  • Anatomy of the Dog the Present Volume of Anatomy of the Dog Is Based on the 8Th Edition of the Highly Successful German Text-Atlas of Canine Anatomy
    Klaus-Dieter Budras · Patrick H. McCarthy · Wolfgang Fricke · Renate Richter Anatomy of the Dog The present volume of Anatomy of the Dog is based on the 8th edition of the highly successful German text-atlas of canine anatomy. Anatomy of the Dog – Fully illustrated with color line diagrams, including unique three-dimensional cross-sectional anatomy, together with radiographs and ultrasound scans – Includes topographic and surface anatomy – Tabular appendices of relational and functional anatomy “A region with which I was very familiar from a surgical standpoint thus became more comprehensible. […] Showing the clinical rele- vance of anatomy in such a way is a powerful tool for stimulating students’ interest. […] In addition to putting anatomical structures into clinical perspective, the text provides a brief but effective guide to dissection.” vet vet The Veterinary Record “The present book-atlas offers the students clear illustrative mate- rial and at the same time an abbreviated textbook for anatomical study and for clinical coordinated study of applied anatomy. Therefore, it provides students with an excellent working know- ledge and understanding of the anatomy of the dog. Beyond this the illustrated text will help in reviewing and in the preparation for examinations. For the practising veterinarians, the book-atlas remains a current quick source of reference for anatomical infor- mation on the dog at the preclinical, diagnostic, clinical and surgical levels.” Acta Veterinaria Hungarica with Aaron Horowitz and Rolf Berg Budras (ed.) Budras ISBN 978-3-89993-018-4 9 783899 9301 84 Fifth, revised edition Klaus-Dieter Budras · Patrick H. McCarthy · Wolfgang Fricke · Renate Richter Anatomy of the Dog The present volume of Anatomy of the Dog is based on the 8th edition of the highly successful German text-atlas of canine anatomy.
    [Show full text]
  • Lab #23 Anal Triangle
    THE BONY PELVIS AND ANAL TRIANGLE (Grant's Dissector [16th Ed.] pp. 141-145) TODAY’S GOALS: 1. Identify relevant bony features/landmarks on skeletal materials or pelvic models. 2. Identify the sacrotuberous and sacrospinous ligaments. 3. Describe the organization and divisions of the perineum into two triangles: anal triangle and urogenital triangle 4. Dissect the ischiorectal (ischioanal) fossa and define its boundaries. 5. Identify the inferior rectal nerve and artery, the pudendal (Alcock’s) canal and the external anal sphincter. DISSECTION NOTES: The perineum is the diamond-shaped area between the upper thighs and below the inferior pelvic aperture and pelvic diaphragm. It is divided anatomically into 2 triangles: the anal triangle and the urogenital (UG) triangle (Dissector p. 142, Fig. 5.2). The anal triangle is bounded by the tip of the coccyx, sacrotuberous ligaments, and a line connecting the right and left ischial tuberosities. It contains the anal canal, which pierced the levator ani muscle portion of the pelvic diaphragm. The urogenital triangle is bounded by the ischiopubic rami to the inferior surface of the pubic symphysis and a line connecting the right and left ischial tuberosities. This triangular space contains the urogenital (UG) diaphragm that transmits the urethra (in male) and urethra and vagina (in female). A. Anal Triangle Turn the cadaver into the prone position. Make skin incisions as on page 144, Fig. 5.4 of the Dissector. Reflect skin and superficial fascia of the gluteal region in one flap to expose the large gluteus maximus muscle. This muscle has proximal attachments to the posteromedial surface of the ilium, posterior surfaces of the sacrum and coccyx, and the sacrotuberous ligament.
    [Show full text]
  • Approach to the Anterior Pelvis (Enneking Type III Resection) Bruno Fuchs, MD Phd & Franklin H.Sim, MD Indication 1
    Approach to the Anterior Pelvis (Enneking Type III Resection) Bruno Fuchs, MD PhD & Franklin H.Sim, MD Indication 1. Tumors of the pubis 2. part of internal and external hemipelvectomy 3. pelvic fractures Technique 1. Positioning: Type III resections involve the excision of a portion of the symphysis or the whole pubis from the pubic symphysis to the lateral margin of the obturator foramen. The best position for these patients is the lithotomy or supine position. The patient is widely prepared and draped in the lithotomy position with the affected leg free to allow manipulation during the procedure. This allows the hip to be flexed, adducted, and externally rotated to facilitate exposure. 2. Landmarks: One should palpate the ASIS, the symphysis with the pubic tubercles, and the ischial tuberosity. 3. Incision: The incision may be Pfannenstiel like with vertical limbs set laterally along the horizontal incision depending on whether the pubic bones on both sides are resected or not. Alternatively, if only one side is resected, a curved incision following the root of the thigh may be used. This incision begins below the inguinal ligament along the medial border of the femoral triangle and extends across the medial thigh a centimeter distal to the inguinal crease and perineum, to curve distally below the ischium several centimeters (Fig.1). 4. Full thickness flaps are raised so that the anterior inferior pubic ramus is shown in its entire length, from the pubic tubercle to the ischial spine. Laterally, the adductor muscles are visualized, cranially the pectineus muscle and the pubic tubercle with the insertion of the inguinal ligament (Fig.2).
    [Show full text]