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Anatomical Science International Mar 2022Although the hip joint is regarded as inherently stable, hip pain and injuries caused by traumatic/non-traumatic hip instability are relatively common in active... (Review)
Review
Although the hip joint is regarded as inherently stable, hip pain and injuries caused by traumatic/non-traumatic hip instability are relatively common in active individuals. A comprehensive understanding of hip anatomy may provide better insight into the relationships between hip stability and clinical problems. In this review, we present our recent findings on the hip morphological characteristics, especially focusing on the intramuscular tendon of the gluteus medius tendon and its insertion sites, hip capsular attachment on the anterosuperior region of the acetabular margin, and composition of the iliofemoral ligament. We further discussed the hip stabilization mechanism based on these findings. The characteristics of the gluteus medius tendon suggest that even a single muscle has multiple functional subunits within the muscle. In addition, the characteristics of the hip capsular attachment suggest that the width of the capsular attachment is wider than previously reported, and its wide area shows adaptive morphology to mechanical stress, such as bony impression and distribution of the fibrocartilage. The composition of the iliofemoral ligament and its relation to periarticular structures suggest that some ligaments should be defined based on the pericapsular structures, such as the joint capsule, tendon, and aponeurosis, and also have the ability to dynamically coordinate joint stability. These anatomical perspectives provide a better understanding of the hip stabilization mechanism, and a biomechanical study or an in vivo imaging study, considering these perspectives, is expected in the future.
Topics: Buttocks; Hip Joint; Humans; Joint Capsule; Ligaments, Articular; Tendons
PubMed: 34686966
DOI: 10.1007/s12565-021-00638-3 -
Pain Physician Jul 2022The superior and middle cluneal nerves are sources of low back, buttock, and leg pain. These nerves are cutaneous branches of the lateral branches of the dorsal rami of... (Review)
Review
BACKGROUND
The superior and middle cluneal nerves are sources of low back, buttock, and leg pain. These nerves are cutaneous branches of the lateral branches of the dorsal rami of T11- S4. Pain arising from entrapment or dysfunction of one or more of these nerves is called "cluneal nerve syndrome." A clear understanding of the anatomy underlying cluneal nerve syndrome and its treatment has been hampered by the very small size of the cluneal nerves and their complex, varying anatomy. Because of differing methods and foci of investigation, the literature regarding cluneal nerves has been confusing and even contradictory.
OBJECTIVES
This paper provides a thorough critical literature review of cluneal nerve anatomy and implications for therapy.
STUDY DESIGN
A modified scoping review.
METHODS
The bibliographic trail of English language papers on the anatomy and treatment of cluneal nerve syndrome was used to resolve the contradictions that have appeared in some of the anatomic descriptions and, where applicable, to examine their implications for therapy.
RESULTS
Recent anatomic and surgical investigations confirm a wider than previously realized range of central nervous system origins of these peripheral nerves, explaining why cluneal nerve dysfunction can cause a wide array of symptoms, including low back, buttock, and/or leg pain or "pseudosciatica."
CONCLUSIONS
Cluneal nerve syndrome is characterized by a triad of pain, tender points, and relief with local anesthetic injections. The pain is a deep, aching, poorly localized low back pain with variable involvement of the buttocks and/or legs. Tender points are localized at the iliac crest or caudal to the posterior superior iliac spine. Muscle weakness and dermatomal sensory changes are absent in cluneal nerve syndrome. If the pain returns after injections, neuroablation, nerve stimulation, or surgical release may be needed.
Topics: Buttocks; Humans; Ilium; Low Back Pain; Nerve Compression Syndromes; Spinal Nerves
PubMed: 35793175
DOI: No ID Found -
Acta Medica Portuguesa May 2023
Topics: Humans; Skin Diseases; Skin; Buttocks
PubMed: 37130570
DOI: 10.20344/amp.19686 -
Polski Przeglad Chirurgiczny Oct 2023<b><br>Introduction:</b> Aquafilling, a widely used soft-tissue filler since 2005, shows multiple adverse effects, necessitating the development of...
<b><br>Introduction:</b> Aquafilling, a widely used soft-tissue filler since 2005, shows multiple adverse effects, necessitating the development of effective methods for its removal. We present a surgical method for removal of Aquafilling present in the breasts, breasts with migration to the chest and/or the abdomen, and the buttocks, and elaborate and discuss the advantages of this method.</br> <b><br>Aim:</b> The aim of this study was to present a surgical method for removal of Aquafilling (soft-tissue filler) present in the breasts, breasts with migration to the chest and/or the abdomen, and the buttocks, and to elaborate the advantages of this proposed technique.</br> <b><br>Materials and methods:</b> The surgical Aquafilling removal method described here was used in 25 patients (age, 21-53 years). The technique was used to remove Aquafilling present in the breasts (14 patients), breasts with migration to the chest and/or the abdomen (7 patients), and the buttocks (3 patients). The detailed course of Aquafilling removal surgery and postoperative treatment for these three types of cases is described.</br> <b><br>Results:</b> Surgical removal of Aquafilling with the described method did not cause any of the previously described ailments in each patient, excluding one patient who only showed significant pain reduction in both breasts preceding each menstruation cycle.</br> <b><br>Conclusions:</b> The method described herein can be recommended for removal of Aquafilling present in the breasts, breasts with migration to the chest and/or the abdomen, and buttocks, since it allowed thorough Aquafilling removal and decreased the local inflammatory state and the risk of potential carcinogenesis.</br>.
Topics: Female; Humans; Young Adult; Adult; Middle Aged; Abdominal Cavity; Buttocks; Postoperative Period
PubMed: 38629282
DOI: 10.5604/01.3001.0053.3999 -
The Journal of International Medical... Aug 2014Nerve injury is a common complication following intramuscular injection and the sciatic nerve is the most frequently affected nerve, especially in children, the elderly... (Review)
Review
Nerve injury is a common complication following intramuscular injection and the sciatic nerve is the most frequently affected nerve, especially in children, the elderly and underweight patients. The neurological presentation may range from minor transient pain to severe sensory disturbance and motor loss with poor recovery. Management of nerve injection injury includes drug treatment of pain, physiotherapy, use of assistive devices and surgical exploration. Early recognition of nerve injection injury and appropriate management are crucial in order to reduce neurological deficit and to maximize recovery. Sciatic nerve injection injury is a preventable event. Total avoidance of intramuscular injection is recommended if other administration routes can be used. If the injection has to be administered into the gluteal muscle, the ventrogluteal region (gluteal triangle) has a more favourable safety profile than the dorsogluteal region (the upper outer quadrant of the buttock).
Topics: Buttocks; Humans; Injections, Intramuscular; Pain; Sciatic Nerve; Sciatic Neuropathy
PubMed: 24920643
DOI: 10.1177/0300060514531924 -
Pain Physician Aug 2022The most common presentation of cluneal neuropathy is ipsilateral low back and gluteal pain. Cluneal neuralgia has been described historically in surgical contexts, with... (Review)
Review
BACKGROUND
The most common presentation of cluneal neuropathy is ipsilateral low back and gluteal pain. Cluneal neuralgia has been described historically in surgical contexts, with much of the description and treatment related to entrapment and decompression, respectively. Treatment options for addressing axial low back pain have evolved with advancements in the field of interventional pain medicine, though clinical results remain inconsistent. Recent attention has turned toward peripheral nerve stimulation. Nonsurgical interventions targeting the superior and medial cluneal nerve branches have been performed in cases of low back and buttock pain, but there is no known review of the resulting evidence to support these practices.
OBJECTIVES
In this manuscript we provide a robust exploration and analysis of the available literature regarding treatment options for cluneal neuropathy. We provide clinical manifestations and recommendations for future study direction.
STUDY DESIGN
Narrative review.
METHODS
This was a systematic, evidence-based narrative, performed after extensive review of the literature to identify all manuscripts associated with interventional treatment of the superior and medial cluneal nerves.
RESULTS
Eleven manuscripts fulfilled inclusion criteria. Interventional treatment of the superior and middle cluneal nerves includes blockade with corticosteroid, alcohol neurolysis, peripheral nerve stimulation, radiofrequency neurotomy, and surgical decompression.
LIMITATIONS
The supportive evidence for interventions in cluneal neuropathy is largely lacking due to small, uncontrolled, observational studies with multiple confounding factors. There is no standardized definition of cluneal neuropathy.
CONCLUSION
Limited studies promote beneficial effects from interventions intended to target cluneal neuropathy. Despite increased emphasis and treatment options for this condition, there is little consensus on the diagnostic criteria, endpoints, and measures of therapeutics, or procedural techniques for blocks, radiofrequency, and neuromodulation. It is imperative to delineate pathology associated with the cluneal nerves and perform rigorous analysis of associated treatment options.
Topics: Buttocks; Decompression, Surgical; Humans; Low Back Pain; Neuralgia; Peripheral Nerves
PubMed: 35901475
DOI: No ID Found -
Anais Brasileiros de Dermatologia 2016Porokeratosis is a skin disorder clinically characterized by annular plaques with keratotic borders resembling the Great Wall of China and histopathologically by cornoid...
Porokeratosis is a skin disorder clinically characterized by annular plaques with keratotic borders resembling the Great Wall of China and histopathologically by cornoid lamellae. The disease has several clinical variants. Porokeratosis ptychotropica, which has recently become part of these variants, is quite rare and little known. The entity is characterized by verrucous plaques - which may resemble a psoriasis plaque - that affect the regions of the buttocks, most commonly the gluteal cleft, with or without extremity involvement. Itching is often present. We report a rare case of porokeratosis ptychotropica and highlight its unusual manifestation (single plaque), the first case reported in the Brazilian literature.
Topics: Biopsy; Brazil; Buttocks; Erythema; Humans; Male; Porokeratosis; Pruritus; Skin; Young Adult
PubMed: 28300921
DOI: 10.1590/abd1806-4841.20164399 -
Journal of Tissue Viability May 2020The objective of this study was to describe the amount, types, and shapes of tissue present in the buttocks during sitting (i.e., seated buttocks soft tissue anatomy),...
AIM
The objective of this study was to describe the amount, types, and shapes of tissue present in the buttocks during sitting (i.e., seated buttocks soft tissue anatomy), and the impact of seated buttocks soft tissue anatomy on biomechanical risk.
MATERIALS AND METHODS
The buttocks of 35 people, including 29 full-time wheelchair users with and without a history of pelvic pressure ulcers were scanned sitting upright on 3" of flat HR45 foam in a FONAR Upright MRI. Multi-planar scans were analyzed to calculate bulk tissue thickness, tissue composition, gluteus maximus coverage at the ischium, the contour of the skin, and pelvic tilt.
RESULTS
Bulk tissue thickness varied from 5.6 to 32.1 mm, was composed mostly of adipose tissue, and was greatest in the able-bodied cohort. Skin contours varied significantly across status group, with wheelchair users with a history of pressure ulcers having tissue with a peaked contour with a radius of curvature of 65.9 mm that wrapped more closely to the ischium (thickness at the apex = 8.2 mm) as compared to wheelchair users with no pressure ulcer history (radius of curvature = 91.5 mm and apex thickness = 14.5 mm). Finally, the majority of participants presented with little to no gluteus coverage over their ischial tuberosity, regardless of status group.
CONCLUSIONS
This study provides quantitative evidence that Biomechanical Risk, or the intrinsic characteristic of an individual's soft tissues to deform in response to extrinsic applied forces, is greater in individuals at greater risk for pressure ulcers.
Topics: Adult; Biomechanical Phenomena; Buttocks; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Sitting Position; Statistics, Nonparametric; Weights and Measures; Wheelchairs
PubMed: 32008891
DOI: 10.1016/j.jtv.2020.01.004 -
Journal of Cosmetic Dermatology Jan 2022Electromagnetic muscle stimulation (EMMS) is a non-invasive body contouring technology for strengthening, firming, and toning the abdomen, buttocks, and thighs that is...
BACKGROUND
Electromagnetic muscle stimulation (EMMS) is a non-invasive body contouring technology for strengthening, firming, and toning the abdomen, buttocks, and thighs that is associated with high patient satisfaction.
AIMS
To gain a greater understanding of factors contributing to patient satisfaction with EMMS.
METHODS
This was a retrospective, non-comparative study of patient information and questionnaires regarding EMMS treatments to abdomen and/or buttocks collected July 1 to December 1, 2019 from clinical practices in the United States. Questionnaires collected and included for study analysis were the Subject Experience Questionnaire (SEQ), the Body Satisfaction Questionnaire (BSQ), and the Subject-rated Global Aesthetic Improvement Scale (SGAIS).
RESULTS
Responses from 146 treated patients were analyzed (abdomen only: n = 94; buttocks only, n = 30; abdomen and buttocks: n = 22). Patients were 79% female with mean age of 41.3 years (range: 19-73). Frequently cited reasons for seeking EMMS treatment were a desire to appear more toned (89%) or slimmer (42%), and to feel stronger (38%). BSQ and SGAIS scores were improved 4 weeks after treatment. On post-treatment SEQ, most patients reported being "satisfied" or "very satisfied" with abdomen (83.2%; n = 89/107) or buttocks (57.4%; n = 27/47) treatment. Most patients reported feeling stronger after abdomen treatment, and across both body areas, patients were more confident, happier with their overall appearance, and motivated to work out and maintain treatment results.
CONCLUSION
This retrospective study of patient questionnaires provides important information on aesthetic and functional factors that can contribute to high patient satisfaction following EMMS treatment of the abdomen and/or buttocks.
Topics: Adult; Buttocks; Electromagnetic Phenomena; Female; Humans; Male; Muscles; Patient Outcome Assessment; Patient Satisfaction; Retrospective Studies
PubMed: 34560820
DOI: 10.1111/jocd.14401 -
The Journal of Bone and Joint Surgery.... Feb 2019The objective of this study was to analyze the literature regarding the diagnosis, pathogenesis, and prevalence of gluteal fibrosis (GF) and the outcomes of treatment.
BACKGROUND
The objective of this study was to analyze the literature regarding the diagnosis, pathogenesis, and prevalence of gluteal fibrosis (GF) and the outcomes of treatment.
METHODS
We searched PubMed, Embase, and Cochrane literature databases, from database inception to December 15, 2016. We used the following search terms including variants: "contracture," "fibrosis," "injections," "injections, adverse reactions,' "gluteal," and "hip." All titles and abstracts of potentially relevant studies were scanned to determine whether the subject matter was potentially related to GF, using predefined inclusion and exclusion criteria. If the abstract had subject matter involving GF, the paper was selected for review if full text was available. Only papers including ≥10 subjects who underwent surgical treatment were included in the systematic analysis. Data abstracted included the number of patients, patient age and sex, the type of surgical treatment, the method of outcome measurement, and outcomes and complications.
RESULTS
The literature search yielded 2,512 titles. Of these, 82 had a focus on GF, with 50 papers meeting the inclusion criteria. Of the 50 papers reviewed, 18 addressed surgical outcomes. The surgical techniques in these papers included open, minimally invasive, and arthroscopic release and radiofrequency ablation. Of 3,733 operatively treated patients in 6 reports who were evaluated on the basis of the criteria of Liu et al., 83% were found to have excellent results. Few papers focused on the incidence, prevalence, and natural history of GF, precluding quantitative synthesis of the evidence in these domains.
CONCLUSIONS
This study provided a systematic review of surgical outcomes and a summary of what has been reported on the prevalence, diagnosis, prognosis, and pathogenesis of GF. Although GF has been reported throughout the world, it requires further study to determine the exact etiology, pathogenesis, and appropriate treatment. Surgical outcomes appear satisfactory.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Topics: Adolescent; Buttocks; Child; Child, Preschool; Female; Fibrosis; Hip Contracture; Humans; Male; Muscle, Skeletal; Postoperative Complications; Treatment Outcome
PubMed: 30801376
DOI: 10.2106/JBJS.17.01670