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American Family Physician Jan 2021Adults commonly present to their family physicians with hip pain, and diagnosing the cause is important for prescribing effective therapy. Hip pain is usually located... (Review)
Review
Adults commonly present to their family physicians with hip pain, and diagnosing the cause is important for prescribing effective therapy. Hip pain is usually located anteriorly, laterally, or posteriorly. Anterior hip pain includes referred pain from intra-abdominal or intrapelvic causes; extra-articular etiologies, such as hip flexor injuries; and intra-articular etiologies. Intra-articular pain is often caused by a labral tear or femoroacetabular impingement in younger adults or osteoarthritis in older adults. Lateral hip pain is most commonly caused by greater trochanteric pain syndrome, which includes gluteus medius tendinopathy or tear, bursitis, and iliotibial band friction. Posterior hip pain includes referred pain such as lumbar spinal pathology, deep gluteal syndrome with sciatic nerve entrapment, ischiofemoral impingement, and hamstring tendinopathy. In addition to the history and physical examination, radiography, ultrasonography, or magnetic resonance imaging may be needed for a definitive diagnosis. Radiography of the hip and pelvis should be the initial imaging test. Ultrasound-guided anesthetic injections can aid in the diagnosis of an intra-articular cause of pain. Because femoroacetabular impingement, labral tears, and gluteus medius tendon tears typically have good surgical outcomes, advanced imaging and/or early referral may improve patient outcomes.
Topics: Adult; Buttocks; Diagnosis, Differential; Family Practice; Female; Hip; Hip Injuries; Hip Joint; Humans; Male; Musculoskeletal Diseases; Pain
PubMed: 33448767
DOI: No ID Found -
Dermatologic Surgery : Official... Oct 2020The etiology of cellulite is unclear. Treatment of cellulite has targeted adipose tissue, dermis, and fibrous septae with varying degrees of success and durability of... (Review)
Review
BACKGROUND
The etiology of cellulite is unclear. Treatment of cellulite has targeted adipose tissue, dermis, and fibrous septae with varying degrees of success and durability of response.
OBJECTIVE
Results from clinical trials that target different anatomical aspects of cellulite can provide insights into the underlying pathophysiology of cellulite.
MATERIALS AND METHODS
A search of the PubMed database and ClinicalTrials.gov website was conducted to identify clinical trials that have investigated treatments for cellulite.
RESULTS
A lack of trial protocol standardization, objective means for quantification of improvement and reported cellulite severity, and short-term follow-up, as well as variation in assessment methods have made comparisons among efficacy studies challenging. However, the lack of durable efficacy and inconsistency seen in clinical results suggest that dermal or adipose tissue changes are not the primary etiologies of cellulite. Clinical studies targeting the collagen-rich fibrous septae in cellulite dimples through mechanical, surgical, or enzymatic approaches suggest that targeting fibrous septae is the strategy most likely to provide durable improvement of skin topography and the appearance of cellulite.
CONCLUSION
The etiology of cellulite has not been completely elucidated. However, there is compelling clinical evidence that fibrous septae play a central role in the pathophysiology of cellulite.
Topics: Aponeurosis; Buttocks; Cellulite; Clinical Trials as Topic; Extracorporeal Shockwave Therapy; Humans; Lipectomy; Massage; Microbial Collagenase; Muscle, Skeletal; Phototherapy; Radiofrequency Therapy; Skin; Skin Cream; Subcutaneous Fat; Thigh; Treatment Outcome
PubMed: 32976174
DOI: 10.1097/DSS.0000000000002388 -
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 -
Journal of Sports Science & Medicine Jun 2019The present systematic review aimed to analyze the activation of the muscles involved in the barbell hip thrust (BHT) and its transfer to sports activities that include...
The present systematic review aimed to analyze the activation of the muscles involved in the barbell hip thrust (BHT) and its transfer to sports activities that include horizontal displacement. A search of the current literature was performed using the PubMed, SPORTDiscuss, Scopus and Google Scholar databases. The inclusion criteria were: (a) descriptive studies, (b) physically trained participants, (c) analyzed muscle activation using normalized EMG signals or as a percentage of maximal voluntary isometric contraction (MVIC) and (d) acute or chronic transfer of the BHT to horizontal displacement activity. Twelve articles met the inclusion criteria and the following results were found: 1) neuromuscular activation: hip extensor muscles (gluteus maximus and biceps femoris) demonstrated greater activation in the BHT compared to the squat. The straight bar deadlift exercise demonstrated greater biceps femoris activation than BHT; 2) Regardless of the BHT variation and intensity used, the muscle excitation sequence is gluteus maximus, erector spinae, biceps femoris, semitendinosus, vastus lateralis, gluteus medius, vastus medialis and rectus femoris; 3) acute transfer: four studies demonstrated a significant improvement in sprinting activities after BHT exercise; 4) as for the chronic transfer: two studies demonstrated improvement of the sprint time, while other two studies failed to present such effect. We concluded that: a) the mechanics of BHT favors greater activation of the hip extensor muscles compared to more conventional exercises; b) regardless of the variation of BHT used, the muscle excitation sequence is gluteus maximus, erector spinae, hamstrings, and quadriceps femoris; c) the acute transfer of the post-activation potentiation of the BHT is significant, improving the sprinting time; and d) despite training with BHT submaximal loads can improve sprint times, further investigations are needed.
Topics: Biomechanical Phenomena; Buttocks; Hamstring Muscles; Hip; Humans; Isometric Contraction; Paraspinal Muscles; Posture; Quadriceps Muscle; Thigh; Weight Lifting
PubMed: 31191088
DOI: No ID Found -
Journal of Athletic Training Nov 2018Weakness or decreased activation of the hip abductors and external rotators has been associated with lower extremity injury, especially in females. Resisted side...
CONTEXT
Weakness or decreased activation of the hip abductors and external rotators has been associated with lower extremity injury, especially in females. Resisted side stepping is commonly used to address hip weakness. Whereas multiple variations of this exercise are used clinically, few data exist regarding which variations to select.
OBJECTIVE
To investigate differences in muscle-activation and movement patterns and determine kinematic and limb-specific differences between men and women during resisted side stepping with 3 resistive-band positions.
DESIGN
Controlled laboratory study.
SETTING
Laboratory.
PATIENTS OR OTHER PARTICIPANTS
A total of 22 healthy adults (11 men, 11 women; age = 22.8 ± 3.0 years, height = 171.6 ± 10.7 cm, mass = 68.5 ± 11.8 kg).
INTERVENTION(S)
Participants side stepped with the resistive band at 3 locations (knees, ankles, feet).
MAIN OUTCOME MEASURE(S)
We collected surface electromyography of the gluteus maximus, gluteus medius, and tensor fascia lata (TFL) for the moving and stance limbs during the concentric and eccentric phases. We also measured trunk inclination, hip and knee flexion, and hip-abduction excursion.
RESULTS
Hip-abductor activity was higher in women than in men ( P ≤ .04). The pattern of TFL activity in the stance limb differed by sex. Women performed the exercise in greater forward trunk inclination ( P = .009) and had greater hip excursion ( P = .003). Gluteus maximus and medius activity increased when the band was moved from the knees to the ankles and from the ankles to the feet, whereas TFL activity increased only when the band was moved from the knees to the ankles. Findings were similar for both the stance and moving limbs, but the magnitudes of the changes differed.
CONCLUSIONS
Compared with placing the band around the ankles, placing the band around the feet for resisted side stepping elicited more activity in the gluteal muscles without increasing TFL activity. This band placement is most appropriate when the therapeutic goal is to activate the muscles that resist hip adduction and internal rotation.
Topics: Adult; Ankle; Biomechanical Phenomena; Buttocks; Electromyography; Exercise; Female; Foot; Hip; Humans; Knee; Male; Muscle, Skeletal; Rotation; Sex Factors; Thigh; Torso; Young Adult
PubMed: 30615490
DOI: 10.4085/1062-6050-46-16 -
BMC Musculoskeletal Disorders Oct 2019Globally, low back pain (LBP) is one of the greatest causes of disability. In people with LBP, dysfunction of muscles such as the gluteus medius have been demonstrated...
INTRODUCTION
Globally, low back pain (LBP) is one of the greatest causes of disability. In people with LBP, dysfunction of muscles such as the gluteus medius have been demonstrated to increase spinal loading and reduce spinal stability. Differences in gluteus medius function have been reported in those with LBP compared to those without, although this has only been reported in individual studies. The aim of this systematic review was to determine if adults with a history, or current LBP, demonstrate differences in measures of gluteus medius function when compared to adults without LBP.
METHODS
MEDLINE, EMBASE, AMED, PsycINFO, PubMED, Pro Quest Database, CINAHL and SPORTDiscus were searched from inception until December 2018 for published journal articles and conference abstracts. No language restrictions were applied. Only case-control studies with participants 18 years and over were included. Participants could have had any type and duration of LBP. Studies could have assessed gluteus medius function with any quantifiable clinical assessment or measurement tool, with the participant non-weight bearing or weight bearing, and during static or dynamic activity. Quality appraisal and data extraction were independently performed by two authors.
RESULTS
The 24 included articles involved 1088 participants with LBP and 998 without LBP. The gluteus medius muscle in participants with LBP tended to demonstrate reduced strength and more trigger points compared to the gluteus medius muscle of those without LBP. The level of activity, fatigability, time to activate, time to peak activation, cross sectional area, and muscle thickness showed unclear results. Meta-analysis was not performed due to the heterogeneity of included studies.
CONCLUSION
Clinically, the findings from this systematic review should be considered when assessing and managing patients with LBP. Future studies that clearly define the type and duration of LBP, and prospectively assess gluteus medius muscle function in those with and without LBP are needed.
TRIAL REGISTRATION
PROSPERO ( CRD42017076773 ).
Topics: Buttocks; Humans; Low Back Pain; Muscle Strength; Muscle, Skeletal
PubMed: 31638962
DOI: 10.1186/s12891-019-2833-4 -
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 -
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