Computed tomography of Ilio-Psoas muscle tumors

A retrospective evaluation of computed tomography scans done at our institution showing psoas muscle tumors is presented. The anatomy of the psoas muscle along with a discussion of normal psoas anatomy which can be mistaken for tumor are reviewed. Primary muscle tumors along with metastatic, neurogenic, and lymphomatous tumors affecting the psoas muscle is discussed. The use of computed tomography for assessment of extent, origin, and structure of psoas muscle tumors is demonstrated.     

Tuberculous psoas abscess

Although its historical significance is well established, Mycobacterium tuberculosis today is considered an extremely rare cause of psoas abscess. Nontuberculous bacterial infection, most commonly secondary to an intraabdominal process but at times appearing without an identifiable source, is responsible for the vast majority of psoas abscesses. The recent resurgence of tuberculosis may portend another change in the etiologic trend of psoas abscess. It is essential that the emergency physician not only recognize the potentially subtle presentation of psoas abscess, but also include tuberculosis in the differential diagnosis of infectious causes of this entity. A case of tuberculous psoas abscess in an HIV-negative man is presented. A review of the anatomy, pathophysiology, clinical presentation, epidemiology, and treatment follows, highlighting the similarities and differences between tuberculous and nontuberculous psoas infection.     

Combined Cardiomyopathy and Skeletal Myopathy: A Variant with Atrial Fibrillation and Ventricular Tachycardia

VLAY, S., et al. : Combined Cardiomyopathy and Skeletal Myopathy: A Variant with Atrial Fibrillation and Ventricular Tachycardia. This article describes a family characterized by combined cardiomyopathy and nonspecific skeletal myopathy who present in the third to fifth decades with cardiac manifestations but earlier have evidence of subtle skeletal muscle dysfunction. They differ from previously defined syndromes and potentially represent a different genetic expression or mutation. Cardiomyopathy presents with atrial arrhythmias including AF and atrial flutter. Life-threatening ventricular tachyarrhythmias occur next with onset of ventricular dysfunction. Electrophysiological study revealed sustained monomorphic VT. Affected family members benefitted from an ICD and progression to congestive heart failure (CHF) occurred late. Skeletal myopathy continues with marked progressive muscle weakness and inability to ambulate without assistance. Genetic analysis is currently ongoing. Neurological evaluation in all three family members revealed nonspecific myopathy affecting the psoas and iliopsoas muscles. Atrophy and wasting of the facial and temporalis muscles were common. Skeletal muscle biopsy revealed myofiber atrophy consistent with myopathy.     

Primary brucellar psoas abscess: presentation of a rare case of psoas abscess caused by Brucella melitensis without any osteoarticular involvement

The psoas abscess is an entity, sometimes forgotten in our daily practice, because of infrequency and difficulties in diagnosis. Primary psoas abscess is very rare and gram-positive micro-organisms account for more than 80% of the cases. Our case, a 62-year-old man was admitted with a 5-year history of back pain and fever. Physical examination was normal, except a palpable hepatomegaly with a mild tenderness over his lower right abdominal quadrant. The Brucella agglutination test was strongly positive with a titre of 1/640, as Rose Bengal Spot test. Blood cultures for brucella were positive on the fourth day and became negative, as the specific therapy started. Further examination with ultrasonography and computed tomography revealed an abscess of 40 + 75 mm in the psoas muscle. Complete resolution of symptoms achieved within 6 weeks. Although clinical presentation of psoas abscesses is often similar and non-specific, early aetiological diagnosis is extremely important, because of high achievement with appropriate antibiotic regimens. Brucellar psoas abscess seems very rare even in Turkey, where Brucella is still highly endemic. Such a case has not been previously reported from Turkey, as far as we know.     

定量CT分析椎旁肌与骨密度的相关性

目的采用定量CT探讨骨密度与椎旁肌的增龄性改变及二者的相关性。方法对2020年6~11月于我院行定量CT骨密度检查的患者进行回顾性分析,采用定量CT测量L3中部层面的椎旁后群肌（竖脊肌和多裂肌）的横截面积;采用星云医学影像后处理平台V9.0测量L4~5椎间隙的腰大肌（椎旁前肌群）的横截面积,分析椎旁肌与骨密度的随着年龄变化的规律和二者的相关性。结果女性的椎旁后群肌的含量（横截面积）在40~60岁明显增多,而男性的随着年龄增长而减少,右侧腰大肌含量随着年龄的增长而降低,而左侧的腰大肌含量在男性40~60岁明显增多,女性40岁以下明显增多。男性的椎旁肌含量随着年龄增长大于女性,骨密度也随着年龄增长而降低,男性骨密度大于女性（男性r=-0.625,P < 0.001;女性r=-0.600,P < 0.001）。腰大肌、椎旁后群肌与骨密度均呈正相关,男性相关性高于女性,右侧高于左侧（男性右侧椎旁后群肌r=0.432,P=0.009;左侧椎旁后群肌r= 0.401,P=0.017;右侧腰大肌r=0.510,P=0.002;左侧腰大肌r=0.447,P=0.007;女性右侧椎旁后群肌r=0.319,P < 0.001;左侧椎旁后群肌r=0.276,P < 0.001;右侧腰大肌r=0.279,P < 0.001;左侧腰大肌r=0.220,P=0.004）。结论椎旁肌随着年龄变化发生改变,男性椎旁肌的含量大于女性,骨密度与年龄呈负相关,腰大肌、椎旁后群肌与骨密度均呈正相关,男性的相关性高于女性,右侧高于左侧,男性的椎旁后群肌与骨密度的相关性低于腰大肌与骨密度的相关性,而女性的椎旁后群肌与骨密度的相关性高于腰大肌与骨密度的相关性。      

Psoas abscess

A psoas abscess is infrequently diagnosed on initial presentation. This report reviews the presentation of a patient with a complicated psoas abscess. The pathophysiology and the clinical and laboratory presentation of patients with this disease entity are reviewed.     

Psoas abscess secondary to tuberculous lymphadenopathy: case report

Tuberculous psoas abscesses, a well-known sequel of tuberculous spondylitis, very rarely develop without concomitant spinal involvement. We report a unique case where a psoas abscess was secondary to retroperitoneal tuberculous lymphadenopathy in a 13-year-old boy who had no demonstrable findings of spinal tuberculosis. Computed tomography showed an obvious communication between the necrotic and calcified retroperitoneal lymph node and the psoas abscess. To the best of our knowledge, fistulization of tuberculous lymph nodes into the psoas sheath has not been reported in the English-language literature. Received: 4 August 2000/Accepted: 6 September 2000     

A clinical comparison of psoas compartment and inguinal paravascular blocks combined with sciatic nerve block

The extent of inguinal paravascular blockade and psoas compartment blockade with sciatic nerve block was evaluated in 60 patients. Volumes of 30 ml and 20 ml 0.35% bupivacaine with 1/200,000 epinephrine were injected for lumbar plexus and sciatic nerve block, respectively. Complete lumbar plexus blockade was achieved in 73% of the group who were treated with the psoas compartment technique and 43% of the group who were treated with the inguinal paravascular technique. Sensory blockade of the femoral, lateral femoral cutaneous and obturator nerves was obtained in 100%, 97% and 77% of the patients in the psoas compartment group, and 93%, 63% and 47% of the patients in the inguinal paravascular group, respectively. Sensory blockade of the lateral femoral cutaneous and obturator nerves was more rapid with psoas compartment block. The study suggests that the psoas compartment block is effective in blocking the femoral, lateral femoral cutaneous and obturator nerves, but the inguinal paravascular block is only effective in blocking the femoral nerve.     

Extraartikuläres Weichteil-Impingement des Hüftgelenks

Introduction

Conservative treatment is the gold standard for painful extra-articular snapping abnormalities of the hips caused by the psoas tendon, trochanteric bursitis and the iliotibial band. Arthroscopic tenotomy, bursectomy or tractus release are indicated if conservative management is not successful. In addition to open techniques, various arthroscopic techniques have also been described.

Therapeutic options

There are three different arthroscopic techniques described for psoas tenotomy: the extra-articular method (tenotomy at the level of the lesser trochanter), the transcapsular technique (tenotomy through the peripheral compartment) and the central technique (tenotomy at the level of the anterior rim with distracted hips). Good results have been published for all three methods. The mechanical irritation of the psoas tendon after total hip replacement is a special indication for arthroscopic tenotomy. The results are good and it is less invasive than the complicated cup replacement procedure with fewer complications. A newly described syndrome is iliopsoas impingement where an atypical tear of the labrum at the anterior rim of the acetabulum occurs. Treatment is carried out by arthroscopic refixation of the labrum and tenotomy of the psoas tendon. Open or arthroscopic procedures are recommended to perform a bursectomy or tractus release but comparative studies are currently lacking.

Conclusion

If conservative treatment of internal snapping hip syndrome and mechanical psoas irritation after total hip replacement fails, arthroscopic psoas tendon tenotomy is an effective method. Bursectomy and tractus release for extra-articular snapping hip syndrome can be carried out by open or arthroscopic procedures with similar results. The scientific evidence in other extra-articular abnormalities of the hip remains poor.     

硬膜外和腰大肌肌沟两种阻滞治疗坐骨神经痛的临床观察

本文对４４０例神经根性坐骨神经痛病人采用硬膜外阻滞，用药配方为类固醇、维生素Ｂ族和利多卡因。对１２７例神经干性坐骨神经痛病人采用腰大肌肌沟阻滞，用药配方１．５％利多卡因和０．１％丁卡因混合液。按ＶＡＳ法及直腿抬高试验评分，分级分析疗效。硬膜外阻滞者总优良率为８５．２２％，腰大肌肌沟阻滞者总优良率为７４．８０％。腰大肌肌沟阻滞操作简便，疗效较好，适合于在门诊处理大量病人，是神经干性坐髓神经痛治疗的首     

Sigmoid diverticulitis presenting as unilateral iliofemoral vein thrombosis

The clinical and radiological findings in a patient presenting with unilateral iliofemoral vein thrombosis caused by psoas abscess secondary to diverticulitis of the sigmoid colon are described. The causes of iliofemoral vein thrombosis and psoas abscess are reviewed.     

电针委中穴对腰肌损伤家兔CK、VEGF和MVD的影响

目的:观察电针委中穴对腰肌损伤模型家兔腰肌磷酸肌酸激酶(CK)、血管内皮生长因子(VEGF)及微血管密度(MVD)表达的影响,从血管再生角度探讨针刺委中穴修复腰肌损伤的可能作用机制。方法:将32只雄性家兔随机分为电针委中穴组(委中组)、电针阿是组(阿是组)、模型组和空白组。委中组、阿是组、模型组均采用腰肌钝挫伤的方法造模,造模后委中组和阿是组分别给予对应穴位的电针治疗。2周后取材进行指标检测。结果:造模2周后,与空白组比较,模型组血清CK及腰肌VEGF和MVD的表达均明显增加(P0.01),委中组和阿是组血清CK和腰肌MVD的表达较空白组明显增加(P0.01,0.05),但腰肌VEGF的表达变化差异无统计学意义。与模型组比较,委中组和阿是组CK及腰肌VEGF和MVD的表达均下降(P0.01),委中组和阿是组的组间比较差异无统计学意义。结论:家兔腰肌损伤2周后,电针委中穴可以降低血清CK的含量,促进腰肌损伤修复,其机制可能与电针调控VEGF表达规律而使其提前发挥其再生血管的作用,缩短微血管再生时间而使微血管密度降低有关。     

The management of malignant psoas syndrome: case reports and literature review

Malignant psoas syndrome (MPS) was first described in 1990, and is characterized by proximal lumbosacral plexopathy, painful fixed flexion of the ipsilateral hip, and radiological or pathological evidence of ipsilateral psoas major muscle malignant involvement. There have been 23 case reports of MPS in medical journals. Despite being associated with a severe and difficult pain, there is no definitive approach to management presented in the palliative care literature. We review the relevant clinical features and the subsequent multidisciplinary pain management in relation to four new cases of malignant involvement of the psoas muscle, and the 23 case reports in the literature. We propose that MPS comprises a continuum of symptoms and signs related to the degree of anatomical destruction with associated inflammatory reaction and muscle spasm, and also the degree of lumbosacral plexopathy causing neuropathic pain. A protocol is presented for the management of the complex pain issues of MPS directed at likely mechanisms. The treatment options include opioids, agents for neuropathic pain, muscle relaxants to manage psoas muscle spasm, and anti-inflammatory agents to reduce peritumoral edema. Direct anti-tumor measures also need to be considered. Further prospective study is needed to validate the proposed methods of assessment and treatment.     

The use of patient-controlled boluses of local anaesthetic via a psoas sheath catheter in the management of malignant pain.

Patients who develop malignant infiltration of the psoas muscle and the lumbar plexus often experience a severe complex pain syndrome characterised by deep somatic pain, neuropathic pain and psoas spasm. Conventional analgesic regimes may not relieve these symptoms adequately. We describe the use of patient-controlled boluses of local anaesthetic via a psoas sheath catheter in this scenario. The recent availability of portable infusion pumps with the capability to deliver large volume boluses with long lockout times made this intervention possible and allowed the patient to be discharged home with effective relief of pain.     

Psoas compartment blockade in a laterally herniated disc compressing the psoas muscle -a case report-

A psoas compartment block has been used to provide anesthesia for orthopedic surgical procedures and analgesia for post-operative pain. Currently, this block is advocated for relieving pain in the lower extremity and pelvic area resulting from various origins. We report a case of a 69-year-old male patient who had gait abnormality with posterior pelvic and hip pain, which were both aggravated by hip extension. From the magnetic resonance image, the patient was found to have a laterally herniated intervertebral disc at the L2/3 level, which compressed the right psoas muscle. This was thought to be the origin of the pain, so a psoas compartment block was performed using 0.25% chirocaine with triamcinolone 5mg, and the pain in both the pelvis and hip were relieved.     

The Nonlinear Relationship Between Psoas Cross-sectional Area and BMI: A New Observation and Its Insights Into Diabetes Remission After Roux-en-Y Gastric Bypass

OBJECTIVETo explore the potential relevance of muscle mass as a variable contributor to BMI in limitations on BMI-based predictions of diabetes remission (DR) after Roux-en-Y gastric bypass (RYGB).RESEARCH DESIGN AND METHODSWe evaluated the relationship between muscle mass and BMI in 501 patients with type 2 diabetes mellitus and overweight or obesity, of whom 186 patients who underwent RYGB were studied for determination of the role of baseline muscle mass and BMI in predicting DR. Muscle mass was assessed by estimated fat-free mass index (eFFMI) and psoas cross-sectional area (CSA).RESULTSA nonlinear relationship existed between psoas CSA and BMI, whereas psoas CSA showed a highly positive correlation with eFFMI. Baseline psoas CSA and eFFMI were better than BMI for predicting 1- and 5-year DR.CONCLUSIONSThe nonlinear relationship between muscle mass and BMI may partially contribute to BMI limitations in predicting DR after RYGB.     

Typhlitis as a rare cause of a psoas abscess

Typhlitis is a life-threatening necrotizing process of the cecum associated with leukemia patients who have undergone chemotherapy. We present a rare complication of typhlitis in a boy with leukemia, in whom a right psoas abscess developed secondary to the inflammatory process of the cecum, with an emphasis on the computed tomographic findings of this severe and potentially life-threatening complication. Typhlitis should be added to conditions of the gastrointestinal tract that cause a psoas abscess such as Crohn's disease, diverticulitis, appendicitis, colorectal carcinoma, and appendiceal tumor. Received: 18 May 2001/Accepted: 15 June 2001     

Pain Management of Malignant Psoas Syndrome Under Epidural Analgesia During Palliative Radiotherapy

Malignant psoas syndrome is a rare malignant condition presenting as lumbosacral plexopathy and painful fixed flexion of the hip. Metastasis to the psoas muscle is observed, which damages the nerve bundles in the lumbosacral plexuses. The syndrome presents as refractory lower back pain with several other neurological symptoms. The pain is difficult to control because it is a mixture of nociceptive and neuropathic pain, which indicates that treatment requires a versatile approach. The authors report a case of severe back pain caused by metastasis to the psoas muscle of advanced gastric cancer in a patient who underwent palliative radiotherapy under epidural analgesia. Despite conventional analgesics and subcutaneous oxycodone, he had difficulties in maintaining supine position because of the back pain and had a problem to receive radiotherapy, which required him to stay still in the same position during the treatment. By epidural analgesia, he could remain in supine position and complete radiotherapy without increasing opioid administration. His back pain was improved after the radiotherapy. Epidural analgesia is an effective treatment choice for a patient who is unable to keep the position during palliative radiotherapy.     

Les lésions de la jonction myotendineuse du psoas-iliaque en traumatologie du sport

The psoas muscle, the main flexor of the hip joint, is highly solicited in sports activities. Sports injuries are however rarely encountered and described. We report a retrospective series of 33 cases of psoas musculotendinous tears at the point where the muscle changes direction over the iliopectineal eminence. History taking is essential to identify anterior hip pain with rapid or progressive onset. The physical examination searches for pain at hip flexion against resistance, observed in 78% of our cases, and a less sensitive sign, pain at muscle stretching. The morphology should be explored with ultrasound, which is highly contributive in the acute phase. MRI can provide complementary information if the injury is older or recurrent. If there is doubt about the diagnosis, the examination should be able to rule out other hypotheses: traumatic injury to the lower tendons, associated or not with bone detachment, abscess formation, or the more widely encountered psoas hematoma. Early management should focus on puncture aspiration of a hematoma associated with selective rest then rehabilitation over 4 to 6 weeks. Chronic and recurrent injuries may require local injections. An analysis of the sports movement should enable a specific management for each sport.     

Changes in biomechanical dysfunction and low back pain reduction with osteopathic manual treatment: Results from the OSTEOPATHIC Trial

The purpose of this study was to measure changes in biomechanical dysfunction following osteopathic manual treatment (OMT) and to assess how such changes predict subsequent low back pain (LBP) outcomes. Secondary analyses were performed with data collected during the OSTEOPATHIC Trial wherein a randomized, double-blind, sham-controlled, 2 × 2 factorial design was used to study OMT for chronic LBP. At baseline, prevalence rates of non-neutral lumbar dysfunction, pubic shear, innominate shear, restricted sacral nutation, and psoas syndrome were determined in 230 patients who received OMT. Five OMT sessions were provided at weeks 0, 1, 2, 4, and 6, and the prevalence of each biomechanical dysfunction was again measured at week 8 immediately before the final OMT session. Moderate pain improvement (≥30% reduction on a 100-mm visual analogue scale) at week 12 defined a successful LBP response to treatment. Prevalence rates at baseline were: non-neutral lumbar dysfunction, 124 (54%); pubic shear, 191 (83%); innominate shear, 69 (30%); restricted sacral nutation, 87 (38%), and psoas syndrome, 117 (51%). Significant improvements in each biomechanical dysfunction were observed with OMT; however, only psoas syndrome remission occurred more frequently in LBP responders than non-responders (P for interaction = 0.002). Remission of psoas syndrome was the only change in biomechanical dysfunction that predicted subsequent LBP response after controlling for the other biomechanical dysfunctions and potential confounders (odds ratio, 5.11; 95% confidence interval, 1.54–16.96). These findings suggest that remission of psoas syndrome may be an important and previously unrecognized mechanism explaining clinical improvement in patients with chronic LBP following OMT.