Unlock Your Hip Flexors
Psoas major Sartorius Psoas major Sartorius Psoas major Psoas major Sartorius Rectus femoris Sartorius Rectus femoris Adductor magnus Gracilis Semitendinosus Sartorius Adductor magnus Gracilis Semitendinosus Sartorius Adductor magnus Gracilis Adductor longus Great saphenous vein Sartorius Psoas major Pectineus Adductor longus Adductor magnus Gracilis
The sheet width quantification method was applied to MR images of a hip joint 37, 38 to determine the thickness of hip joint cartilage. The original voxel dimensions were 0.62 x 0.62 x 1.5 (mm3). Sinc interpolation was applied along the z-direction to make the voxel isotropic, and then further applied along all the three directions to make the resolution double. The resultant sampling pitch was 0.31 (mm) in all the three directions. The volume size used in the experiment was 256 x 256 x 100 (voxels) after interpolation. In the related work 10 , hip joint cartilages were assumed to be distributed on a sphere approximating the femoral head. The user needs to specify the center of the sphere, and the cartilage thickness is then estimated along radial directions from the specified center. The method applied here does not use the sphere assumption, and thus can potentially be applied to badly deformed hip joints as well as to articular cartilages of other joints.
The need for uniform outcome variables when reporting treatment effects has led to a proposition of a score by Sartorius and co-workers. This classification allows for better dynamic monitoring of disease severity in individual patients, and therefore forms a complimentary system to the Hurley classification. The Sartorius score lacks a subjective evaluation of the patient, i.e. what is the burden of disease for the individual patient How much pain
Cartilage is a gelatinous matrix that covers bone surfaces at a large number of articulations. It is glassy smooth, glistening, and bluish-white in appearance. It is found in the connections between the ribs and the sternum, and on the surface of articulating bones of the shoulder and hip joints, elbow, knee, and the wrist. Cartilage pads are positioned between spinal vertebrae. One important function of cartilage is to absorb com-pressive shocks and thereby prevent bone damage. Cartilage drastically reduces friction between opposing bony surfaces and enables rotation of one surface over the other. The only cell type found within the cartilage matrix are chondrocytes. These cells live in small pockets known as lacunae, and all nutrient and waste product exchange occur by diffusion
The adult hip is a multiaxial ball-and-socket synovial joint composed of two bony structures the femur and the acetabulum. This bony architecture provides the hip with inherent stability. Three biomechanical and anatomic geometries of the femur and acetabulum are significant to joint stability and preservation of the labrum and articular cartilage appropriate femoral head-neck offset, acetabular anteversion, and acetabular coverage of the femoral head. Proper function of the hip joint necessitates that the amount of offset from the femoral head to the femoral neck be enough to allow a full range of motion without impinging upon the acetabular labrum. A lack of offset from the femoral head to the femoral neck has been described as a cause for femoroacetabular impingement 1 . Flexion at the hip may cause the osseous femoral head-neck junction to come into contact with the acetabular labrum, resulting in impingement 1-3 . A large femoral head can compensate for a flat head-neck junction...
EMG is a technique used to measure the electrical input (excitation) of a specific muscle. Considerable literature regarding EMG of the hip musculature for walking, climbing stairs, and various sporting motions has been reported. Due to space limitations and the completeness of data content, only the EMG of hip muscles during gait are presented below. Although EMG studies are valuable in determining which and when individual muscles are active, it is important to note that EMG cannot provide information regarding the amount of force a specific muscle is producing. This limitation of EMG underscores the importance of computer modeling techniques in understanding hip mechanics during functional activities and in understanding the basic mechanics associated with hip stabilization and the interaction of bony geometries and the actual muscle forces that stabilize the hip joint. Pectineus, Pirifirmis, Superior and Inferior Gemullus, and Obturator Internus and Externus Muscles Studies on the...
Times ''myofilamentous masses''), form the major portion of the muscle cell. Archetypal tonic skeletal muscle, such as the frog sartorius, exhibits an extreme degree of regularity of its myofibrils, each of which is cylindrical, uniform in diameter, and closely aligned with its neighbors in terms of sarcomere register. The presence of uniform, small-diameter myofibrils is said to constitute a Fibrillenstruktur, whereas larger, amorphous masses of myofilaments are termed Felderstruktur. In the fast-beating hearts of such small mammals as shrew and mouse, the myofibrils of working cardiomyocytes tend to be of smaller diameters (i.e., more nearly a Fibrillenstruktur e.g., see Fig. 3) than those of cells in slower-beating hearts (e.g., dog, monkey), whose myofibrils are thicker and more variable in cross-sectional profile (Felderstruktur) (Figs. 4 and 5). An obvious consequence (or, perhaps, advantage) of having a contractile system of Fibrillenstruktur conformation is the conferral of a...
For example, the addition of Ba2+ (0.5 mM) to frog sartorius muscle fibers, which have a high gCl gK ratio of about 4.0, has very little immediate effect. However, when the fibers are first equilibrated in Cl -free solution to reduce gCl to zero, Ba2+ produces a prompt depolarization, an increase in Rm , and automaticity. Another way to view this effect of Cl- is by Cole's (1968) parallel capacitance-inductance (CmLm) circuit for an excitable membrane that tends to oscillate spontaneously when the RCi shunt resistance (and RNa) is very high. The apparent inductance Lm arises because of the peculiar behavior of the K+ resistance, namely, anomalous rectification. The rapid turnoff of this inwardly rectifying K+ channel causes a very fast decrease in gK with depolarization.
Cephalosporin C is first oxidized and deaminated by a D-amino acid oxidase (DAO), which can be obtained from various fungal species, like the yeasts Trigo-nopsis variabilis and Rhodotorula gracilis or the ascomycete Fusarium solani. The resulting a-keto-adipyl-7-ACA, upon decarboxylation, is converted into glutaryl-7-ACA (G-7-ACA). DAO is a flavoenzyme containing flavin adenine dinucleotide as the prosthetic group and catalyzes oxidation of D-amino acids to their corresponding keto acids. In a second step, the glutaryl side chain of G-7-ACA is deacyl-ated by a glutarylamidase from Pseudomonas diminuta 263 . The molecular data of other potentially suitable enzymes and genes from various sources are given by Isogai 264 . It is noteworthy that the enzymatic splitting process could have only been rendered economical and therefore commercially employable through a significant increase of glutarylamidase yield on the fermentation level by using a gene-recombinant E. coli-strain.
Further spread of disease extends above the renal vessels in the retroperitoneal and retrocrural spaces. Lymphatic spread may also extend to nodes lateral to the paracaval and para-aortic groups these nodes are are sometimes referred to as echelon nodes. The so-called echelon node on the right was first described by the anatomist Rouviere, in his elegant description of anatomic dissection.10 An echelon node on the left has also been described. With the knowledge derived from CT, it is now clear that these echelon nodes lie on the anterior surface of the iliopsoas and, although an unusual site of disease, may be a first site of relapse (Figure 6-4).11
The muscles that move the thigh are attached to the femur and to some part of the pelvic girdle. (An important exception is the sartorius, described later.) They can be separated into anterior and posterior groups. The muscles of the anterior group primarily flex the thigh those of the posterior group extend, abduct, or rotate it. The muscles in these groups are shown in figures 9.35, 9.36, 9.37, 9.38, in reference plates 66 and 67, and are listed in table 9.12. Muscles that move the thigh include the following Psoas major Gluteus maximus Pectineus Adductor magnus Adductor longus Gracilis
The earliest known fossil of the Pedetidae was recorded from the early Miocene at Elizabethfeld in Namibia as Para-pedetes namaquensis while a larger form of the modern spring-hare (Megapedetes) appeared later in the Miocene in East Africa. The fossil record may be traced via the early Pliocene site at Taung (P. gracilis) in the northwestern Cape Province of South Africa (where notable australopithecine remains were discovered) to Pleistocene deposits in Bulawayo, Zimbabwe (as Pedetes capensis).
The ureters begin at the ureteropelvic junction, where the renal pelvis joins the ureter. Within the abdomen, the ureters descend retroperitoneally and anterior to the psoas major muscle, where they cross the pelvic inlet to enter the minor (true) pelvis. Within the minor pelvis, the ureters descend retroperitoneally and anterior to the common iliac artery and vein, where they may be compromised by an aneurysm of the common iliac artery. The ureters end at the ureterovesical junction by traveling obliquely through the wall of the urinary bladder (intramural portion of the ureter), and they define the upper limit of the urinary bladder trigone. The intramural portion of the ureter functions as a check valve (ureterovesical valve of Sampson) to prevent urine reflux.
Some species of medusae (e.g., Gonionemus) can inflict severe stings on humans, as do some hydroid colonies such as the species of Millepora (fire corals) and some aglaopheniids. When present in swarms, even small medusae like those of Clytia can inflict slight stings on swimmers. The most important threat to human activities is the predation of some medusae (e.g., Aequorea victoria) and floating hydroids (e.g., Clytia gracilis) on the eggs and larvae of commercially exploited fish. This kind of predation can reduce the success of fish recruitment, reducing the yield of fisheries.
Fig. 8.60 The sagittal MR section of the hip joint (left) after the intravenous administration of contrast demonstrates an effusion in the joint surrounded by contrast-enhancing synovium (arrow). Compare the normal contralateral side (right). Fig. 8.60 The sagittal MR section of the hip joint (left) after the intravenous administration of contrast demonstrates an effusion in the joint surrounded by contrast-enhancing synovium (arrow). Compare the normal contralateral side (right).
The respiratory diaphragm is the musculotendinous sheet separating the abdominal and thoracic cavities (Fig. 7). It is also considered the primary muscle of respiration. The diaphragm originates along the inferior border of the rib cage, the xiphoid process of the sternum, the posterior abdominal wall musculature, and the upper lumbar vertebra. The medial and lateral arcuate ligaments are thickenings of the investing fascia over the quadratus lumborum (lateral) and the psoas major (medial) muscles of the posterior abdominal wall that serve as attachments for the diaphragm (Fig. 7). The vertebral origins of the diaphragm are the right and left crura. The crura originate on the bodies of lumbar vertebrae 1-3, their intervertebral discs, and the anterior longitudinal ligament spanning these vertebrae.
(1) The ball-and-socket-type synovial joint has the freest motion in all directions. A spherically rounded head (ball-like) fits into a receiving concavity (socket). The hip joint is an example of the ball-and-socket type, with the spherical head of the femur fitting into the cup or socket (acetabulum) of the pelvic bone.
Using scissors, transect the sartorius and gracilis, and lift aside their cut edges to observe the deeper muscles of the thigh. rectus femoris 6. Transect the tensor fasciae latae and rectus femoris muscles and turn their ends aside. Locate the vastus intermedius and vastus lateralis muscles beneath. (Note In some specimens, the vastus intermedius, vastus lateralis, and vastus medialis Sartorius Gracilis External oblique Rectus abdominis Tensor fasciae latae Rectus femoris Vastus medialis Gracilis (cut) Gracilis (cut) Adductor group Semimembranosus Rectus femoris Sartorius Gracilis
The shoulder joint is formed by the head of the humerus and the small, shallow pear-shaped cavity of the scapula. This joint allows the greatest range of motion of any joint in the body, mainly because the cavity of the scapula is shallow in depth and also the articular capsule enclosing it is remarkably loose. Perhaps because of the greater degrees of freedom, the shoulder joint is also the most frequently dislocated joint.
Achilles' tendon Adductor longus Adductor magnus Biceps femoris Gracilis (X2) Gastrocnemius (X2) Gluteus maximus Gluteus medius Rectus femoris Sartorius Semimembranosus Semitendinosus Soleus Tensor fascia lata Tibialis anterior Vastus lateralis (X2) Vastus medialis Achilles's tendon (not a muscle) Pectineus Adductor longus Gracilis Rectus femoris Sartorius Sartorius
These complaints likely reflect lesions of the myelinated posterior columns (fasciculi gracilis and cuneatus), rather than the spinothalamic tracts (36). In contrast, objective sensory signs of diminished pain and temperature sensation indicate involvement of the latter pathways. Vibratory sense impairment is extremely common and almost always precedes detectable abnormality of joint position sense. The author has observed subtle reduction in the ability to perceive a vibrating tuning fork in many mildly affected patients early in the course of the disease.
After injection, patients are transferred on a stretcher to the MR unit within 30 minutes to minimize chance of extravasation from the joint. All hips are imaged on 1.5 Tesla field strength MRI or higher to allow for sufficient signal and resolution. We use a phased array surface coil centered over the hip 12 . Scout images are checked to ensure proper coverage and signal output. We prefer a smaller field of view (14-16 mm) to enhance resolution and visualization of the labrum. We also use a combination of T1- and T2-weighted sequences with and without fat saturation in the true coronal and sagittal planes, as well as the oblique axial plane, that is directly perpendicular to the anterior acetabu-lum (ie, parallel to femoral neck) (Fig. 3). Our diagnostic checklist includes not only evaluation of the labrum, but a search for cartilage defects, ligamentum teres tears, anterior and posterior capsular injuries, joint debris, iliopsoas and rectus femoris insertional injuries, marrow...
The end of the gonopodium has hooklike structures to facilitate the transfer of the spermatozeug-mata. It is not known how the bundles are transported to the tip of the gonopodium. Females can store sperm for extended periods of time. Some females are capable of superfetation, that is, they have the ability to carry more than one brood of embryos at different stages of development. There are two gestation extremes in type 1 the embryo is nourished by the yolk reserves laid down before fertilization ( lecithotrophy ) in type 2 the egg is very small, without much yolk, but the embryo is heavily nourished by maternal fluids transferred by a kind of placenta ( matrotrophy ). There are various intergrade levels of maternal nourishment, depending on the species. In Tomeurus gracilis, the egg is expelled, and development is external and dependent on the yolk reserve. This exceptional situation is, in reality, an extreme form of type 1 gestation. For the rest of the...
As arthroscopic treatments of the hip continue to evolve, there is an increasing need to understand the basic performance biomechanics of the hip joint. This information is important, as it can provide the foundation by which joint function, pathology, and therapeutic modalities can be evaluated. There are a number of recent studies that have applied different approaches to study the hip biomechanics, particularity in THR. However, there is clearly a void in the 17 Fuss FK, Bacher A. New aspects of the morphology and function of the human hip joint ligaments. Am J Anat 1991 192(1) 1-13. 36 Herzog W, ter Keurs HE. Force-length relation of in-vivo human rectus femoris muscles. Pflugers Arch 1988 411 (6) 642-7. 39 Van Den B, Anton J, Read L, et al. An analysis of hip joint loading during walking, running, and skiing. Med Sci Sports Exerc 1999 31(1) 131-42. 41 Paul JP. Biomechanics. The biomechanics of the hip-joint and its clinical relevance. Proc R Soc Med 1966 59(10) 943-8. 45 Bullough...
Behavioral and psychological signs and symptoms of dementia are heterogeneous and can be difficult to categorize, even for the expert. However, clinical experience and studies teach us that certain symptom patterns can be discerned a relatively recent consensus conference on the issue asserted in a summary statement issued by the International Psychogeriatric Association that behavioral signs and symptoms occur commonly and can include observable motor and verbal behaviors as well as psychological phenomena (Finkel, Costa e Silva, Cohen, Miller, & Sartorius, 1996). These signs and symptoms, summarized in Table 12.1, do not meet the usual criteria for
The muscles that stabilize the shoulder, hip, and the limbs are called the appendicular musculature. These muscles account for approximately 40 of the human musculature. The appendicular musculature is divided into two groups (1) the muscles of the shoulders and upper extremities (arm, forearm, hand) and (2) muscles of the pelvic girdle (hip joint) and lower extremities (thigh, leg, foot). Some of the muscles of the appendicular musculature act on a single joint. These are called monoarticular muscles. Gluteus maximus, the major muscle group of the buttocks, is a monoarticular muscle it only acts on the hip joint. Other muscles may act at two or more joints. For example, the hamstring muscle, the semitendinosus and biceps femoris, traverses two joints and acts both on the hip and the knee. These muscles have the capacity to extend at the hip and flex at the knee. The quad muscle, rectus femoris, and the calf muscle, gastrocnemius, also act on two joints and as such are called...
Euglena gracilis g-tocopherol methyltransferase (c.f E.C. 126.96.36.199), molecular weight 150000 and optimum pH 7.5, incorporates a methyl group into both g-tocopherol and b-tocopherol, in both cases forming a-tocopherol G754 . 3-Octa- and 3-nonaprenyltoluquinols are formed in Euglena gracilis and sugar beet, with octaprenyl- and nonaprenyl pyrophosphates as co-substrates respectively g-tocopherol is another product A201, A1584, G754 . Plastoquinones, a- and g-tocopherol are formed in spinach and lettuce chloroplasts, with phytyltoluquinone as a possible intermediate A2522, D902 .
A tulip anther enzyme, molecular weight 55000 and optimum pH 8.0 acts on p -coumaroyl CoA, feruloyl CoA and caffeoyl CoA to form naringenin, homoeriodictyol and eriodictyol respectively it is inhibited by CoA, flavanones and thiols. The preparation was claimed to be free from chalcone-flavanone isomerase activity the expected chalcone intermediates were not detected A3792 . A similar enzyme found in Haplopappus gracilis, optimum pH about 8 for p-coumaroyl CoA, and 6.5-7 for caffeoyl CoA was called flavanone synthase. The reaction was not stoichiometric, with small amounts of by-products such as benzalacetones being formed A3362 a similar series of reactions was found in Petroselinum crispum A2618 . These publications all come from early studies on the enzyme system, and despite the claims that chalcone-flavanone isomerase activity was
Is caused by the disease And how is the quality of life affected Pain can be assessed on a visual analog scale (VAS), and the quality of life may be assessed using a validated questionnaire such as the Dermatology Life Quality Index (DLQI) or Skindex. In a study of quality of life in 60 pa-3 tients a good correlation was observed between the Sartorius score and the Skindex score for quality of life, offering support for the validity of the proposed scores 13 .
Key features of any investigations should remain the randomization, which has independent value even when assessed in an open or a single-blinded fashion. The central problem is one of control, but in an exploratory period abstention from active treatment is enough. In future cases sham procedures may be carried out when possible, providing there are objective documentation and an adequate follow-up. There must be randomization of both patients and lesions to prevent bias. Follow-up should be for a minimum of 3-6 months and it is advisable to include both patient-centered subjective methods of assessment as well as more objective methods. Subjective methods can include health-related quality of life questionnaires developed for skin diseases, e.g., DLQI or Skindex 14, 15 , and VAS scores of pain and disease severity. Objective quantification may include standardized clinical scores such as the Sartorius score 16 , ultrasound imaging and photography.
Quantification of the material properties of bone, such as strength and elastic modulus, using noninvasively measured parameters is important to predict fracture risk and evaluate effects of treatment for osteoporotic patients. Osteoporotic change is initiated from trabecular bone within both ends of long bones, vertebral bodies of the spine, flat bones such as the pelvis, and carpal and tarsal bones. Therefore, fractures related to osteoporosis occur in the trabecular-bone-rich regions. The vertebral body, distal radius (wrist joint), and proximal femur (hip joint) are the most common sites for fractures associated with the osteoporosis. There are three major approaches (assumptions) to predicting material properties (Fig. 10).
The hip assumes an essential role in most sports-related activities. The hip is not only responsible for distributing weight between the appendicular and axial skeleton, but it is also the joint from which motion is initiated and executed. It is known that the forces through the hip joint can reach three to five times the body's weight during running and jumping 1,2 . Considering the amount of demand athletes place on their hips, orthopedic surgeons will evaluate them as patients having hip pain. blur the lines in appropriately differentiating between the hip and back 17-22 . Low back pathology involving the paravertebral muscles can lead to an abnormal soft tissue balance, causing an irregular tension absorbed by the hip joint, which leads to knee pain, groin pain, leg length discrepancies, and limited ranges of motion in the hip 23 . Muscle contractures of the hip flexors or extenders as well as leg length discrepancy have also been identified as factors that can cause hip and low...
Once the static stabilizers of the hip including the iliofemoral ligament and labrum are injured, the hip must rely more on the dynamic stabilizers for stability. It is hypothesized that when capsular laxity is present, the psoas major, a dynamic stabilizer of the hip, contracts to provide hip stability. Over time, this condition can lead to stiffness, coxa saltans, or flexion contractures of the hip 14 . In addition, due to the origin of this muscle from the lumbar spine, a chronically contracted or tightened psoas major may be a major contributor to low back pain. Thus, hip instability or capsular laxity can trigger a whole spectrum of disorders that the physician must take into consideration when considering various treatment options.
Begin with the muscles on the medial side. Note the presence of two large wide surface muscles. The lateral muscle is the sartorius, the medial muscle is the gracilis. On a human these two muscles are relatively narrow and do not hide the underlying muscles as they do in the cat. Furthermore the sartorius is an anterior muscle in the human. Remove the gracilis and sartorius from the hip on one side to expose the deeper muscles. Deep to the sartorius are the lateral tensor fascia lata muscle with its broad, coarse tendon and the quadriceps femoris. The quadriceps femoris as its name suggests is composed of four parts. Each part is a muscle with its own name. These four are the vastus lateralis (located laterally), rectus femoris (central), vastus medialis (medial) and the deep vastus intermedius which cannot be seen unless you pull or cut the rectus femoris out of the way. Deep to the gracilis are two of the hamstrings and the adductors. The semitendinosus is barely visible on the...
Several species are currently regarded as not threatened as a result of their widespread distribution. Three species are listed as Endangered Dactylopsila tatei lives on Fergusson Island and possibly on Goodenough Island, a small island west of New Guinea P. gracilis lives only in a small area in north Queensland, and relies on sap of grass trees (Xanthorrhoea) part of the year and Leadbeater's possum, which lives in a very small and diminishing area in Victoria. Almost all the known populations of G. leadbeateri live in a eucalypt area destined for rotary clear-felling every 50-80 years. Some other species are considered Vulnerable due to habitat loss. A captive breeding program and recovery plan has been established for Gymnobelideus. For P. australis and P. norfolcensis, recovery plans are being implemented to identify habitat threats, protect key habitats, etc.
Projectional errors which reduce the accuracy of plain radiographs preclude the determination of crucial angles such as the orientation of the acetabulum. After further processing, 2D CTs of the pathological hip joint provide all essential angles but inaccuracies caused by positioning and projection errors remain. In contrast, 3D-CT analysis for preoperative planning enables the surgeon to take all important angles into consideration and provides accurate measurements.
Article, chapter, and book citations on the PsychLit using culture and health psychology as key words are limited. For example, a search on chapters and books for the period of 1987 to 1996 produced 13 citations, only 2 of which (i.e., Keitel, Kopala, & Georgiades, 1995 Schroder, Rescheke, Johnston, & Maes, 1993) were specifically related to culture and health psychology. The PsychLit citation for books, however, was not inclusive of the volume edited by Dasen, Berry, and Sartorius (1988) Health and Cross-Cultural Psychology Toward Applications.
That the family's ability to make reasonable decisions is underestimated. Also, a physician's medical expertise is confused with moral expertise when in fact physicians have no special moral credentials. It is not clear that the court has special moral credentials either. Additionally, the problem with decision making by the court is that such a process is very costly, cumbersome, and slow and ignores the special moral relationship between the patient and the family. Detailed criticism of the medicalization and or judicialization of decision making is widespread in the literature (Beauchamp & Childress, 1994 Buchanan & Brock, 1989 Cranford & Doudera, 1984 Faden & Beauchamp, 1986 President's Commission, 1983 Sartorius, 1983).
Blood-stream parasite Trypanosoma brucei, which is closely related to the photosynthetically-active euglenophyte Euglena gracilis, possesses a gnd gene of cyanobacterial origin and might therefore be secondarily non-photosynthetic (Krepinsky et al. 2001 Martin and Borst 2003). In other studies, Andersson and Roger (2002) discovered that oomycetes and some heteroloboseid amoebo-flagellates harbor cyanobacterial gnd genes, too a lateral gene transfer event might explain these results. Alternatively, the gnd phylogeny could indicate that these organisms once harbored plas-tids of primary or secondary origin. If the latter is true, more genes of cyanobacterial origin should be found in ongoing genome projects.
Adaptation by acquisition of prokaryotic genes does not seem to be restricted to anaerobic protists within the eukaryotic domain. For example phy-logenomic analyses of apicomplexan genome sequences - extensively covered in Chapter 8, Huang and Kissinger, of this book - have shown that LGT plays a role in the genome evolution of these parasites, including modification of the metabolic repertoire (Huang et al. 2004 Striepen et al. 2004). Like apicomplexans, kinetoplastids are parasitic protists that have evolved from free-living ancestors. Indeed, a recent phylogenomic analysis of the three available kinetoplastid genomes - Trypanosoma brucei, Trypanosoma cruzi, and Leishmania major - identified almost 50 genes showing strong support for prokaryote-to-eukaryote transfers (El-Sayed et al. 2005). The gene encoding dihydroorotate dehydrogenase of Trypanosoma cruzi is one kinetoplastid gene with a prokaryotic origin that has been studied in more detail (Annoura et al. 2005). This enzyme is...
Until recently, sports-related hip injuries have received little attention. There are three reasons for this. First, perhaps hip injuries are less common than other joints. Second, investigative skills for the hip have been less sophisticated, including clinical assessment and imaging studies. Third, there have been fewer interventional methods available to treat the hip including both surgical techniques and conservative modalities. Thus, there has been little incentive to pursue this area when there were few treatment options available. Operative arthroscopy has revolutionized the management of athletic hip injuries. Numerous intraarticular disorders have been identified that previously went unrecognized and untreated. In the past, athletes were simply resigned to living within the constraints of their symptoms, often ending their competitive careers. This is a work in progress. Clinical assessment skills are improving understanding of hip joint...
Charcot's sign Right upper quadrant pain, jaundice, fever gallstones. Courvoisier's sign Palpable, nontender gallbladder with jaundice pancreatic malignancy. McBurney's point tenderness Located two thirds of the way between umbilicus and anterior superior iliac spine appendicitis. Iliopsoas sign Elevation of legs against examiner's hand causes pain, retrocecal appendicitis.
Among the species, great variation in size, scalation, diet, habitat, and many other characters can be seen. There are several species of erycine snakes that are not known to exceed 3 ft (1 m) in length. The Haitian vine boa, Epicrates gracilis, is one of the most elongate and slender of all snakes. The boa constrictor is a large species, approaching 15 ft (4.6 m) in maximum length.
One of the diseases carrying major 3D problems is slipped capital femoral epiphysis (SCFE), defined as the slippage of the femoral head relative to the femoral neck along the proximal femoral growth plate. This disease affects particularly the proximal femur of adolescents whose growth plate is not yet calcified and therefore is soft enough to give way for a slippage under certain circumstances. During a slippage the femoral head shifts and rotates along the proximal end of the femoral neck, usually posteriorly and inferiorly (Fig. 1). Such a slippage changes the geometry of the hip joint, leading to an incorrect position of the femoral head relative to its joint partner, the acetabulum. This misalignment is the cause of a dysfunction of the hip joint. Initially the loss of motion may be tolerated, but eventually pain and stiffness of the joint will result from early arthritic degeneration.
Proximal and distal are terms applied specifically to the limbs. Proximal means nearer to the shoulder joint or the hip joint. Distal means further away from the shoulder joint or the hip joint. Sometimes proximal and distal are used to identify the beginning and end of the gut tract--that portion closer to the stomach being proximal while that further away being distal.
Dynamic movement occurs at the hip joint and is characterized and constrained by the anatomy of the region, including osseous, ligamen-tous, and musculotendonous structures. The majority of patients who require hip arthroscopy are young, active individuals with a history of hip or groin pain. In some athletes, the onset of hip pain may be due to a traumatic event such as a fall, tackle, or collision. However, in many sports, athletes suffer a minor hip injury or perform repetitive motions that exacerbate a chronic pathologic or congenital hip condition that leads to increased capsular laxity and labral tears over time. One of the obvious benefits of arthroscopic hip surgery in this population is that it allows the surgeon to perform procedures within the hip joint with a minimal amount of postoperative morbidity, allowing for a return to sporting activities in a shorter time period. This type of surgery is relatively new, with only a few experts advancing in the field worldwide....
Kevin Crawford MDab Marc J Philippon MDcd Jon K Sekiya MDe William G Rodkey DVMc J Richard Steadman MDcd
Technologic advance and refinement of technique have together revolutionized the modern field of hip arthroscopy. These advances have enabled surgeons to address subtle pathology in and around the hip joint that previously was either misdiagnosed or poorly understood. As both the indications and the applications of this surgical technique have expanded, one area of significant interest in the hip joint is articular cartilage injury. Previous authors have shown that articular cartilage defects rarely heal spontaneously regardless of whether acute, chronic, or degenerative 1 . The vast majority of studies addressing the treatment of articular cartilage lesions have involved the knee. Various techniques have been employed in an attempt to treat this difficult problem including abrasion chondroplasty, osteochondral drilling, the use of osteoarticular autograft or allograft plugs, bulk allograft techniques, autologous chondrocyte implantation, and microfracture 2-6 . Microfracture of the...
They include the psoas major, iliacus, gluteus maximus, gluteus medius, gluteus minimus, tensor fasciae latae, pectineus, adductor longus, adductor magnus, and gracilis. b. They include the biceps femoris, semitendinosus, semimembranosus, sartorius, and the quadriceps femoris group.
Euglenophytes are suitable for studying the effects of photosynthetic loss in unicellular organisms. Two of them, the photosynthetically active Euglena gracilis (Hallick et al. 1993) and the leuco-plast bearing and photosynthetically inactive Astasia longa (Gockel and Hachtel 2000), share many common features in their plastid genomes for example two tandemly arranged direct repeats (TR). On the other hand they differ in gene content, especially in genes encoding for components of the photosynthesis machinery, which have been lost in A. longa. Therefore, the situation seems very similar to that in parasitic land plants, in which loss of functions led to the loss of the corresponding genes. Thus, their plastid genomes are dynamic structures from which genes are simply eliminated when their encoded functions are no longer necessary. The deletion of all photo-synthetic genes led to the shrunken plastome of 73 kb in Astasia longa, which is only half the size of the Euglena gracilis...
Maintaining an appropriate femoral head position within the joint capsule and labral complex is paramount to normal hip function and failure in this mechanism can lead to debilitating labral and cartilage compression in active individuals. Thus, hip congruency, although affected by, is not solely dependent upon the femoral head-acetabular bony and labral constituents for complete hip stabilization. The ligaments described above and the muscles that cross the hip joint contribute and provide for articular congruency (ie, proper joint rotation of the femoral head within the acetabular-labral complex) and maintain articular stabilization (ie, limit translations of the femoral head within the acetabular-labral complex). To accomplish this, muscles that cross the hip must act as force
Anderson and Pandy 38 developed a muscle model that included select hip musculature to analyze a complete gait cycle. This model contained 54 independent muscles, and the results estimated each muscle's contribution to the support phase of gait. A muscle's potential for generating support was described by its contribution to the vertical ground reaction force per unit of muscle force. Of the hip muscles, the gluteus medius, maximus, and minimus provided the majority of the support in first 0 to 30 of stance (Fig. 1A) . From foot flat to just after contralateral toe-off (eg, 10-50 of stance), the gluteus maximus and posterior medius minimus contributed significantly to the vertical ground reaction force. With assistance from joints and bones to gravity, the anterior and posterior gluteus medius minimus generated nearly all the support evident in midstance. Posterior gluteus medius minumus provided support throughout midstance, while the anterior gluteus medius minimus contributed only...
The function of these ligaments has been well described in terms of limiting ranges of motion. There is debate in the literature over which ligament might limit what motion. Most authors agree that the iliofemoral ligament limits extension 16 , the pubofemoral ligament limits abduction, and the ischiofemoral ligament limits internal rotation. It is thought that with an elongated or surgically resected iliofemoral ligament, the ligamentum teres has a limiting effect on external rotation. There is debate regarding the ligament limitation in other motions and debate as to what role is played by the functional subdivisions of each ligament (such as the lateral and medial iliofemoral ligament) 17 . The ligamentum orbicularis appears to be overlooked as a major key in stability of the hip joint. Traditionally, the ligamentum orbicularis was thought to be relevant only to extension by tightening the posterior capsule 18 . It now appears to play a vital role in stability, particularly in the...
The hip joint is a ball and socket joint enveloped in dense capsular tissue. The Y-shaped triradiate cartilage acetabulum covers 170 of the femoral head 3 . The acetabular labrum is a fibrocartilaginous structure that outlines the ace-tabular socket. Labral attachment occurs at the periphery of the labrum to the capsule, and is anchored anteriorly and posteriorly at the acetabular transverse ligament. The posterior labrum has a sulcus that can be mistaken for pathology (Fig. 1). Its free margin articulates with the articular surface. The thickness of the labrum and its morphology may slightly vary, but it is from 2 to 3 mm thick, and extends 2 to 3 mm past the acetabular socket. Neuroreceptors have been identified and may provide propioception to the hip joint 4 . This may explain the decrease in propioception and pain with labral tears. Kelly and colleagues 5 have shown a limited blood supply to the periphery of the labrum (Fig. 2), demonstrating the healing potential for detached...
Plain radiographs are the most useful imaging tool for the initial evaluation of hip complaints. Radiographs can reveal degenerative disease, bony lesions, dysplastic changes, the presence of loose bodies, and impingement. An MRI allows improved visualization of the soft tissues, early degenerative changes, and osteonecrosis 12,13,18 . Plain MRI does not accurately identify labral or chondral defects primarily because the lack of joint distension makes it more difficult to assess the cartilage surface. Sekiya et al found that plain MRI is not adequate for measuring the articular cartilage of the hip joint in avascular necrosis (AVN) when compared with hip arthroscopy 19 . They suggested that either direct visualization by arthrotomy or arthroscopy of the hip joint is required for accurate evaluation and staging of cartilage, especially in Marcus-Enneking stage IV AVN 19 .
An athlete is performing squats to strengthen knee muscles. The movement is slow enough to assume static equilibrium. Consider the four-link system shown in Fig. 6.8 to represent the athlete during squatting. The beam representing the hip is connected to the rod representing the upper leg at the hip joint. A tension-carrying cord representing the calf muscle connects the foot to the thigh. The quad muscle connects the thigh and the leg through a frictionless pulley mechanism representing the patella joint. The joints at H, K, and A are hinge joints. Determine the tension in hamstring, calf, and quads as a function of the angle the leg makes with the horizontal plane (6). Solution For simplicity we assume symmetry with respect to the horizontal plane passing through the knee joint. Let P denote the force transmitted at the hip joint to each leg. The force P is then equal to half the weight of the upper body plus the weight used for the squat. For symmetry, we assume that...
LD Latissimus dorsi LL Left lobe of liver OF Oblique fissure PAP Parietal peritoneum PEC Peritoneal cavity PM Psoas major PV Portal vein QL Quadratus lumborum R8-10 Ribs 8-10 RAB Rectus abdominis RC Right crus of diaphragm RL Right lobe of liver SA Serratus anterior Figure 9-4. Cross-section and CT scan at approximately vertebral level T12, where the portal triad is located. (A) Schematic diagram showing where the cross-section was taken. (B) Cross-section through a cadaver. (C) CT scan. Note the various structures indicated by the key. In addition, note the psoas major and quadratus lumborum muscles along the sides of the vertebral body. The right and left lobes of the liver are shown in relation to the portal vein, common hepatic artery, and inferior vena cava. The right adrenal gland lies posterolateral to the inferior vena cava. The left adrenal gland lies between the body of the stomach and the abdominal aorta. (Reprinted with permission from Barrett CP, Anderson LD, Holder LE,...
Fig. 9.2a This is a normal abdominal film. The liver shadow occupies the right upper abdomen. Its inferior margin can only be guessed on this film. The peritoneal fat stripe along the right lateral abdominal wall is visible, however. The spleen in the left upper abdomen is completely disguised by the splenic flexure of the colon. Almost the whole colon is filled with air. Stool is seen in the cecum, the descending colon, and the sigmoid colon. The small bowel is not visible at all. The gastric bubble is barely appreciated medial to the splenic flexure. In this slim patient the retroperitoneal fat is not abundant enough to clearly outline the contours of the kidneys and the iliopsoas muscle. b The lower margin of the liver, the contour of the kidney, and the border of the iliopsoas muscle are beautifully depicted in this patient. c In this patient, air-filled large-bowel loops are projecting over the liver. This entity is called Chilaiditi syndrome and tends to be an incidental finding...
Iliopsoas group psoas major iliacus psoas minor gluteus maximus gluteus medius gluteus minimus tensor fasciae latae pectineus adductor longus adductor magnus adductor brevis gracilis hamstring group biceps femoris semitendinosus semimembranosus sartorius quadriceps femoris group rectus femoris vastus lateralis vastus medialis vastus intermedius muscles that move the foot tibialis anterior peroneus tertius extensor digitorum longus
Entoprocts have been reported from tropical, temperate, and polar marine waters, and from shallow seashore to deep seas of more than 1,640 ft (500 m). One colonial species, Ur-natella gracilis, occurs worldwide in inland waters. Barentsia discreta bending. (Illustration by Emily Damstra) Urnatella gracilis bending. (Illustration by Emily Damstra) Barentsia discreta bending. (Illustration by Emily Damstra) Urnatella gracilis bending. (Illustration by Emily Damstra) 1. Freshwater colonial entoproct (Urnatella gracilis)-, 2. Solitary entoproct (Loxomitra kefersteinii) 3. Marine colonial entoproct (Barentsia discreta). (Illustration by Emily Damstra)
Because of the medulla oblongata's location, all the ascending and descending nerve fibers connecting the brain and spinal cord must pass through it. As in the spinal cord, the white matter of the medulla surrounds a central mass of gray matter. Here, however, the gray matter breaks up into nuclei that are separated by nerve fibers. Some of these nuclei relay ascending impulses to the other side of the brain stem and then on to higher brain centers. The nucleus gracilis and the nucleus cuneatus, for example, receive sensory impulses from fibers of the fasciculus gracilis and the fasciculus cuneatus and pass them on to the thalamus or the cerebellum.
M. brevicaudata Species M. cowani M. dobsoni M. dryas M. gracilis M. longicaudata M. parvula M. principula M. pulla M. pusilla M. talazaci M. thomasi Micropotamogale Genus M. lamottei Species M. ruwenzorii Oryzorictes Genus O. hova Species O. talpoides O. tetradactylus Potamogale Genus P. velox Species Setifer Genus C. whitakeri C. wimmeri C. xantippe C. yankariensis C. zaphiri C. zarudnyi C. zimmeri C. zimmermanni Cryptotis Genus C. avia Species C. endersi C. goldmani C. goodwini C. gracilis C. hondurensis C. magna C. meridensis C. mexicana C. montivaga C. nigrescens C. parva C. squamipes U. andersoni Species U. gracilis U. investigator U. soricipes
The range of movements of all extremity joints, as well as the cervical and lumbar spine, are observed with the deficits or asymmetries recorded. A therapist will often use a goniometer and or inclinometer to record exact range of motion (ROM). Precise measurements allow the clinician to establish a baseline to record improvement or disease progression. Flexibility is assessed with particular attention to large muscle groups such as the hamstrings, hip flexors, gastrocnemius-soleus complex, and the pelvic and shoulder girdle muscles (1).
The human skeleton is divided into two parts the axial and the appendicular (Fig 1.4). The axial skeleton shapes the longitudinal axis of the human body. It is composed of 22 bones of the skull, 7 bones associated with the skull, 26 bones of the vertebral column, and 24 ribs and 1 sternum comprising the thoracic cage. It is acted on by approximately 420 different skeletal muscles. The axial skeleton transmits the weight of the head and the trunk and the upper limbs to the lower limbs at the hip joint. The muscles of the axial skeleton position the head and the spinal column, and move the rib cage so as to make breathing possible. They are also responsible for the minute and complex movements of facial features.
Degenerative labral tears (Fig. 3) in the athletic population can be the result of wear-and-tear injuries, and may be associated with degenerative changes of the hip joint. These types of tears can cause mechanical symptoms during athletic participation. Labral tears can also be caused by structural abnormalities of the hip joint, leading to abnormal loading of and irritation to the labrum and adjacent result from anterior impingement and leverage of the head posteromedial into the acetabulum 9 . This process may lead to arthrosis of the hip joint.
Treatment of any disease should be graduated to reflect disease intensity. For HS this means that staging according to Hurley's criteria is beneficial and should be done prior to therapy (see Table 25.1). It is however important to realize that disease evolution in individual patients is not simply linear, and that the stages imply different needs and therapeutic opportunities because of the predominant features of each stage, e.g., scarring in Stage III (see Fig. 25.1). Of all patients, it is estimated that as many as 75 remain in Hurley Stage I, 24 progress to Hurley Stage II and only a small minority progress further. In addition to the staging of the disease it is mandatory to obtain information about the frequency of flares before the start of therapy. The use of the lesional score of Sartorius (see Chap. 3) and the counting up of the number of painful days and of the intensity of pain may be very helpful for that purpose.
Postural instability is created by a pattern of weakness, muscular tightness, and standing alignment changes that diminish the patient's ability to control their center of gravity during transfers and gait. A common presentation is that of a stooped forward posture of the upper body with tight anterior chest wall musculature and a crouched lower body posture. A series of stretching exercises designed to diminish kyphosis of the thoracic spine and increase flexibility in the pectoralis major and minor muscles can lead to improved upper body posture and upper limb function. In the lower aspect of the body, strengthening of the lumbar paraspinal musculature and stretching of the hamstring and hip flexor muscles can be used to improve posture. It is important not only to stretch the key muscles in patients with poor posture, but to also strengthen the appropriate muscles to achieve good biomechanical alignment. To improve muscle length, therapists use several techniques, including heat...
Disease onset, but may influence the course of the disease. Overweight and obese patients have significantly more severe disease, as evaluated by the Sartorius' index 1 . The smoking of tobacco may, in contrast, be a risk factor for the development of HS. In terms of disease severity, 3 current smokers appear to have slightly more severe disease, but the difference does not reach statistical significance. These factors are of clinical importance to the management of patients.
Anders Johannesson for his valuable comments about previous versions of the manuscript, Dr. Karin Sartorius for useful advice, Dr. Zoe and Francis P. Walsh for linguistic revision and Gun-Britt Karlberg and Barbro Andersen for their help. This work was supported by grants from Karolinska Institutet, the Edvard Welander Foundation, Finsen Foundation and the Foundation for Cancer and Allergy Research.
Allopauropus gracilis (Hansen), showing the 3-branched antenna that is the most prominent feature of the subclass. (Photo by Ernest C. Bernard, University of Tennessee. Reproduced by permission.) Allopauropus gracilis (Hansen), showing the 3-branched antenna that is the most prominent feature of the subclass. (Photo by Ernest C. Bernard, University of Tennessee. Reproduced by permission.)
The focus of rehabilitation following osteoplasty is to avoid impingement of the hip and inflammation of the iliopsoas while restoring full ROM and strength. In cases that involve significant shaving of the femoral neck, caution must also be taken to limit impact activities that may increase risk of femoral neck fracture during the first 8 weeks (Table 2).
The pectineus (pek-tin'e-us) muscle runs from the spine of the pubis to the femur. It adducts and flexes the thigh (fig. 9.35). The adductor longus (ah-duk'tor long'gus) is a long, triangular muscle that runs from the pubic bone to the femur. It adducts the thigh and assists in flexing and rotating it laterally (fig. 9.35). The gracilis (gras'il-is) is a long, straplike muscle that passes from the pubic bone to the tibia. It adducts the thigh and flexes the leg at the knee (fig. 9.35).
Basically, the introduction of feral pigs allowed the golden eagle, a mainland species, to become established on the islands. Unlike bald eagles, golden eagles prey on island foxes. One study found that with 90 golden eagle predation, island fox numbers declined to zero. Released from competition with island foxes, island spotted skunk (Spilogale gracilis amphiala) populations also increase as an indirect consequence of feral pigs supporting golden eagle populations. In other words, feral pigs feed the golden eagles which eat the foxes which frees up space for the skunks.
Muscle strength was measured in terms of grip strength using a JAMAR hand-held dynamometer, knee extensor (quadriceps) using a Nicholas Manual Muscle Tester dynamometer, and hip flexor (iliopsoas) using a Nicholas Manual Muscle Tester dynamometer. Testing was performed by a trained nurse using a standardized protocol. Performance data was also collected on participants, including time required to complete a four-meter walking course and to stand from a chair with arms folded five times. Blood samples were collected from most participants.
Age-related muscle changes Both rats and mice show a decline in muscle mass during aging (Cartee, 1995). In rats this decline in muscle mass is due to both declines in muscle fiber number and fiber cross-sectional area. The declines in fiber number are less pronounced, but the declines in fiber cross-sectional areas are comparable to those seen in humans (Cartee, 1995). As seen in humans, the decline in fiber cross-sectional area is due predominantly to atrophy of type II muscle fibers. Interestingly, several muscles in the rat do not experience declines in muscle mass the adductor longus, epitrochlearis, and flexor digitorum longus. Both epitro-chlearis and flexor digitorum longus have a comparable number of type II fibers compared to the gastrocnemius muscle, roughly 75 , that undergoes significant atrophy during aging. The reason for these differential susceptibilities to the effects of age on muscle is not known, but provides the advantage of having internal aged controls that can...
Recent advancements in hip arthroscopy have expanded our knowledge of the management of athletes with hip injury. Adaptations to arthroscopic instrumentation have been established to overcome the constrained hip joint and dense muscular envelope. Flexible instrumentation has also been developed for improving access to the hip joint in both the central and peripheral compartments.
Athletic hip injuries leading to disabling intra-articular hip pain most commonly involve labral tears 1,2 . Labral tears in the athletic population can occur from an isolated traumatic event or from repetitive trauma 2 . Structural abnormalities of the hip joint may also place athletes at higher risk for labral pathology. It is uncommon to have isolated labral tears, and they are usually associated with other intra-articular injuries 3 . In this article, identifying lab-ral tears and associated lesions in the hip, arthroscopic management of these injuries, and return to sport are highlighted. Arthroscopic intervention for extraarticular hip injuries is also discussed.
The hip joint has both an intraarticular and a peripheral compartment. Most hip pathology is found within the intraarticular region therefore, distraction is necessary to achieve arthroscopic access. The patient can be placed supine or in the lateral decubitus position for performing the procedure 5,6 . Both techniques are equally effective therefore, the choice is simply dependent on the surgeon's preference. An advantage of the supine approach is its simplicity in patient positioning, while the lateral approach may be preferable for severely obese patients.
Chromosomes are processed such that rDNA genes are found on macronuclear chromosomes ranging from 8 to 15 kb and containing either a single or pair of rDNA clusters with no other genes (Prescott 1994). In fact, extrasomal processing and amplification of rDNAs occurs in diverse lineages of eukaryotes (i.e. Euglena gracilis, Dictyostelium discoideum, Entamoeba histolytica, Xenopus laevis embryos reviewed in Zufall et al. 2005). Perhaps the effect of this processing is to maintain high levels of homogeneous rDNAs that are necessary to meet the requirements of translation.
Early ROM is initiated to restore joint motion and decrease tissue scarring in the joint. ROM is started the day of surgery using a continuous passive motion (CPM) machine, passive ROM exercises, and stationary bicycling. The CPM is typically used 8 6 to12 hours per day for 4 to 6 weeks. With early PROM, emphasis is placed on internal rotation and flexion of the hip to prevent formation of adhesions between the joint capsule and the labrum. Progressive stretching of the piriformis and iliopsoas muscles is beneficial in preventing muscle contractures. Early stretching of the posterior hip capsule is achieved through quadruped rocking (Fig. 1). Stationary bicycling with minimal resistance is done for 20 minutes daily, starting the day of surgery.
Radiographs are an integral part of the assessment process. Subtle findings may be indicative of significant intraarticular pathology, and the bony morphology can be evaluated for variants such as dysplasia and impingement implicated in hip joint pathology. Conventional MRI is improving, but even high-resolution studies have up to a 42 false negative interpretation 4 . Also, even with imaging evidence of pathology, the clinician must determine whether these findings explain the athlete's symptoms. Gadolinium arthrography combined with MRI has a greater sensitivity. Along with the contrast, bupivicaine should always ( ) be used as the injection diluent. Whether or not the athlete experiences significant pain relief from the anesthetic effect of the injection is the most reliable indicator of the presence of joint pathology.
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