Microanatomy of the nerve to iliacus muscle and its clinical significance / Microanatomía del nervio del músculo ilíaco y su importancia clínica

The iliacus muscle, arising from iliac fossa is innervated chiefly by nerves to iliacus and femoral nerve. The tendon of iliacus muscle in the caudal part fuses with the tendon of psoas major muscle to form iliopsoas tendon As the iliacus/iliopsoas is responsible for flexing of the thigh and the forward tilting of the pelvis, body posture, Olympic lifts, daily activities like walking and running, so impairment of above functions, due to spinal cord injury or injury to nerves to iliacus, remained a grey area to explore manifestation of nerve lesions at fascicular level. Therefore an experimental study was designed to map the complex fascicular pathways suffering from splits, fusions and multiplexing coupled with measurement of distances of closely sampled histological slides. Tracking, correlation and interpretation of fascicles, in these slides of a cropped femoral nerve in iliacus region from a 70 year old female cadaver were analyzed. The study resulted in three schematic models of fascicular pathways in 3 nerves to iliacus and 2 tabular models of 2 remaining nerves to iliacus revealing complete picture of fascicles interrupted by dynamic transformational processes. These results would facilitate MRI neurographic interpretation at fascicular level and neurosurgical treatment through identification. The fascicular identification and setup would also discover anatomical complications and location of injury. Besides the huge data volume evolved off this experiment, the study would not only open up grey area for neuroanatomical research but also would revolutionize the neurosurgical repair and grafting of nerves to iliacus at fascicular level.

El músculo ilíaco, que se inserta en la fosa ilíaca, está inervado principalmente por los nervios ilíaco y femoral. El tendón del músculo ilíaco en la parte caudal se fusiona con el tendón del músculo psoas mayor para formar el tendón del músculo iliopsoas. Los músculos ilíaco e iliopsoas son responsables de la flexión del muslo y la inclinación hacia delante de la pelvis, la postura del cuerpo, los levantamientos olímpicos, las actividades diarias como caminar y correr, por lo que el deterioro de las funciones anteriores, debido a lesiones de la médula espinal o de los nervios ilíacos, constituyen una dificultad para explorar la manifestación de lesiones nerviosas a nivel fascicular. Por lo tanto, se diseñó un estudio experimental para mapear las complejas vías fasciculares que presentan divisiones, fusiones y multiplexación, junto con medición en muestras histológicas. Se analizó el seguimiento, correlación y la interpretación de los fascículos en muestras de secciones del nervio femoral en la región ilíaca de un cadáver femenino de 70 años. Se obtuvieron tres modelos esquemáticos de vías fasciculares en 3 ramos del nervio ilíaco y dos modelos tabulares de los 2 ramos nerviosos restantes del nervio ilíaco, que muestran una imagen completa de los fascículos interrumpidos por procesos de transformación dinámica. Estos resultados facilitarían la interpretación neurográfica de la resonancia nuclear magnética a nivel fascicular y el tratamiento neuroquirúrgico a través de su identificación. La identificación y configuración del fascículo también permitirían descubrir complicaciones anatómicas y la localización de la lesión. Además del enorme volumen de datos que se desprendió de este estudio, éste no solo contribuiría a la investigación neuroanatómica, sino también puede aportar a la reparación neuroquirúrgica y al injerto de nervios al músculo ilíaco a nivel fascicular.

Lesión del músculo ilíaco por ejercicio inadecuado / Iliacus muscle injury caused by inadequate exercise

Resumen: Antecedentes: La lesión traumática del músculo ilíaco es rara; generalmente es causada por trauma o ejercicio intenso, que ocasiona hematoma del músculo con neuropatía del nervio femoral como complicación. Los hematomas espontáneos del mismo ocurren en pacientes con trastornos de la coagulación. Caso clínico: Masculino de 45 años con 18 días de evolución, con dolor intenso en la nalga, ingle y fosa ilíaca derechas e incapacidad de realizar flexión de la cadera, originados durante la realización de movimientos repetitivos (flexión de la cadera con elevación bilateral de las extremidades inferiores en posición supina). A la exploración: dolor a la flexión y/o rotación interna de la cadera derecha, maniobra Thomas positiva, cuádriceps con fuerza muscular 2/5; zona de parestesias en el territorio del nervio femoral derecho. La resonancia magnética de pelvis mostró ruptura parcial del músculo ilíaco, con sangre entre sus fibras. El paciente fue tratado con reposo y analgésicos durante ocho días, extensión gradual de la cadera, muletas axilares con apoyo parcial; a los ocho días se inició con diatermia a fosa ilíaca, ejercicios activos asistidos de flexión-extensión de cadera, bicicleta ergométrica y fortalecimiento del cuádriceps. La evolución fue satisfactoria; fue dado de alta asintomático a las seis semanas.

Abstract: Background: Traumatic iliacus muscle injury is rare; it is usually caused by trauma or intense exercise involving the pelvic girdle; it can produce a hematoma with femoral nerve neuropathy. Spontaneous muscle hematomas occur in patients with coagulation disorders. Clinical case: A 45-year-old male with 18 days of evolution, with an intense pain in the right buttock, groin and iliac fossa, with an inability for hip flexion and ambulation caused by inadequate exercise (supine double leg lifts). On the physical examination: intense pain with bending and/or internal rotation of the right hip, positive Thomas maneuver, quadriceps rated 3/5; area of paresthesia in the right femoral nerve territory. Pelvic magnetic resonance imaging showed: right iliacus muscle tear with blood between its fibers. Initial treatment was rest and analgesics for eight days and gradual extension of the hip, axillary crutches with partial weight bearing and diathermy on the right abdominal lower quadrant, active hip exercises, bicycle and right quadriceps strengthening. The evolution was satisfactory, with full recovery in six weeks.

Femoral Neuropathy Secondary to Iliacus Hematoma: A Case Report / 대한고관절학회지

A 17-year-old male patient complained of acutely developed severe paresthesia, pain, and weakness of the right lower extremity. He fell to the ground during performance of hand-stand physical exercise. Despite administration of conservative treatment for two weeks in a private clinic, motor function of the hip flexor and knee extensor were measured as poor grade. EMG showed femoral nerve and lateral femoral cutaneous nerve injury. Findings on MRI and CT revealed a mass measuring 8x5x7 cm in the iliac fossa. After evacuation of the hematoma(400 cc), neurologic dysfunction and thigh circumference were fully recovered, compared with the contralateral side, after one and half year follow up. This condition rarely occurs in individuals without coagulopathy. We reported on a rare case of iliacus hematoma and femoral neuropathy treated by surgical decompression in a patient with no coagulopathy.

Femoral Neuropathy due to Iliacus Muscle Hematoma in a Patient on Warfarin Therapy

Spontaneous hematomas of the iliacus muscle are rare lesions and these are seen in individuals receiving anticoagulation therapy or patients with blood dyscrasias such as hemophilia. It can cause femoral neuropathy and resultant pain and paralysis. Although there is no clear consensus for the treatment of femoral neuropathy from iliacus muscle hematomas, delays in the surgical evacuation of hematoma for decompression of the femoral nerve can lead to a prolonged or permanent disability. We report here on a rare case of a spontaneous iliacus muscle hematoma that caused femoral neuropathy in a patient who was taking warfarin for occlusive vascular disease and we discuss the treatment.

Anatomical variations in formation and branching pattern of the femoral nerve in iliac fossa: A study in 64 human lumbar plexuses.

Femoral nerve is used for nerve block in several surgeries and is vulnerable to compression in tight ilio-psoas compartment. The knowledge of origin and variations of femoral nerve in iliac fossa is important for anatomists, anesthetists and surgeons to prevent iatrogenic femoral nerve palsy. We dissected 32 human cadavers to study the anatomy of the femoral nerve. We dissected the lumbar plexus bilaterally; dissected the psoas major muscle to see formation of the femoral nerve. We measured the length of the femoral nerve from its formation to inguinal ligament; and recorded variations of the femoral nerve with digital photography. The average length of the femoral nerve was 144 mm. Anatomical variations of the femoral nerve were found in 25% lumbar plexuses. These variations included abnormally long L2 root, early division of the femoral nerve, origin of lateral cutaneous nerve of thigh from the femoral nerve, origin of nerve to pectineus from the femoral nerve in iliac fossa, splitting of the femoral nerve into two slips by psoas major or accessory slips of iliacus muscle. The aim of this study was to highlight variations in branching pattern of the femoral nerve in iliac fossa for appropriate exposure of the femoral nerve.

Immature Heterotopic Ossification in the Iliacus Muscle in Spinal Cord Injury: A Case Report

Heterotopic ossification (HO) is a frequent complication associated with spinal cord injury and can lead to significant problems during rehabilitation. Surgical resection of HO could be applied to patients who do not respond to conservative treatment. To reduce the risk of recurrence after the operation, radiation therapy and NSAID or bisphosphonate administration may be utilized. We report the case of a 48-year-old male with a T3-sparing spinal cord injury who underwent successful treatment of immature HO in the iliacus muscle with a combination of surgical resection, radiation therapy, and NSAID administration.

Rupture of the Iliacus Muscle and Paralysis of the Femoral Nerve during Taekwondo Practice – Report of a Case / 대한정형외과학회잡지

We preset a rare case of traumatic rupture of the iliacus muscle associated with paralysis of the femoral nerve. It occurred in a healthy 17 year old boy immediately after a fall on his back during the Taekwondo practice. The clinical picture is characterized by pain in the groin, a tender mass in the iliac fossa, flexion contracture of the hip, and a complete paralysis of the ipsilateral femoral nerve. This condition rarely occurs in individuals without bleeding tendency