ABSTRACT
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.
Subject(s)
Humans , Male , Muscle, Skeletal/injuries , Thigh , Femoral Neuropathy , Femoral Nerve/injuries , Hematoma/etiology , Middle Aged , Muscular DiseasesABSTRACT
Os autores descrevem caso de paciente do sexo feminino, com 23 anos de idade, submetida à cirurgia do joelho para realinhamento patelar com uso de garrote pneumático e que desenvolveu neurapraxia femoral. Faz-se breve revisão da literatura sobre as vantagens e desvantagens do uso do garrote em cirurgias do joelho e discute-se a necessidade da sua indicação, considerando-se as complicações acarretadas por seu uso incorreto.
The authors describe the case of a 27 year-old female patient submitted to knee surgery for patellar realignment with the use of a pneumatic tourniquet, who developed femoral neurapraxia. They make a brief literature review about the advantages and disadvantages of using a tourniquet in knee surgeries, and discuss the need for tourniquet indication considering the complications entailed by the incorrect use of the tourniquet.
Subject(s)
Humans , Female , Adult , Femoral Nerve/injuries , Femoral Neuropathy/etiology , Tourniquets/adverse effectsABSTRACT
Between January 1995 and September 1997, 83 patients having bilateral inguinal and/or crural hernia underwent. a prosthetic herniorrhaphy which is complicated in two cases by an iatrogenic lesion of the crural nerve. Reoperation was required in both of cases. In the first case [of late diagnosis], there is a fibrosis around the mesh sheathing the crural nerve. The follow up was favourable after neurolisis. The second patient was reoperated in the immediate postoperative period. The crural nerve was picked up by the mesh side fixing knot. The follow up was also favourable after neurolisis. The crural nerve iatrogenic lesion occurring during the groin hernia repair with a wide preperitoneal prosthesis must be prevented by a vigorous operative procedure particularly at the time of side attaching of the mesh. This side securing of the mesh is unnecessary. The arising of a pain or a leg functional disability during the post operative period must evoke a crural nerve lesion, and lead to a surgical exploration
Subject(s)
Humans , Male , Hernia, Inguinal/surgery , Hernia, Femoral/surgery , Femoral Nerve/injuriesABSTRACT
Os autores apresentam um caso de paralisia do nervo femoral, em paciente submetida à histerectomia total abdominal, devido à miomatose uterina. Trata-se de lesäo traumática do nervo femoral por afastador cirúrgico. Os aspectos anatômicos, funcionais e terapêuticos säo descritos a seguir.