Getting Powerful Shapely Glutes
Noninflicted scald burns show a pattern of cooling liquids, following gravity down a surface, and splash marks. Inflicted scald burns are often circumferential on extremities or involve buttocks and show clear lines of demarcation between normal and burned skin with no splash marks.
Conduct a sensory body map exercise by yourself or with your partner to explore the exact locations of pleasant, decreased, or altered sensations. This exercise can enhance intimacy, as well as teach you about changes in your sensual and sexual pleasure zones. As with the treatment of all sexual symptoms in MS, experimentation and communication are the keys to maximizing sexuality.
In the first half of the century, patients who were not candidates for sphincter repair underwent sphincter reconstruction with muscle transpositions involving either the gluteus maximus or gracilis. These techniques only met with moderate success because the static, striated muscle flaps were prone to fatigue with chronic contraction. The transposed muscle did not have any involuntary tone at rest, and patients had to perform awkward movements to achieve imperfect continence.
Several types of supports for surgically treated limbs have been described and introduced in the past few decades, but, as underlined by Kalnberz 6 , the majority of these solutions are not very practical. However, the use of some simple tricks after the patient has been put on the operating table in supine position is more than enough in most cases (Fig. 2) a folded cloth can be placed under the buttock and, after preparation of the operating field, the lower limb can be slightly elevated by means of some folded cloths.
The posterior IVS (Tyco US Surgical) procedure was initially described as a means of enhancing posterior pelvic floor support as a component of the Integral Theory described by Petros. As initially described, this procedure entails placing a piece of multifilament Prolene mesh through the pararectal space onto the vaginal apex to help provide apical support. The tape is inserted along the medial aspect of each buttock approximately 2 to 3 cm posterior and lateral to the anus using a blunt tunneler. In our initial experience, and in cadaveric dissections, we have
Warfarin-induced skin necrosis (WSN) is a rare thrombotic complication that occurs during initiation of oral anticoagulation therapy in patients with acute thromboembolic events. The presentation begins with intense skin pain quickly followed by erythema, hemorrhagic blisters, and, finally, full thickness skin necrosis, typically involving the breast, buttock, and thigh (64). The incidence of WSN was probably higher when it was customary to use warfarin loading doses of 15 -30 mg, to rapidly obtain a therapeutic prothrombin time, compared with the current standard practice of starting with 5-10 mg and adjusting subsequent doses based on daily INR results. A plausible mechanism for this rare adverse drug reaction is a rapid fall in protein C activity paralleling the decline in factor VII activity during the first 24 to 48 hours of warfarin therapy because both proteins have half-lives of approximately 6 hours and their synthesis is vitamin K-dependent (65). Although the prothrombin...
Every effort should be made to keep urine and feces off the patient's skin, washing the skin with soap and water and keeping the buttocks and genital area dry (lotion or powder may be used depending upon the patient's skin type) when the patient is incontinent. g. Obese patients may need assistance washing and drying areas under skin folds (groin, buttocks, under breasts, and so forth.)
The usual presenting symptom is severe pain that is located in the low back region or proximal buttock. The pain interferes with the patient's ability to ambulate. The neurological examination remains normal. The straight-leg raising test remains negative but the patient may experience increased pain when the lower extremity is manipulated.
A furuncle, or boil, is an acute perifollicular staphylococcal abscess of the skin and subcutaneous tissue. Lesions appear as an indurated, dull, red nodule with a central purulent core, usually beginning around a hair follicle or a sebaceous gland. Furuncles occur most commonly on the nape, face, buttocks, thighs, perineum, breast, and axillae.
Of the knee extensor muscles to prevent knee bucking. This stimulation can be provided through surface (Ewins et al., 1988 Bajd et al., 1999 Bijak et al., 2005) or implanted electrodes. An example of an implanted system for restoring standing is the CWRU VA system (Davis et al., 2001). It consists of eight channels of stimulation applied through surgically implanted epimysial and intramuscular electrodes targeting the gluteal muscles, semimembranosus, vastus lateralis, and lumbar erector spinae. Standing is generated through open-loop application of continuous trains of FES to maintain extension of the lower limbs. Feedback-based control algorithms have also been developed that use sensor signals providing information about the joint angles (Wood et al., 1998) or the load taken by the hands (Donaldson Nde and Yu, 1996 Riener and Fuhr, 1998) to modify appropriately the amplitude of stimulation applied to the muscles during standing. The advantage of feedback control is that it delays...
The expression of disease is variable and often mild. Onset in first or second decade. Initially the lower half of the face is involved -cannot purse lips or whistle - then spread into trapezius and pectorals occurs with scapular 'winging'. Lumbar lordosis develops from spinal muscle weakness. Pelvic musculature and quadriceps may eventually become involved. Dromedary or camel-backed gait with protrusion of the buttocks is characteristic. Calf and deltoid muscles may be hypertrophic.
The piriformis syndrome is characterized by nondisco-genic, extrapelvic, sciatic nerve compression in the area of the greater sciatic notch. The symptoms include pain and dysesthesias isolated to the buttock region, radiating to the hip or posterior thigh, and or occurring distally as radicular pain.42 The symptoms of piriformis syndrome are thought to be caused by entrapment of one or more divisions of the sciatic nerve by the piriformis muscle.43,44 The original description of this condition dates back to 1928 when Yeoman45 first described the possibility of a pathologic relationship between the sciatic nerve and the piriformis mus Clues for diagnosing piriformis muscle syndrome can be gained through a detailed and focused clinical examination. Interestingly, the clinical presentation does vary widely between published case reports therefore, no single examination or criterion is available to confirm the diagnosis. Piriformis muscle syndrome should be suspected in cases of sciatica...
Case Study Somatic subtype with a theme of infestation A woman of 67 was referred by a dermatologist because of 'neurotic excoriations'. She had been seen by many physicians over a period of 10 years, complaining of worms which crawled under her skin and laid their eggs, especially around her genital region. She had an irresistible urge to scratch and dig out the 'eggs' and as a result her genital area, buttocks, and thighs were covered with excoriations. She denied any itch and said she dug out the parasites to prevent further spread. No physical treatments had helped. On examination she was alert and showed no evidence of dementia. Her physical health was otherwise good. On most topics she could converse reasonably, but on the 'worms' she was vehement and angrily denied they were 'imagination'. She appeared to have an isolated delusional system of somatic type.
The patient's weight-bearing status can vary depending on the surgeon's findings and procedure performed. Typically, weight bearing is allowed as tolerated, and crutches are discontinued within the first week. Although the discomfort associated with ar-throscopy might be surprisingly little, there can still be a significant amount of reflex inhibition and poor muscle firing as a result of the combination of penetration with the arthroscopic portals and the traction applied during the procedure. The gluteus medius muscle is a prime example of this. In a typical ar-throscopic procedure the anterolateral and posterolat-eral portals pass through this muscle. Clinically, it is common for the patient to have a difficult time regaining muscle tone and appropriate firing of this muscle after surgery. This problem is analogous to the effects of an arthroscopic knee surgery on the vastus medialis muscle. Functionally, this muscle is needed to maintain a level pelvis during ambulation. Addi...
The superior gluteal nerve and artery are the most superior of 10 neurovascular structures that exit through the sciatic notch (Figure 6.7). They course transversely in a posterior to anterior direction between the deep surface of the gluteus medius and the superficial surface of the gluteus minimus, innervating and supplying blood to both. The sciatic nerve exits the notch under the piriformis tendon and then lies posterior to the other short external rotators in a vertical direction as it courses distally (see Figure 6.7).
Characteristic of a mucinous adenocarcinoma. Tumour has extended through the anal sphincter into the fat of the ischioanal fossa and buttock to abut onto the natal cleft, it also extends cranially into the lower rectum (asterisk). Natal cleft (NC) ischioanal fossa (IAF).
Louis was born the second of two sons to immigrant parents who lived in the Italian district in a large metropolitan area. His father, Luigi, worked as a gardener for the diocese, putting in long hours in backbreaking work. Although he enjoyed working with his hands in the soil, Luigi desperately wanted his sons not to follow him in his line of work, but to get an education and make something of themselves. To this end, he and his wife were extremely frugal, saving their money only to spend on their sons. Louis's mother was a pious, devout, and fearful woman. She harbored a great, quiet anger, her life governed by duty and sin. She raised her sons to be clean of body, heart, and mind, and to repent and pray away any transgressions. The brothers, both handsome and intelligent boys, grew to be fiercely competitive, jockeying for position within the family, seeing who could be the best behaved in their parents' eyes. When one or the other did something bad, the other brother would make...
Henoch-Schonlein purpura (HSP) and hemolytic uremic syndrome (HUS) are common vasculitides in children. HSP typically consists of purpuric rash of buttocks and lower extremities, arthralgias, angioedema, and acute abdominal pain. GI symptoms, including abdominal pain, occult bleeding, massive bleeding, and intussusception, may precede dermatologic findings. Hematuria also can be present. HUS classically presents with a triad of microangiopathic hemolytic anemia, thrombocytopenia, and oliguric renal failure. One of the many complications of HUS is colitis causing melena and possibly perforation. The cause is unknown.
Partialism involves an exaggerated sexual interest in a specific part of the body. Heterosexual males have an exaggerated sexual arousal to breasts and buttocks, the body parts that most easily discriminate males from females. Homosexuals, likewise, are attracted to the genitals, buttocks, and chest areas of other males, areas of the body that discriminate males from females. Partialism may also involve an exaggerated sexual interest in a portion of the body less likely to be a culturally supported sexualized part of the body, such as leg muscles, feet, or hands.
How often do you consistently exercise aerobically at 4-5 days per week Remember, exercising only 3 days a week will maintain your current fitness and body fat. You need at least 4-5 days per week to reduce body fat levels. How long are your exercise sessions Are you on and off the track or treadmill in 15-20 minutes If so, you are not exercising long enough. To burn body fat, you need at least 40-45 minutes of aerobic exercise that employs the large muscle groups such as the thighs and buttocks. Exercise should not leave you breathless, and a longer duration, lower intensity workout is effective at reducing body fat.
The repair starts with the imbrication of the levator muscles, found just beneath the two ends of divided scar tissue, using interrupted 2-0 polypropylene sutures. The IAS is plicated with interrupted 2-0 polydioxane acid sutures (Figure 6-8.3). These sutures are placed far enough laterally for a snug repair that is then verified by inserting an index finger into the anal canal. At this point in the procedure, the ends of the external sphincter muscle should overlap without significant tension and are secured with interrupted 2-0 polydioxane mattress sutures, using the scar tissues to provide a significant portion of the suture fixation (Figure 6-8.4). All retractors and buttocks tapes are removed before tying of the sutures of the overlapped ends to avoid a lax repair. The sutures are tied snugly but not so tight as to induce muscular ischemia. The wound is closed
CT is sometimes used instead of diagnostic peritoneal lavage to evaluate blunt abdominal trauma. However, it is time consuming and requires specialized personnel. The accuracy rate is high (92 per cent) and it is able to define the location and magnitude of intra-abdominal injuries in hemodynamically stable patients with blunt or penetrating trauma to the back, buttocks, or flank. It may be useful in cases of significant hematuria, in evaluating the genitourinary system when intravenous contrast is used, and in examining the extent of pelvic fractures. One limitation is the failure to detect injuries to the intestines.
Patients received an objective evaluation of muscular tenderness before and after the two-week treatment protocol, measuring the pain response to a device that transmitted a measurable amount of pressure to different sites of the body. Typically, at the end of the clinic visit, muscles and muscular attachment sites in the neck, shoulders, lower back, and buttocks would demonstrate two- or even threefold less pain sensitivity to pressure than when first measured. The evaluation was made in a blinded fashion, such that old readings were not known to the measurer prior to making the new readings.
The area and to separate the two suture lines. Grafts of omentum, gracilis, sartorius, gluteus maximus, rectus, and bulbocavernosus muscle have been described. The bulbocavernosus muscle transposition is most frequently reported (Figure 13-2.5). The procedure is performed with the patient in the lithotomy position and a transperineal incision is made between the anus and vagina. The rectum is dissected from the vaginal wall, and both defects are sutured closed. A vertical incision is made over one of the labia majora, and skin flaps are created. The bulbocavernosus muscle and associated fat pad are mobilized and tunneled through a subcutaneous space to lie between the two closures. The vascular supply to this flap is the perineal branch of the pudendal artery.
Individuals with BDD are preoccupied with the idea that some aspect of their appearance is unattractive, deformed, or 'not right' in some way. Concerns usually focus on the face or head but can involve any body area. (5,10 The skin, hair, and nose are most often disliked (e.g. acne, scarring, lines, or pale skin, hair thinning, or a large or crooked nose). Concern with bodily asymmetry (e.g. 'uneven' buttocks) is common. Although the concern usually focuses on specific areas, it may involve overall appearance. An example of this is muscle dysmorphia, in which patients think that their body build is small and puny, when in reality it is large and muscular. BDD by proxy consists of a preoccupation with supposed flaws in another person's appearance, which may lead to insistence that the person have surgery or dermatological treatment.
Vesicovaginal fistula caused by radiation therapy can be repaired as previously described, provided that the tissues are well-vascularized. The placement of nonirradiation tissues between the bladder and vaginal closure is required. When radiation-induced VVF is associated with radiation necrosis and fibrosis, mobilization of vascular pedicles is required. Vascular sources may include muscles such as the gluteus maximus or rectus abdominis, or a labial or omental flap. Before attempting repair, recurrent malignancy must be ruled out by biopsy of affected tissues.
Foramina are located using bony landmarks. The acute phase test is performed under local anesthesia using a 20-gauge spinal insulated needle (Medtronic Inc., Minneapolis, MN) attached to an external neurostimulator (Medtronic Inc.). The needle is placed in the sacral foramina, and an electrical current is gradually applied to the needle until a visual muscle response is obtained. Muscle responses include movement of the external sphincter and lateral rotation of the leg (S2), contraction of pelvic floor and plantar flexion of the big toe (S3), or contraction of the anus (S4). The chronic phase of PNE involves placement of a temporary stimulator lead into the same position as the testing needle. This lead is left in place for a trial period of 1 to 2 weeks to allow evaluation of functional response. The decision to proceed from temporary to permanent stimulation is made on the basis of 50 functional improvement in either the number of episodes or incontinence-free days. For placement...
Patients complain of discomfort across the lower back, usually in an L3-S1 distribution with associated buttock and lateral back pain. The pain may radiate into the legs and be associated with non-specific paresthesiae. The relationship with exercise, rest and posture is varied. Some will complain that any movement is painful and they may, in extreme cases, take to a wheelchair, whilst, at the other end of the spectrum, continual gentle movement is reported as beneficial, leading to a lifetime of fidgeting and moving to get comfortable . There is usually a long history of analgesic use, partially effective at best. Most patients will have undergone outpatient physiotherapy and many will have attended alternative practitioners (chiropractic, osteopathy, acupuncture, etc.). Treatments will frequently be described as effective, but only in the short term, or becoming less effective over the years.
Inferior gluteal nerve Gluteus medius and minimus and tensor fasciae latae L4, L5, SI roots. Patient pulls heel towards the buttock and tries to maintain this position against resistance. Patient pulls heel towards the buttock and tries to maintain this position against resistance.
The sacroiliac joint is approached, with the patient in prone position, via a direct posterior route under CT control (Fig. 20), which allows sampling of the joint space and both iliac and sacral subchondral bone (4). However, if only the anterior aspect of the joint is involved, it may be necessary to use a posterolateral route through the gluteal muscles and iliac bone under fluoro-scopic or CT guidance (Fig. 21) (7,8). The inferior portion of the sacroiliac joint, 1cm above the inferior margin of the joint, is usually the best site for biopsy with both approaches. At this level, the thickness of the iliac bone, which must be crossed prior to penetrating the sacroiliac joint, is much less than at a higher level and the joint space is simply anteroposteriorly oriented.
Physical description Covered with reddish-black hair. Dark skin. Thick head-hair that hangs down the back like a mane. Low forehead. Eyes with a reddish tinge. Flat nose. High cheekbones. Enormous teeth. Muscular arms and legs. Females have large breasts and buttocks. Fingers long and thick. Splayed feet.
Skin from the buttock is continuous with the anal margin and continues to the lower border of the IAS. This epithelium is keratinized stratified squamous with hair follicles, sweat glands, and sebaceous glands. Proximal to the level of the dentate line, the epithelium is nonkeratinized squamous with no dermal appendages. There is a transition zone where squamous and columnar epithelium are mixed and then the columnar epithelium of the rectum predominates. Vertical mucosal folds known as anal columns are found at the upper anal canal just above the dentate line. Anal valves connect these folds at the inferior margins. Above each valve is the anal pit or sinus, which drains on average eight anal glands.
The perianal space is that area surrounding the anal canal in the immediate area of the anal verge. Laterally it is continuous with the fat of the buttocks. Cephalically, it is continuous with the intersphincteric space and it contains the distal EAS, branches of the inferior rectal vessels, nerves, and lymphatics. The external hemorrhoid plexus lies in the perianal space and communicates with the internal hemorrhoid plexus at the dentate line.
Adipose tissue has a number of functions in the body which include mechanical cushioning (e.g. in the buttocks, and around some internal organs) and thermal insulation, but its main role from a metabolic point of view is that of storing chemical energy in the form of triacylglycerol, and releasing it in the form of non-esterified fatty acids when it is needed by other tissues. However, recent years have seen an explosion of interest in adipose tissue as an endocrine organ as well as a metabolic one. It is now recognised that adipose tissue secretes a number of substances, some of which are true hormones, others that may act locally, and that this capability gives adipose tissue an especially important role in metabolism.
The abdominal aorta bifurcates at the L4 level to form the common iliac arteries. These pass infero-laterally to divide at the level of the pelvic brim into the external and internal iliac arteries. They lie anterior to the common iliac veins. The external iliac artery follows the iliopsoas muscle to pass under the inguinal ligament. It gives origin to the deep circumflex iliac and inferior epigastric arteries, which supply the anterior abdominal wall. It lies antero-lateral to the external iliac vein. The internal iliac artery supplies the pelvic viscera, buttocks, medial thighs and perineum. It passes postero-medially into the pelvis dividing into anterior and posterior divisions at the superior edge of the greater sciatic foramen. The anterior division gives rise to the umbilical, obturator, vesical, middle rectal, vaginal, uterine, internal pudendal and inferior gluteal arteries. The posterior division gives rise to the superior gluteal, iliolumbar and lateral sacral arteries.
Physical description Height, 5 feet-6 feet 6 inches. Covered in reddish-gray or black hair. Older individuals are grayer. Head-hair is thick and matted. Slanting forehead. Brows and cheekbones are prominent. Face is bare. Glowing eyes. Wide, flat nose. Ears stick out. Lower jaw is massive. Large teeth. Short neck. Thick hair on chest and hips, close-cropped and thick on the belly. Long arms. Buttocks are relatively hairless. Knees are calloused. Feet and palms are hairless. Feet are wider and shorter than a man's. Significant sightings Maj. Gen. Mikhail Top-ilski, head of a scouting party in the fall of 1925, ran across a group of Golub-yavan during a skirmish with White Russian guerrillas in the Vanch District, Tajikistan the guerrillas had taken refuge in an ice cave that the creatures apparently used as a shelter. One wildman was shot and inspected by the party's physician. The dead creature was 5 feet 6 inches tall and looked much more human than apelike, though it was covered...
Electrodes placed over the gluteus medius and maximus for improved stability, whereas patients with lesions at T-10 or lower usually do not require paraspinal stimulation at all (Figures 16.6, 16.7, and 16.8). We comment that improved trunk stability affects not just patient safety, but also helps to reduce fatigue, thus improving ambulation performance and appearance (which is not just an aesthetic aspect but also a psychological one).
Physical description Height, more than 3 feet when standing. Quadrupedal shoulder height, 16-20 inches. Covered with black, gray, or brown hair. Round head, about 6-7 inches long. Curly head-hair. Face looks human. Flat mouth. Hands and feet have nails. Toenails are flat. No hair on the buttocks. Short tail, if any.
Typically occurs in summer and early fall. Causes herpangina with multiple small vesicles on tonsils and soft palate. Coxsackievirus A16 causes so-called hand-foot-mouth disease, characterized by small ulcers on tongue and buccal mucosa, and vesicles on hands, feet, and occasionally buttocks.
The female mite burrows into the skin, and after 1 month, severe pruritus develops A multiform eruption may develop, characterized by papules, vesicles, pustules, urticarial wheals, and secondary infections on the hands, wrists, elbows, belt line, buttocks, genitalia, and outer feet.
Injection of corticosteroids or local anesthetics is a well-known procedure in musculoskeletal radiology. Until now, fluoroscopy or CT guidance has been used. Because both methods are using ionizing radiation and the patient population is usually younger, MR is an attractive alternative. The technique used is similar to the procedures described under CT guidance. Pereira et al. (40,41) described their first experiences in 12 patients with 24 steroid injections into the sacroiliac joints. All procedures were successfully carried out on an open 0.2 T open system, and clinical improvement was observed in 10 of 12 patients suffering from persistent buttock pain.
The anterolateral portal penetrates the gluteus medius before entering the lateral aspect of the capsule at its anterior margin (Figure 10.13). The superior gluteal nerve lies an average of 4.4 cm superior to the portal. The posterolateral portal penetrates both the gluteus medius and minimus before entering the lateral capsule at its posterior margin (Figure 10.14). Its course is superior and anterior to the piriformis tendon. The portal lies closest to the sciatic nerve at the level of the capsule, with the distance averaging 2.9 cm. An average distance of 4.4 cm separates the portal from the superior gluteal nerve. Gluteus Medius M. Gluteus Medius M.
Particularly favoured sites are the skin between the fingers, the underside of the wrists, the elbows and knees, navel, breasts, shoulders, buttocks, scrotum, and penis. The face and scalp are not usually infested, except in children. The length of the ducts varies between a few millimetres to several centimetres. The number of ducts and adult females can sometimes exceed 100. The average number of ducts per infected person may be about 10-15. The itching, which is an immunological response to mites and their faeces, is particularly serious during night-time. In newly infested persons the itching begins not until about a month after the initial infestation. The itching will often indirectly cause secondary bacterial infections of the skin with purulent ulcers. Infested persons will develop an extensive rash with erythema and follicular papules that can cover areas where no mites can be found (Alexander 1984 Varma 1993). Scabies-infected individuals with...
A few characteristic features may clue the examiner to suspect an intraarticular hip problem. These hallmarks include complaints of anterior, inguinal, or medial thigh pain. Complaints of lateral hip pain or posterior or buttock symptoms are more commonly caused by extraarticular sources such as trochanteric bursitis, abductor muscle injury, or sciatica. A history of catching or popping of the hip may be related to intraarticular pathology, but these symptoms can also occur with disorders outside the joint.
Pathomechanics of the hip and pelvis are viewed as primarily reflecting the joint pathology and secondarily reflecting joint compensation. For example, for a patient with degenerative changes within the joint, the primary disorder is the antalgic gait caused by joint pain. Secondary dysfunction may ensue due to weakness of the gluteus medius, presenting as an abductor lurch (Trendelenburg's gait). Disorders of the sacroiliac joint (S-I joint) and lumbar spine also become considerations with chronic hip dysfunction because of altered gait and weight-bearing mechanics (Figures 17.1, 17.2). The clinical presentation of a patient with an ac-etabular labral tear is similar to the patient presentation with a meniscal tear. The patient can complain of a sharp catching pain that is often associated with a popping and a sensation of locking or giving way of the joint.15,18,19 Patients can have pain in the anterior groin, anterior thigh, buttock, greater trochanter, and medial knee. The reason...
The frotteur rubs up against the buttocks, thighs, breasts, or vaginal area with his hand, his leg, his pelvic area, or with a newspaper or some other object. Despite being in a crowded public setting, while rubbing a complete stranger, he finds it easy to fantasize a close sexual relationship with the victim and can get an erection in seconds. Sometimes he will push his erect penis, underneath his clothes, up against the woman's thighs or buttocks.
FIGURE 9 Greater trochanteric bursitis. (A) Longitudinal sonogram obtained over the greater trochanter in a patient with pain radiating into the buttocks. A complex bursa (B ) is seen containing nodular hypoechoic soft tissue, contiguous with the greater trochanter (GT ). The patient complained of localized pain with the transducer positioned over this area. (B) Transverse sonogram over the greater trochanteric bursa shows a 22-gauge spinal needle (black arrows) positioned deep into the gluteal muscles (gm) with its tip within the bursa. The appearance of echogenic micro-bubbles (whitearrow) is evident during the injection on real-time observation.
The hip musculature can be conceptualized as a superficial layer and a deep layer. The fascia lata covers the entire hip region including the three muscles that make up the superficial layer the tensor fascia lata, sartorius, and gluteus maximus (Figure 6.3). The fascia lata also splits to cover the deep and superficial surface of the tensor fascia lata and gluteus maximus encasing these muscles. The tensor fascia lata and the gluteus maximus insert as a continuation, forming the iliotibial band. The gluteus maximus also partly inserts into the proximal femur at the gluteal tuberos-ity. This fibromuscular sheath was described by Henry8 as the pelvic deltoid, reflecting the fashion in which it covers the hip much as the deltoid muscle covers the shoulder. Interestingly, the gluteus maximus is the largest muscle in the body, and the sarto-rius, which crosses two joints, although quite weak, is the longest. The gluteus medius has a transitional relationship between the superficial and...
Response to hormonal treatment is variable between patients. This is particularly notable and potentially problematic for males. As with people born female, breast development spans a continuum. Patients may erroneously believe that more hormone will result in greater breast development. They neglect the fact that people born female have quite adequate female hormone production but the limiting factor is tissue response. In addition to breast development, male patients report increased hip and buttock fat, skin softening, and loss of sex drive and erection capacity.
Physical examination reveals a delicate, thin, balding man. Palpation of the lower abdomen acupuncture points (CV2,3,4, ST25,30, SP12,KI11) detects tenderness. Turning the patient prone and palpating the buttock area (BL27-34) also reveals tender acupuncture points. I elect to give the patient a KI-BL circuit treatment. I have provided a diagram of the KI-BL Distinct Meridian Channel and the organ coverages (Figures 9-5.1 and 9-5.2). Needles are placed at the abdominal points first, and then the patient is turned prone. When I place the needles in the buttock, frank muscle twitches are noted. This would indicate correct assessment of pathology amenable to an acupuncture approach.
Wasting is variable but may be extremely severe, resulting in a skull-like appearance of the head, stick-like limbs, and flat breasts, buttocks, and abdomen. The hands and feet feel cold and readily turn blue in winter. The skin is dry with an excess of downy hair (lanugo) covering the cheeks, the nape of the neck, the forearms, and the legs. Heartbeat is slow (50-60 beats min) and the blood pressure is low (e.g. 90 60 mmHg) with orthostatic lability. During the routine physical examination muscle power should be tested to detect proximal myopathy, as explained below.
Using diagnostic intra-articular blocks producing temporary symptomatic relief as the reference (criterion) standard, the prevalence of primary SI joint pain and chronic low back pain is in the range of 18 to 30 based on two studies (2,3). The SI joint has a diffuse innervation pattern without a fixed course for the efferent nerves. Therefore, there is no effective nerve block for the SI joint and only intra-articular injections can selectively anesthetize the SI joint. One confounder may be the degree of pain the patient is in at the time of the injection. If the patient is not in a high level of pain, then the opportunity for demonstrating dramatic improvement is lessened. Control injections (control blocks) are useful in mitigating the placebo effect. Because of the risks of a false positive response, the placebo injection of normal saline at another time would be useful to show no improvement. Alternatively, anesthetic agents of different time durations (lidocaine vs. bupivacaine)...
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