The human gluteus maximus muscle (GMX) is characterised by its insertion to the iliotibial tract (a lateral thick fascia of the thigh beneath the fascia lata), which plays a critical role in lateral stabilisation of the hip joint during walking. In contrast, in non-human primates, the GMX and biceps femoris muscle provide a flexor complex. According to our observations of 15 human embryos and 11 foetu- ses at 7–10 weeks of gestation (21–55 mm), the GMX anlage was divided into 1) a superior part that developed earlier and 2) a small inferior part that developed later. The latter was adjacent to, or even continuous with, the biceps femoris. At 8 weeks, both parts inserted into the femur, possibly the future gluteal tuberosity. However, depending on traction by the developing inferior part as well as pressure from the developing major trochanter of the femur, most of the original femoral insertion of the GMX appeared to be detached from the femur. Therefore, at 9–10 weeks, the GMX had a digastric muscle-like appearance with an intermediate band connecting the major superior part to the small inferior mass. This band, most likely corresponding to the initial iliotibial tract, extended laterally and distally far from the muscle fibres. The fascia lata was still thin and the tensor fasciae latae seemed to develop much later. It seems likely that the evolutionary transition from quadripedality to bipedality and a permanently upright posture would require the development of a new GMX complex with the iliotibial tract that differs from that in non-human primates. (Folia Morphol 2018; 77, 1: 144–150)
We found that during the step up task, the activation of the right erector spinae muscle, right biceps femoris muscle, left erector spinae muscle and the left biceps femoris muscle occurred before the beginning of the movement. The most frequently registered pattern of muscle activation on the side that carried out the step was: right biceps femoris muscle → right erector spinae muscle → right gluteus maximus muscle. Greater diﬀ er- ences in muscle activation patterns were found on the side of the supporting leg. In conclusion, the ﬁ ndings have indicated that variability in patterns of muscle ac- tivation during the step up task does exist. It may be a reﬂ ection of the ability of the central nervous system to prepare diﬀ erent motor programs (in the meaning of the varying involvement of diﬀ erent muscles) for any given motor task. This situation requires further study for an explanation of registered diﬀ erences among indi- vidual subjects and furthermore, to compare the results obtained between healthy subjects with ones obtained from subjects with diseases or disturbances of the loco- motor system.
Recently, we have provided detailed geometric and topological data describing the arteriolar network structure of the rat gluteus maximus muscle . The data was collected in vivo using intravital videomicroscopy (IVVM), capturing the geometry and topology of the network under native baseline conditions. Our approach represents a marked improvement upon many previous studies of skeletal muscle arteriolar networks, both in terms of the technique in obtaining data as well as in the size and complexity of the networks. For example, previous studies describing microvascular geometry/topology have used vascular casting methods, requiring perfusion of vasodilatory agents and fixatives in an effort to visualize microvascular networks [4,5]. However, data captured under such conditions will vary from baseline conditions, especially with regards to diameters (due to the infusion of vasodilatory agents), bifurcation angles (evidence for change in angle with change in flow, which would change under maximal dilation ), and hemodynamics (blood flow, RBC distribution, resistance would all change under maximum diameters). Additionally, detailed analysis of skeletal muscle arteriolar network geometry and topology is often limited to the distal portions of networks (terminal arteriolar branches).
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ISCHIAL ULCERS: These account for around a quarter of all pressure ulcer cases and are common in paralysed individuals. The ulcer can manifest clinically as a stage IV ulcer over the ischial area with ischial bone exposed in the base of the ulcer. In case of long standing cases, the floor of the ulcer is covered with granulation tissue whereas in acute cases necrotic tissue can be seen. The ulcer base can represent the necrotic periosteum of the ischial bone. The ulcer can extend under the gluteus maximus muscle and the hipjoint, and infection can descend into the posterior thigh compartment to form a necrotizing fasciitis. Ischial ulcer can extend superiorly into the coccygealarea or inferiorly in the perineal area to involve the urethra in male patients. In certain cases, bowel diversion may be undertaken, like in cases where there are multiple ulcers perianally, bilateral ischial ulcers or coccygeal ulcer. This is to avoid post-operative infection and flap failure. The diverting colostomy procedure can be temporary or permanent, according to the patient’s wishes. A temporary colostomy can be reversed within 6months after flap surgery to demonstrate complete healing and no breakdown in the new flap, which indicates patient compliance to prevent flap breakdown. A double-loop type colostomy is indicated when the patient is at an end stage for flap surgery and the anus is to be closed permanently during the procedure of disarticulation and total thigh flap. The choice of surgical reconstruction depends on many factors, including whether the ulcer is primary or recurrent, the size of ulcer, and whether the patient is ambulatory or sensory. For the closure of defects in stage IV ischial ulcers, the following options are available-
With 37 subjects, it was confirmed by ultrasonogra- phic images that using a two-inch RLAI needle could ensure IM administration at the injection site when using the “four- and three-way split” method and the speciali- zed needle marked at 40 mm level. With the “four- and three-way split” method, the RLAI was administered into the gluteus maximus muscle even when the injection needle was not inserted at a vertical angle. It is recom- mended that RLAI can be safely delivered into the muscle, if the two-inch specialized needle is marked at the 40 mm point indicating that the needle must only be inserted up to this level. As shown by ultrasonographic data, insertion up to this level assures insertion of the needle past the subcutaneous level and into the gluteus muscle regardless of the patients’ BMI.
performed on the right side, 3% during the single-leg squat performed on the left side, 2% during the step-up exercise performed on the right side and 1% during the step-up exercise performed on the left side. However, the effect sizes for all comparisons were negligible. The hip can internally rotate when the gluteus maximus muscle is not activated sufficiently (Souza & Powers, 2009). Accordingly, the lack of change in gluteus maximus muscle activation in the current study may be because the participants were not internally rotating. The gluteus maximus muscle is a hip extensor and is not activated very strongly in slow movements, such as walking, but it is more active as speed increases (Lieberman et al., 2006). The change in gluteus maximus muscle activation during the mechanical restriction condition, compared to without, may have been minimal because of the amount of hip flexion performed by the participants. More activation is required from the gluteus maximus muscle as the knees are flexed more than 90 degrees (Caterisano et al., 2002). The box that was used in the current study was 42 cm high and allowed the participants to reach approximately 90 degrees of hip flexion during both the single-leg squat and step-up exercises. The participants were instructed to have as much ankle, knee and hip flexion as they could during the exercises, however, if the participants did not attain 90 degrees of hip flexion, then this may provide
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anterior approach we ligated the posterior trunk of the in- ternal iliac artery to aid exposure of the sciatic notch, re- duce the tumour’s blood supply and control intra-operative bleeding. We feel that ligation of the posterior branch of the internal iliac artery allows control of the superior gluteal artery, which predominantly supplies the gluteus maximus muscle, which in our case was completely removed. In gen- eral, the total excision of the gluteus maximus muscle has little functional impact on a normal gait and stable pelvis on standing, as was the case in our two patients.
Computed tomography (CT) images revealed a hydronephrotic left kidney and dilatation of the left ureter. No ureteral calculus, neoplasm, or obstruc- tion was found, and no abnormal findings that would explain her left abdominal pain were identi- fied. Other CT findings were absence of the sternal head of the right pectoralis major, asymmetrical malformation of her chest wall due to hypoplasia of the right rib cage (Fig. 2), a shortened sternal body and anomaly of the xiphoid process (Fig. 3), spinal curvature to the right (Fig. 4), hypoplasia of the right ilium (Fig. 5), advanced atrophy of her right kidney (Fig. 6), hypoplasia of the right gluteus mini- mus (Fig. 7), and cystic mass in her right ovary (Fig. 8). Contrast-enhanced CT revealed a disruption of her right internal iliac artery (Fig. 9). Blood ex- aminations revealed no abnormalities. Urine analysis revealed leukocytosis but no urinary blood. Neph- ritis was diagnosed and antibiotics were prescribed. She is currently showing improvement and receiving out-patient treatment. She has recently been on the verge of developing glaucoma and is seeing an ophthalmologist.
Chronic non specific low back pain is the pain lasting for more than 12 weeks, exceeding the normal healing time of tissues Elders and Burdorf; Sang et Symptomatic relief in pain is always achieved but there have been a significant increase in the recurrence of this hronic pain on resumption of daily activities. One reason contributing to these recurrences is the inability to understand the interaction between muscles surrounding the hip and back pain. Altered lumbopelvic rhythm and Deconditioning of e hip due to long standing back pain has been a major cause of affected functions according to the This Deconditioning of hip muscles create a vicious cycle of pain, disuse, einonen et al., 2000; Daily activities require adequate strength in antigravity muscles and hence Deconditioning of hip extensors mainly the gluteus maximus which is a prime antigravity muscle needs to be addressed in chronic pain.
An intramuscular injection (IMI) is an injection gi- ven directly into the central area of a specific muscle. Certain medicines need to be adminis- tered by the gluteal route for these to be effec- tive. The aim of this study was to determine the influence of body mass index (BMI), subcutane- ous fat, and muscular thickness of the dorso- gluteal IMI site among healthy Japanese women. There were 39 healthy female subjects who vo- lunteered and met the criteria. Their ages ranged from 40s to 60s (50.82 ± 6.04). With the data col- lected using the B-mode ultrasound images of the dorsogluteal site, it was found that the dis- tance from the epidermis to the under-fascia (DEUF) of the gluteus maximus was dissimilar between the subject’s right and left buttocks. It was found that the distance from the epidermis to the iliac bone (DEI) was significantly more on the right than on the left buttocks. In the case of an adult Japanese woman with a BMI of 21 or more, the DEUF of the gluteus medius was found to be about 30 mm, and the DEI was approxima- tely 50 mm or more. Based on these findings, it is recommended that a needle length of 38 mm (1.5 inches) can be safely used to administer IMIs to the gluteus medius muscle to effectively and efficiently deliver medications through the IMI route.
muscle weakness, neural injury (sciatic nerve), and vascular injury. No infections occurred in the series. Moreover, there was no major swelling, hematomas, and wound dehiscence in these cases. All patients could sit with their legs crossed (Fig. 7). Neither out- toe gait nor Ober’s sign was observed, and there were no recurrent contracture of hip abductors, no snap- ping, and no residual hip pain or gluteal muscle wast- ing were seen. There are 15 patients with associated knee pain. After surgery, knee pains of these patients were released.
Table 1 provides a brief synopsis of several studies that investigated the reliability of MMT in both healthy and symptomatic subjects. The Table does not show the sub- stantial amount of normative data that exists regarding muscle strength relating to patient age, position, tasks per- formed, and so on [51,52]. There also exists a large body of data demonstrating how electromyographic signals are used as an objective representation of neuromuscular activity in patients. The EMG is a valid index of motor unit recruitment and reflects the extent to which the muscle is active; however there are some difficulties with the sensi- tivity and specificity of electrodiagnosis . All of these studies using MMT and instrumentation have collectively made a significant contribution to the study of neuromus- cular function and represent different aspects of the mus- cular activity going on in patients.
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Furthermore, studies have demonstrated the pathologic changes caused by pressure to be more severe in muscle than in skin and subcutaneous layers. These histologic studies revealed that early signs of damage occur in the upper dermis, with dilation of capillaries and venules and swelling and separation of endothelial cells. Then, perivascular infiltrates, platelet aggregates, and perivascular hemorrhage develop in the dermis. Additionally, subcutaneous fat demonstrates signs of necrosis along with early vascular changes. Interestingly, the epidermis shows no signs of necrosis until late because epidermal cells are able to withstand a prolonged absence of oxygen both in vivo and in vitro.
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Individual studies have found differences in the acti- vation, strength, and number of trigger points in the gluteus medius muscle between those with and with- out LBP [12, 16–18]. Due to these differences in glu- teus medius muscle function, perhaps this muscle has a role in either the development or exacerbation of LBP. The mechanism by which this occurs is suggested to relate to the role in which the gluteus medius muscle plays in providing both frontal and transverse plane stability of the pelvis and lower back [13–15]. Determining the nature of gluteus medius function in those with LBP compared to those without is a key component to more effective assessment techniques and management of the condition. Therefore, a sys- tematic review that collectively evaluates gluteus med- ius function in those with and without LBP is required. This systematic review aims to determine, by review of case-control studies, if adults with a history of, or current LBP, demonstrate differences in measures of
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The sciatic nerve (SN) is the largest branch of the sacral plexus. It has two components, the tibial nerve (TN) and common fibular nerves (CFN) enclosed in a common fascial sheath. In the majority of cases, SN leaves the pelvic cavity by passing through the greater sciatic foramen below the piriformis muscle and nor- mally it divides into two separate trunks outside the pelvis, usually at the level of the upper angle of the popliteal fossa .
denervation, the muscle fiber atrophy and fat fills the space created by the reduction in fiber size. In the present study, fat filled the space that was created by the loss of fibers result- ing from an impaired denervation–reinnervation process. Therefore, we advocate another hypothesis: the interstitial spaces created by muscle tissue loss followed by an impaired denervation–reinnervation process can lead to a crude FI- related implicitly to disuse but directly to denervation in the anterior GMin.
the gluteus medius line of action for the force. We quar- tered the line and chose three points (except the origin and end), through the points we drew a horizontal line, the plane corresponding to the spiral transaxial CT scans (Figure 1B). Areas of interest (the section of the gluteus medius muscle) were manually circumscribed and auto- matically computed (Figure 2A, B and C). The density was measured in Hounsfield units (HU) and was evalu- ated by measuring the mean density of the cross- sectional area in the region of interest, CSA and RD for gluteus medius muscle were determined twice by 2 inde- pendent observers to calculate the intra- and inter- observer reproducibility.
The current clinical paradigm suggests that tibial motion is controlled by structures distal to the tibia. This study was undertaken as a first step towards understanding the effect of the proximal hip musculature on transverse plane tibial rotation. Specifically, gluteus maximus was identified as the muscle with the largest capacity for transverse plane hip rotation and its activity quantified during walking. Our data showed that subjects with a rapid deceleration of the tibia had high gluteus maximus activation. This was in comparison to subjects with a slow deceleration of the tibia who had relatively lower gluteus maximus activation. It is possible that a high level of gluteus maximus activation results in a larger external torque being applied to the femur which ultimately leads to a more rapid deceleration of the tibia.
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The main advantage of perforator flaps spare the underlying muscle, providing “life boat” for any recurrent problem and because of thick subcutaneous fat layer and with a generous arc of rotation , pedicled perforator flap may be used to fill even the deep wounds. The other advantages of this flap are, preserving of the muscle function and major artery, no tension in donor site closure, design the flap as per defect, minimal donor site morbidity, less chance for recurrence and in case of recurrence local tissue will be available for secondary procedures.
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Background: While performing sacrectomy from a posterior approach enables the en bloc resection of sacral tumors, it can result in deep posterior peritoneal defects and postoperative complications. We investigated whether defect reconstruction with gluteus maximus (GLM) adipomuscular sliding flaps would improve patient outcomes. Methods: Between February 2007 and February 2012, 48 sacrectomies were performed at He Nan Cancer Hospital, Zhengzhou City, China. We retrospectively examined the medical records of each patient to obtain the following information: demographic characteristics, tumor location and pathology, oncological resection, postoperative drainage and complications. Based on the date of the operation, patients were assigned to two groups on the basis of closure type: simple midline closure (group 1) or GLM adipomuscular sliding reconstruction (group 2). Results: We assessed 21 patients in group 1 and 27 in group 2. They did not differ with regards to gender, age, tumor location, pathology or size, or fixation methods. The mean time to last drainage was significantly longer in group 1 compared to group 2 (28.41 days (range 17 – 43 days) vs. 16.82 days (range 13 – 21 days, P < 0.05)) and the mean amount of fluid drained was higher (2,370 mL (range 2,000 – 4,000 mL) vs. 1,733 mL (range 1,500 – 2,800 mL)). The overall wound infection rate (eight (38.10%) vs. four (14.81%), P < 0.05) and dehiscence rate (four (19.05%)] vs. three (11.11%), P < 0.05) were significantly higher in group 1 than in group 2. The rate of wound margin necrosis was lower in group 1 than in group 2 (two (9.82%) vs. three (11.11%), P < 0.05).