Mechanoreceptors in collateral knee ligaments: an animal experiment.
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The mechanoreceptors in the collateral ligaments of the knee joint in rat hindlimbs were studied. In group II (n=10) the femoral and obturator nerves were sectioned. In both groups III and V (n=20) the sciatic nerve was sectioned. In group V (n=10) the sectioned sciatic nerve was sutured 4 weeks after sectioning. In group IV (n=10) all three nerves were sectioned. Group I (n=10) served as control. After 4 months all animals were killed. The ligaments of the knee joint were preserved and stained with gold chloride, paraffin-embedded and cut in sagittal serial sections. The results showed that 4 months after partial or total denervation of the limb, there was necrosis and a decrease in the number of mechanoreceptors, which was dependent upon the severity and site of the lesion. After suture of the sciatic nerve the increase in mechanoreceptors suggested a regenerative process. (+info)
Anatomical study of the obturator internus, gemelli and quadratus femoris muscles with special reference to their innervation.
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The manner of innervation of the obturator internus, superior and inferior gemelli, and the quadratus femoris in humans (101 pelvic halves) and in rhesus monkeys (Macaca mulatta: 8 pelvic halves) were investigated. In most specimens, the inferior gemellus originated from the lateral surface of the ischial tuberosity and also from the medial surface (intrapelvic origin) just beneath the obturator internus and was covered by the falciform process of the sacrotuberous ligament. The superior gemellus was frequently innervated by the nerve to the obturator internus and the nerve to the quadratus femoris (60.4%), and the inferior gemellus was innervated by the obturator internus nerve in two specimens. The quadratus femoris nerve originated from more cranial segments than the obturator internus nerve, however these nerves had various communication patterns inside and outside the muscles. According to the intramuscular nerve distribution, in some specimens the branches to the superior gemellus from the quadratus femoris nerve extended to the inferior gemellus, and the branches to the inferior gemellus were distributed to the obturator internus. The present findings revealed that the positional relationships among the branches to the obturator internus and gemelli muscles are relatively constant, although the branching patterns and innervation patterns were varied. The various patterns and routes are considered to reflect the variability of the differentiation patterns of the anlage of the muscles. A possible schematic model of the positional relationships between the muscles and the nerves is proposed. (+info)
Pelvic presentation of a hip joint ganglion: a case report.
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Ganglia may be found near any joint. The hip joint is one location where these lesions have been reported. In most instances the ganglia found around the hip are small, deep-seated, and not palpable. Palpable ganglia are commonly larger and present as a groin mass. We report a ganglion cyst that was not palpable due to its intrapelvic location. (+info)
Two case reports of obturator nerve block for transurethral resection of bladder tumour.
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This report describes two cases of severe adductor muscle spasm during transurethral resection of bladder tumours and subsequent successful management with the help of obturator nerve block. Obturator nerve blocks are useful during surgery to remove large, advanced tumours in the distal lateral wall of the bladder. (+info)
Diagnosis and laparoscopic repair of type I obturator hernia in women with chronic neuralgic pain.
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BACKGROUND: We performed a pilot study review of 7 female patients suffering with obturator neuralgia produced by a type I obturator hernia. Diagnosis and laparoscopic treatment of this rare hernia are presented. METHODS: Patients with chronic pelvic pain and signs of obturator neuralgia were identified retrospectively by chart review. These patients had been referred to our chronic pelvic pain clinic. Outcomes of their surgery from February through November 2001 were analyzed. Median length of follow-up was 11 months (range, 6 to 16). A new technique using Cooper's ligament and arcus tendineus fasciae pelvis was used for the tension-free mesh hernia repair. RESULTS: In this pilot study, 6 of 7 patients (86%) received greater than 50% relief of their chronic pelvic pain, which leads to the conclusion that we have at least 95% confidence that the pain reduction achieved is greater that 50%. Due to the small sample size, no statistically meaningful conclusions could be reached. All of the patients have reported some pain relief and increased function since surgery. CONCLUSION: Symptomatic type I obturator hernias may be more common than previously thought. Patients with obturator neuralgia, persisting longer than 6 months despite conservative therapy, may respond to laparoscopic reduction of the pilot fat tag and mesh overlay of the obturator canal. (+info)
A new inguinal approach for the obturator nerve block: anatomical and randomized clinical studies.
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BACKGROUND: Obturator nerve block is highly recommended for knee surgery in addition to a femoral nerve block. The main disadvantage of the classic approach at the pubic tubercle is low patient acceptance due to pain and discomfort. The authors hypothesized that the use of a new inguinal obturator nerve block technique would reduce pain and discomfort in patients. METHODS: The inguinal approach was simulated in five fresh cadavers. Injection of latex was performed in two cadavers. The location of the needle and the extent of latex solution were analyzed. Fifty patients scheduled to undergo arthroscopic knee surgery were randomly assigned to receive obturator nerve block using either the inguinal (n = 25) or the pubic tubercle approach (n = 25). RESULTS: In all cadavers, the needle was close to the obturator nerve branches, which were surrounded by the latex solution. In the clinical study, visual analog scale pain scores and discomfort of block placement were significantly lower in the inguinal group compared with the pubic tubercle group (P < 0.01). In the inguinal group, there was a significant decrease in block performance time (P < 0.05) and in bolus of propofol and fentanyl used for the procedure (P < 0.01). Twenty minutes after application of the block, adductor strength decrease, occurrence, and location of cutaneous distribution of the obturator nerve were not significantly different between the groups. The incidence of minor complications was significantly increased in the pubic tubercle group (P < 0.05). No major complications were observed. CONCLUSIONS: The new inguinal approach decreases patient discomfort and pain of block placement as well as the time and sedation and analgesics required for a similar quality of sensory and motor block compared with the pubic tubercle approach. (+info)
Detailed anatomy of accessory obturator nerve blockade.
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BACKGROUND: The accessory obturator nerve (AON) often innervates the hip joint and adductor longus. The AON is present in 10-30% of patients, and thus it is clinically important that it is also considered during obturator nerve (ON) blockade. METHODS: The study was performed on 12 cadavers (24 body-sides) and the AON beginning from the lumbar plexus was observed. The needle was classically penetrated into the ON to gain access to the AON and upon definition of detailed AON anatomy, morphometric measurements were conducted. In addition, novel maneuvers used in the study were described. RESULTS: Throughout the dissections, the AON was detected on three sides (12.5%) and the mean AON- pubic tubercle distance was measured as 4.0 cm. The needle was withdrawn and positioned medially and almost parallel to the skin. It was then advanced through the superior pubic ramus to reach the AON. CONCLUSION: Owing to its anatomical structure, the AON can be easily accessed during classical ON blockade using the maneuvers described here. Further clinical studies are needed to investigate if supplementing ON blockade with AON blockade might improve the clinical efficiency and quality of the blockade. (+info)
Effect of FK506 administration after obturator nerve injury: a functional and ultrastructural study.
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The frequency of obturator nerve damage due to pelvic diseases, fractures or gynecologic procedures is uncertain. In the present study, we investigated the effect of FK506, a potent macrolide antibiotic and immunosuppresant, on obturator nerve recovery at morphological and functional levels. Forty female Wistar rats were randomly divided into four groups (control, sham, FK506-treated, vehicle-treated). In half of animals (FK506-treated and vehicle-treated) an obturator nerve crush (30 seconds clamp) was created. In FK506-treated group FK506 administration (1 mg/kg/day, subcutaneously) was performed on each postoperative day. All the rats were functionally evaluated by pinch and adduction tests preoperatively and postoperatively at one, two, three and four weeks after nerve injury. On the 28th postoperative day obturator nerve samples were collected and analyzed qualitatively by light and electron microscopy. FK506 treatment resulted in dramatic improvement in nerve function and in the ultrastructure of nerve fibers suggesting its therapeutic potential in traumatic obturator nerve injury. (+info)