Thigh Compartment Research Articles

Morphological Variability of the Thigh Muscle Traps in an Ultrasound That Awaits Clinicians.

Objectives: Muscles and their tendons present a considerable diversity of morphological variations. The aim of this study was to explore variants of muscles and tendons from compartments of the thigh and to raise awareness about potential problems during ultrasound examination. Materials and Methods: This comprehensive review of the literature was created on the basis of scientific articles sourced from PubMed. The search included all relevant papers related to the topic, ensuring that the most up-to-date studies were incorporated. In order to achieve these results, we created the exclusion criteria and extracted papers that did not meet the requirements of our review. Relevant papers were incorporated, and tracking of citations was fulfilled. The described method allowed for a broad yet detailed understanding, ensuring that the review of the literature covers all key aspects of the presented research. Results: Various aspects of thigh muscle anomalies were already undertaken; however, as this study has shown, current knowledge, while valuable, is insufficient to draw definitive conclusions regarding the prevalence and clinical implications of these muscle variations. A more robust body of ultrasound-based research is essential to accurately characterize these anomalies, establish their frequency, and assess their impact on clinical decision-making, including diagnostic accuracy, surgical planning, and therapeutic interventions. Conclusions: Numerous anatomical variations of the thigh muscles and tendons that were described in literature over the years might have clinical implications and could lead to mistakes during diagnosis by ultrasound imaging.

Anatomical investigation of tensor vastus intermedius: A cadaveric study

The major muscle in the anterior compartment of the thigh known as quadriceps femoris is made up of four parts; rectus (straight) femoris and three vasti (vastus lateralis, medialis and intermedius). A recently discovered muscle, making the fifth part, called the Tensor vastus intermedius (TVI) has been found in-between vastus lateralis (VL) and vastus intermedius (VI). The aim of this investigation was to study the presence of the TVI muscle, identify neurovascular supply as well as variations in the nature of the muscle and to ultimately classify them. The cadaveric study was conducted in the Gross laboratories of Yusuf Maitama Sule University, Bayero University and Ahmadu Bello University, all in Nigeria. Thirty lower limbs were examined using standard dissection techniques and the TVI was demonstrated in all of them. We then classified the muscle into four types, I to IV based on their origin, course and insertion. The Type I were the independent type; constituting 12 cases (40%), the VI-type (Type II) 7 cases (23%), the VL-type (Type III) 5 cases (17%) and the common type (Type IV) 6 cases (20%). The TVI was supplied by muscular branches of the femoral nerve and receives vascular supply by branches of lateral circumflex femoral artery and vein.

An updated meta analysis on traumatic causes of thigh compartment syndrome

An updated meta analysis on traumatic causes of thigh compartment syndrome

Clinical Reasoning: An Unusual Etiology of Lumbosacral Plexopathy in a Patient With HIV.

We present a compelling case of uncontrolled diabetes, who initially presented as diabetic lumbosacral radiculoplexus neuropathy (DLRPN), with radicular pain in the right lower limb (LL) followed by asymmetric weakness of both LLs (right greater than left) with wasting in the medial compartment of the right thigh and significant sensory loss in the bilateral sural and right saphenous nerve distribution. Electrophysiology was suggestive of right lumbosacral radiculoplexus neuropathy. Incidentally, the patient tested positive for HIV-1 at our tertiary care center. CSF analysis revealed markedly elevated protein levels (>400 mg/dL) with lymphocytosis, a red flag for DLRPN. This observation led to further workup. Nerve biopsy showed large collections of perivascular endoneurial and epineurial lymphoid inflammatory cells, which favored an alternative diagnosis. This case highlights the intricate interplay between HIV infection, diabetes, and neurologic manifestations, challenging the initial clinical suspicion of DLRPN. This study emphasizes the importance of considering atypical presentations of neuropathy, especially in the context of coexisting medical conditions, and emphasizes the significance of comprehensive diagnostic workup, including CSF studies and nerve biopsy, for an accurate diagnosis.

Treatment strategy for compartment syndrome at multiple regions due to injuries caused by a tree fall: a case report

BackgroundCompartment syndrome commonly occurs in patients with forearm and lower leg fractures. Compartment syndromes of the gluteal and thigh muscles are less common. It is imperative that compartment syndrome be diagnosed and treated with fasciotomy as soon as possible. However, there are few reports on the diagnosis and treatment strategies for compartment syndromes that occur simultaneously in multiple anatomical regions or in the ipsilateral gluteal region and thigh.Case presentationWe report on a 76-year-old man who was obliquely crushed under a tree extending from the right forearm to the left groin. He was brought to our emergency room, where he was diagnosed with compartment syndrome of the right forearm and left lower leg and crush syndrome. Emergency fasciotomy was performed. On the day after admission, swelling and tightness of the left gluteal thigh became apparent, and intracompartmental pressures were elevated, which led to an additional diagnosis of these compartment syndromes. A fasciotomy was performed, the gluteal skin incision was made according to the Kocher–Langenbeck approach (one of the posterior approaches for hip fractures), and the thigh was approached by extending the incision laterally. This surgical approach enabled the decompression of the compartments through a single incision and allowed for easier wound treatment and closure.ConclusionThis case highlights the diagnosis and treatment of compartment syndrome in four anatomical regions. Extension of the Kocher–Langenbeck approach to the lateral thigh can be a useful surgical approach for ipsilateral gluteal and thigh compartment syndrome.

Poster 374: Tendon Tears Among Patients Treated with Exogenous Therapeutic Anabolic Steroids: An Eight Year Retrospective Analysis in a Single Institution

Objectives: Many individuals are currently treated with exogenous testosterone for a diverse array of medical conditions. However, in some clinical studies, testosterone treatment is associated with a higher risk of tendon injuries, especially among male bodybuilders and professional athletes. In the literature to date, most tendon ruptures among anabolic steroid users were reported to be at the long head of the biceps (39%), pectoralis (29%), triceps (16%), and Achilles tendon (8%). Additionally, several basic science studies have shown an increased risk of tendon injury biomarkers associated with exogenous anabolic steroid use. Anabolic steroid use has increased since the 1990s, including use among non-athletes. However, the hazards of using testosterone in the nonathlete population has been scarcely described. This study aims to determine the risk of tendon ruptures and surgical intervention for these injuries among exogenous therapeutic testosterone users as well as the risk of recurrent injury after surgery in this setting. Methods: After IRB approval, patient medical records from October 2015 to July 2023 at our institution were quieried for testosterone users. The patient records were reviewed to identify a cohort of testosterone users and a cohort of all non-users in the same time period. ICD-10 diagnosis codes for tendon injury were used to search for specific tendon injuries. Exclusion criteria from both the user and nonuser groups included active tobacco smoking, type 2 diabetes, chronic inflammatory conditions, and the use of fluoroquinolone or corticosteroid medications. Results: A total of 1.3 million patients were identified as being evaluated at our institution during the study time frame which included 12,939 (1% of the population, 83% male) testosterone users with a total of 14,884 reported tendon ruptures. The incidence of these injuries among our non-athlete patients being treated with therapeutic exogenous testosterone was considerably lower when compared to what has been reported among the NFL player (9.1%) and bodybuilder (22%) populations. In our study, testosterone users had a 2.9-fold increased risk of tendon rupture compared to nonusers (3.2% vs. 1.1%, [95% CI, 2.6-3.2]; p<0.0001). However, no statistical differences were reported among female users (1.4%) vs. nonusers (1.0%) with an odd ratio (OR) of 1.36 [95% CI, 0.9-1.9]; p=0.10). Overall, a higher increase in risk of tendon ruptures was found among patients aged 35-44 years (OR: 2.9) and over 85 years (OR: 2.5). Conversely, middle-aged adults (35-44 years) had the highest risk of rotator cuff tears (OR:4.69). Only two previous studies have been conducted, with conflicting results regarding the association between testosterone use and tendon ruptures. Interestingly, no significant differences were observed in NFL players concerning tendon ruptures. However, bodybuilders were reported to have an elevated risk of tendon ruptures (OR: 4.7). In our series, among testosterone users, rotator cuff tear was the most prevalent tendon rupture location (77%, OR: 3.28), followed by the posterior thigh compartment (8%, OR: 3.60), foot and ankle (4%, OR: 3.13), Achilles’s tendon (3%, OR: 2.76). Although the long head of the biceps tendon had a overall low rate of injury in our series (1%) it had the highest OR at 7.7. It is assumed that we did not find a pectoralis rupture in this series because it is associated with specific activities in which this population had a low degree of participation. Conclusions: Therapeutic testosterone use increases the risk of tendon ruptures compared to patients not using therapeutic exogenous testosterone. This risk was most prevalent in men over the age of 55 years. The most common tendon tear location was rotator cuff tendon tears, and the stratification of tendon tear locations differed significantly compared to other previously reported anabolic steroid user populations (e.g. body builders).

Muscular Location of the Hydatid Cyst on the Limbs (About 7 Cases)

Echinococcosis or hydatidosis is an anthropozoonosis following development in humans and certain animals from the larva of a cestode transmitted by dogs: Echinococcus granulosus. The soft parts of limbs represent a rare location of this parasite. We present a retrospective study of a series of 7 case of isolated and primary hydatid cyst (kh) in peripheral muscles. The preferred terrain was that of men of rural origin (85.7%), the average age is 43.4 years. swelling that has been present for at least 3 months was the first reason for consultation. There is no change in general condition. The preferred seat was at the level of thigh muscles 6 times out of 7 (85.7%), including 4 at the level of the adductor compartment of the thigh. The diagnosis is based on imaging and immunological reactions and it was confirmed by histology. All patients benefited from a surgical excision supplemented by chemotherapy based on antiparasitics.

Skeletal muscle architecture and aging: A comparison of ultrasound techniques and an assessment of intrarater reliability.

To assess intrarater reliability of ultrasound-determined measurements of skeletal muscle characteristics across different measurement outcomes, imaging techniques, and age groups. 2D ultrasound images (B-mode) of the quadriceps were obtained from young (26 ± 4 year, n = 8 M, 8 F) and older (70 ± 7 year, n = 7 M, 5 F) adults on two occasions, separated by 6 ± 3 days. With participants in both standing and supine postures, images were collected from five anatomical sites along the anterior (two sites) and lateral (three sites) compartments of the thigh corresponding to 56%, 39%, and 22% (lateral only) of femur length. Images were analysed for muscle thickness, pennation angle, and echogenicity. Intraclass correlation coefficients (ICC) were used to assess reliability. Muscle thickness values were higher (p < 0.05) on images collected in the stand versus supine posture only for muscles of the anterior compartment, independent of age. Echogenicity values were higher (p < 0.05) in the vastus intermedius on images collected in the supine versus stand posture only in older adults. Pennation angle values were not impacted by imaging posture (p > 0.05). ICC values for thickness, echogenicity, and pennation angle were generally higher for analyses conducted on images collected in the supine versus stand posture. Imaging posture generated a greater difference in ICC values in the lateral versus anterior muscles and in older versus younger participants. Our findings suggest that participant posture during imaging impacts the absolute values and intrarater reliability of ultrasound-determined muscle characteristics in a muscle-specific fashion, and this effect is greater in older compared to younger individuals.

Delayed Compartment syndrome after total knee replacement: A case report with short review

Purpose: We would like to report a case which developed delay anterior thigh compartment syndrome after total knee replacement surgery and review the underlying risk factors. Method: A 67years old lady was suffered from delay thigh anterior compartment syndrome 4 days after total knee replacement surgery. Urgent fasciotomy was performed. Later work up showed a large intramuscular haematoma within the anterior compartment which required drainage. Discussion: Short review was performed to identify the risk factors for developing compartment syndrome after total knee replacement surgery. Management strategy and prognosis was also discussed. Conclusion: Compartment syndrome should be diagnosed and treated promptly. Patient with underlying risk factors must be identified and with close monitoring of this rare complication in post-operative period.

Thigh compartment syndrome: Outcomes in an urban level 1 trauma center

IntroductionThigh compartment syndrome (TCS) is a rare surgical emergency associated with a high risk of morbidity with mortality rates as high as 47 %. There is sparse literature discussing the management as well as outcomes of these injuries. The purpose of this study is to review a consecutive series of patients presenting to a single urban Level 1 trauma center with TCS to identify injury characteristics, clinical presentation, and outcomes associated with this injury. MethodsA trauma database was queried for all patients with a diagnosis of TCS at a single level 1 urban trauma center between January 1, 2011 and December 31, 2021. Demographic and injury variables collected included age, sex, BMI, mechanism of injury, and creatine phosphokinase levels (CPK). Hospital quality measures including time from admission to surgery, length of both hospital and ICU stay, complications, and cost of care were collected. Descriptive statistics are reported as median [interquartile range] or N (percent). ResultsThere were 14 patients identified with a diagnosis of TCS. All were men with an average age 33.5 [23.5 - 38] years and an average BMI of 26 [22.9–28.1]. The most common cause of injury was blunt trauma (71.4 %), and the remaining 28.6 % were gunshot wound injuries. Within the cohort, 6 (42.9 %) patients sustained a femoral shaft fracture, and 4 (28.6 %) patients sustained a vascular injury. The median initial CPK of patients within this cohort was 3405 [1232–5339] and reached a peak of 5271 [3013–13,266]. The median time from admission to diagnosis was 6.8 [0–236.9] hours. The median time from admission to the operating room was 8.2 [0.6–236.9] hours, and the median number of operating room visits was 3 [2 - 6]. Five patients (35.7 %) wounds were closed with split thickness skin grafting. There were 12 (85.7 %) patients who required ICU care. The median ICU length of stay was 7.5 days [4–15]. The median hospital length of stay was 16.5 days [13.25–38.0]. The median total charges for a patient with thigh compartment syndrome was $129,159.00 [$24,768.00 - $587,152.00]. The median direct variable cost for these patients was $86,106.00 For comparison, the median direct variable cost for patients with femur fractures without TCS at this institution was $8,497.28 [$1,903.52–$21,893.13]. No patients required readmission within 60 days. There were no mortalities. ConclusionTCS is a rare and life-threatening injury associated with significant morbidity. Despite rapid diagnosis and fasciotomy, the majority of the patients have prolonged hospital courses, ICU lengths of stay, and significant costs of treatment. Providers can reference the outcomes reported in this study when caring for TCS patients.

Thighplasty at the Time of Stage-1 Bone-Anchored Osseointegration Surgery.

For patients with transfemoral amputations and difficulty tolerating conventional socket-based prostheses, osseointegrated (OI) implants have enabled increased prosthetic use, improved patient satisfaction, and shown promising functional outcomes1,2. Although the use of OI implants effectively eliminates the soft-tissue-related challenges that have plagued socket-based prostheses, the presence of a permanent, percutaneous implant imparts a host of new soft-tissue challenges that have yet to be fully defined. In patients undergoing OI surgery who have redundant soft tissue, we perform a thighplasty to globally reduce excess skin and fat, tighten the soft-tissue envelope, and improve the contour of the residual limb. First, the orthopaedic surgical team prepares the residual femur for implantation of the OI device. After the implant is inserted, the residual hamstrings and quadriceps musculature are closed over the end of the femur, and the subcutaneous tissue and skin are closed in a layered fashion. Although the anatomic location and amount of excess soft tissue are patient-dependent, we perform a standard pinch test to determine the amount of soft tissue that can be safely removed for the thighplasty. Once the proposed area of resection is marked, we proceed with longitudinal, sharp dissection down to the level of the muscular fascia. At this point, we use another pinch test to confirm the amount of soft-tissue resection that will allow for adequate resection without undue tension3. Excess subcutaneous fat and skin are carefully removed along the previously marked incisions, typically overlying the medial compartment of the thigh in the setting of patients with transfemoral amputations. The thighplasty incision is closed in a layered fashion over 1 or 2 Jackson-Pratt drains, depending on the amount of resection. Depending on the amount of redundant soft tissue, thighplasty may not be necessary at the time of OI surgery; however, in our experience, excess soft tissue surrounding the transcutaneous aperture can predispose the patient to increased shear forces at the aperture, increased drainage, and increased risk of infection4. Although superficial infectious complications are most common following OI surgery, the need for soft-tissue refashioning and excision is one of the most common reasons for reoperation1,5. Our group has been more aggressive than most in our use of a vertical thighplasty procedure to globally reduce soft-tissue motion in the residual limb to avoid reoperation. Although much of the OI literature has focused on infectious complications, recent studies have demonstrated reoperation rates of 18% to 36% for redundant soft tissue following OI surgery1,5. We believe that thighplasty at the time of OI not only reduces the likelihood of reoperation but may also decrease infectious complications by reducing relative motion and inflammation at the skin-implant interface4,6. The thighplasty procedure is ideally performed as part of the first stage of the OPRA (Osseointegrated Prosthesis for the Rehabilitation of Amputees) procedure to limit the likelihood of problematic ischemia-related complications.We utilize a confirmatory pinch test both before and throughout the thighplasty procedure to ensure adequate resection without undue tension.The thighplasty excision pattern utilizes a long vertical limb designed to decrease the circumferential laxity of the residual limb. Maximal tension is borne on the vertical limb and not on the transverse extensions, as these are prone to scar widening and distortion of surrounding tissues.Closed-suction drainage is utilized liberally to decrease the likelihood of a symptomatic seroma. OI = osseointegratedOPRA = Osseointegrated Prosthesis for the Rehabilitation of AmputeesPVNS = pigmented villonodular synovitisT-GCT = tenosynovial giant-cell tumor.BMI = body mass indexPMH = past medical history.

Factors Associated with Development of Thigh Compartment Syndrome Following Subtrochanteric and Diaphyseal Femoral Fractures.

Acute compartment syndrome of the thigh (CST) is an ongoing challenge for orthopaedic surgeons as the diagnosis is often difficult to establish. Currently, there is a shortage of studies investigating risk factors for the development of thigh compartment syndrome following subtrochanteric and diaphyseal femoral fractures. This study aimed to identify risk factors associated with the development of CST following femoral fractures. Retrospective review performed in a level one trauma center from January 2011 to December 2020 for all patients with non-pathological acute subtrochanteric or diaphyseal femoral fractures. Variables collected included demographics, injury severity score (ISS) scores, mechanism of injury, classification of femoral fracture, open versus closed injuries, development of compartment syndrome, time to compartment syndrome diagnosis, number of subsequent surgeries, and primary wound closure versus split-thickness skin graft. The statistical analysis of this study included descriptive analysis, simple logistic regression, paired T-test, and Wilcoxon Signed Rank. Thirty-one (7.7%) patients developed thigh compartment syndrome following 403 subtrochanteric or diaphyseal femoral fractures. The mean (SD) age for those who developed CST was 27.35 (8.42). For every unit increase in age, the probability of developing CST decreased. Furthermore, male gender had 18.52 times greater probability of developing CST (P <0.001). AO/OTA 32-C3 and subtrochanteric femoral fracture patterns demonstrated 15.42 (P = 0.011) and 3.15 (P <0.001) greater probability of developing CST, respectively. Patients who presented to the hospital following a motor vehicle accident (MVA) or gunshot wound (GSW) had 5.90 (P= 0.006) and 14.87 (P < 0.001) greater probability of developing CST, respectively. Patients who were male, younger in age, and had a 32-C3 and subtrochanteric femoral fractures were at increased probability of developing CST. High energy trauma also increased the risk of developing CST. A high index of suspicion should be expressed in patients with these risk factors.

Anterior Thigh Myxofibrosarcoma with Management of Wide Excision and Modified Anterior Thigh Compartment Resection : A Case Report

Introduction: Myxofibrosarcoma (MFS) is a type of malignancy from the group of malignant fibrous histiocytoma. Myfxofibrosarcoma is a type of soft tissue neoplasm that is aggressive. The clinical symptoms are not pathognomonic and the histological picture is very heterogeneous, often receiving delayed treatment and causing misdiagnosis. Complementary histochemical and immunohistochemical staining is mandatory to confirm the diagnosis of MFS. Extensive surgical treatment and followed by radiotherapy is the first choice of myxofibrosarcoma treatment.&#x0D; Case Presentation: A 54-years old woman complained of a lump on her left thigh that had been getting bigger for the past 2 years. The lump initially looked the size of a marble, then grew to the size of a tennis ball in the last 7 months. On physical examination, a mass was found in the left thigh area, a hard, fixed mass, the size of a tennis ball. Fine needle aspiration examination showed suspicious results for myxofibrosarcoma. The patient underwent a Magnetic Resonance Imaging examination in the left lower extremity area and underwent wide excision and anterior thigh compartment resection surgery.&#x0D; Discussion: Wide resection is the standard treatment for MFS [4]. The choice of procedure for each patient is different and should be based on tumor size, location, stage, surrounding neurovascular and bony elements, as well as functional and cosmetic considerations [4]. The minimum resection margin in MFS is at least 1 cm which aims to minimize the risk of local recurrence [4]. The recommended resection margin is at least 2 cm for MFS resection [4]. We had plan a 2 cm margin of the entire preoperative MRI enhancement area. It should be noted that the local recurrence rate for MFS in margin-negative resections is relatively high compared with other STS subtypes.&#x0D; Conclusion: We recommend Wide Excison and Modified Anterior Thigh compartment Resection is recommended procedure for anterior thigh myxofibrosarcoma. This procedure involves preserving uncontaminated thigh neurovascular, and only resecting one of the sarcoma-infiltrated muscle heads and preserving the other quadriceps muscle head of the thigh to maintain knee extension function. This paper is the first report on the successful treatment of anterior thigh myxofibrosarcoma without weakness of knee extension complication.

Exogenous Peptide Injection Causing Medical Thigh Compartment Syndrome

BackgroundAcute compartment syndrome can be caused by any condition that increases the pressure of an intracompartmental muscular space, resulting in ischemia, which is a limb-threatening emergency. This case report is the first known documented example of an exogenously injected peptide causing compartment syndrome. The use of natural supplements and holistic therapies is on the rise, specifically, peptide injections. It is important to obtain the history of use and routes of administration of these substances. Case ReportWe present a case of a 43-year-old man who presented to the Emergency Department with worsening thigh pain. The patient had injected a “peptide cocktail” into his thigh 3 days prior. Physical examination revealed trace pitting edema of the left leg with moderate muscle spasm and tenderness of the medial aspect of the distal thigh with associated numbness along the medial aspect of the knee. Point-of-care ultrasound detected intramuscular edema and free fluid in the leg. He was found to have acute compartment syndrome of the thigh secondary to the peptide cocktail injection, causing a large hematoma posterior to the adductor magnus. The patient required fasciotomy and hematoma evacuation. He ultimately left against medical advice during his hospitalization. Why Should an Emergency Physician Be Aware of This?In an age when many patients look for supplements to aid with weight loss and muscle growth, it is essential to be aware of peptide injection therapies and the potential complication of compartment syndrome.

Unusual presentation of antepartum lumbosacral plexopathy: A rehabilitation approach

Background: This case report focuses on a woman in her late thirties (gravida three para three) referred from Neurology to Physical Medicine &amp; Rehabilitation department due to pain, lower limb weakness, walking difficulties, and dependence in daily activities. Her symptoms, which began during the second trimester of pregnancy, progressed from burning sensations in her feet to muscle weakness affecting her legs and thighs in the peripartum period. Case presentation: Following delivery, diagnostic investigations indicated lower creatine phosphokinase levels, MRI findings showed muscle atrophy in the posterior compartment of both thighs, and an electromyography and nerve conduction study confirmed bilateral lumbosacral plexopathy. Treatment and outcomes: Rehabilitation commenced six weeks postpartum, but the patient faced challenges due to her functional limitations. The treatment included a multifaceted approach encompassing medical management, physical therapy, and occupational therapy. Notably, the patient demonstrated significant improvement within two weeks of inpatient rehabilitation. Conclusion: This case underscores the effective management of antepartum lumbosacral plexopathy using a comprehensive rehabilitation strategy. Early intervention and a multidisciplinary approach are pivotal in achieving positive outcomes in similar clinical presentations.

Heterotopic Ossification in Hemophilia: A Multi-Center Case Series

CONCLUSION Heterotopic Ossification (HO), or Myositis Ossificans Traumatica, is the post-traumatic formation of unwanted abnormal benign lamellar ectopic bone within extra skeletal tissue locations. HO can form in varying sizes and sites in the body and can significantly impair muscle performance, range of motion (ROM), and function. Since the recent adoption of diagnostic musculoskeletal ultrasound (MSKUS) in hemophilia care, providers and physical therapists have deepened their understanding of hemarthropathic and hemarthrosis progression. MSKUS has also aided in detecting soft tissue injuries, muscle hematoma, and resultant HO formation. Despite advances in therapies for hemophilia, HO is emerging as an unforeseen complication of contusion and injury-related muscle bleeding in hemophilia. Its detection is important as delayed or inappropriate rehabilitation may prolong recovery and disability time. This multicenter retrospective case series sought to verify and confirm HO detection and investigate whether specific types and severities of hemophilia are at increased risk of HO. Deidentified data and MSKUS images from 29 cases were collected from 9 Hemophilia Treatment Centers from the USA, the Netherlands, and Canada from 2016 to June 2023. The case series was declared exempt from IRB approval. Diagnostic and evaluative data was compiled in Redcap. Images were reviewed and diagnostically confirmed by an RMSK-certified Doctor of Physical Therapy and a Radiologist. A single clinic subset was compared to the national hemophilia incidence taken from the ATHN dataset 2022. We detected HO formation in 29 patients across 9 HTCs. Trauma-induced HO was observed in all bleeding disorder types and severities. (See Table 1). The patients' ages at the time of the inciting injury ranged from 7-56 years, with a mean age of 22.3 and a median of 16.The study's highest incidence of HO cases occurred in patients with type A hemophilia totaling 22/29 subjects or 74.8% of all cases. Except for one severe A, one severe B and a moderate B, the patients were not on prophylactic hemostatic management at the time of injury. The majority of HO (n=24, 82.8%) occurred in the anterior and lateral compartments of the thigh and hip. There were 5 incidents in the upper extremity (4 in the upper anterior arm, 1 in the hand). 24 cases were due to blunt trauma except for 4 in the psoas at the level of the anterior hip and 1 in the elbow flexors of the upper arm. HO formation was mostly associated with deep muscle bleeds next to the bony cortex (n=24). HO was detected on average at 22.97 days after injury (median 21, range 11 to 60), with most detected with MSKUS (n=24) by the physical therapist (n=22) and physician (n=2) in clinic. At the Washington Center for Bleeding Disorders (WACBD), where strict MSKUS follow-up was possible in 7 patients, HO induction was confirmed at day 23, 26, 18, 11, 14, 20, and 22 for a mean of 19.14 days (SD = 5.24). Our study shows that HO occurs regularly in Hemophilia despite its omission in the recently revised 2020 World Federation of Hemophilia guidelines. Notably, the severity or type did not appear to be the sole determinant of HO formation, as the combined total of mild and moderate hemophilia genotypes was 21 (72.4%). Conversely, though limited by the study's small sample size, 74.8% of the HO incidence was reported in type A hemophilia, which appears to be an overrepresentation when compared to the ATHN dataset 2022 report, which indicates an overall 45.59% type A hemophilia incidence. The increased detection of HO in hemophilia may be explained by the growing use of MSKUS by HTC physicians and physical therapists. MSKUS has the advantages of safety and earlier HO detection than radiography. As shown in Fig. 1, HO bears the sonographic signature of hyperechoic contours and deeper acoustic shadowing. The WACBD conducted a review yielding an HO incidence of 23.68% (9 of 38 contusion events) compared to 9-17% in the non-hemophilia population. Though the single-center report is of limited significance, the suggestion of increased HO risk to hemophilia patients merits further study. This case series acknowledges HO as a complication of deep contusions in people with bleeding disorders, especially those not on hemostatic prophylaxis. Further study is needed to determine HO's incidence and risk in Hemophilia. Hemophilia treatment guidelines must be revised to include this complication.

Thigh muscle thickness on ultrasonography for diagnosing sarcopenia: The Kyoto-Kameoka study.

The Asian Working Group for Sarcopenia 2019 consensus reported that evidence for the diagnosis of sarcopenia based on ultrasonography findings is lacking. The revised European Working Group on Sarcopenia in Older People consensus stated that ultrasonography is reliable and valid for assessing muscle size in older adults. The present study aimed to determine the predictive accuracy of ultrasonography for sarcopenia in older adults in Japan. A total of 1229 participants aged 65-91 years were included in this cross-sectional study. The thickness of the anterior compartment of the right thigh was assessed using B-mode ultrasonography. The measurement position was at the midpoint of the thigh. In addition, the grip strength, gait speed, Five-Time Sit-to-Stand Test, Short Physical Performance Battery score and skeletal muscle mass index were evaluated. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia 2019 algorithm. We calculated the area under the receiver operating characteristic curve. The area under the receiver operating characteristic curves (95% confidence intervals) and cutoff values for the thigh muscle thickness in sarcopenia were 0.901 (0.856-0.946) and 4.0 cm in men, respectively, and 0.923 (0.851-0.995) and 3.1 cm in women, respectively. The area under the receiver operating characteristic curve for each subdomain of sarcopenia, such as grip strength and gait speed, ranged from 0.618 to 0.872. In the present study, the suggested cutoff mid-thigh muscle thicknesses on ultrasonography for predicting sarcopenia were 4.0 cm in men and 3.1 cm in women. Geriatr Gerontol Int 2024; 24: 156-161.

Prevalence Of Hamstring Tightness Among School Children Between 7-15 Years Of Age Group In Pune. Maharashtra: A Cross Section Study

Hamstring are located at the posterior compartment of the thigh from hip to knee and from medial to lateral aspectThe purpose of this study is to assess the prevalence of hamstring tightness in school going children of age 7-15 years Methods- 912 samples of school students of age 7-15yrs were included in the study according to inclusion and exclusion criteria. An outcome test known as the active knee extension test was used. Result- Total prevalence of hamstring tightness in females in right lower extremity - 415 i.e.(88.2%) and in left lower extremity 379 i.e.(80.6%). Conclusion- The study concluded that females showed statistically significant higher percentage of hamstring tightness than male participants.

Giant lipoma of thigh – Case report of rare tumour

Lipomas are tumours which arise from fat tissues and are most common soft tissue tumours. When lipomas turn malignant, they are known as liposarcoma. Lipomas of length greater than 10cm or weight greater than 1000 grams is defined as giant lipoma. Lipomas are mostly asymptomatic at presentation, however when enlarged they can cause symptoms like pain, difficulty in walking due to compression of underlying neurovascular structures. A male patient aged 65 years presented with non-painful swelling in the left thigh which gradually increased in size over last 6 months. The patient did not have any symptoms due to swelling. On examination the swelling was measured 20x15 cm not fixed to skin or underlying bone or soft tissues. No inguinal lymph node was palpable. Contrast Enhanced Magnetic Resonance Imaging (CEMRI) of thigh showed a well circumscribed fat enhanced lesion in the anterior compartment of the left thigh which measures approximately 10.4 x 12.5 x 21.4 cm. The mass lesion was abutting &amp; medially displacing the femoral neurovascular bundle without encasement. Core biopsy from lesion showed adipocytes with background myxoid stromal and skeletal tissue. No cellular pleomorphism mitosis or increased vascularity is evident. Patient underwent excision of tumour with intact capsule under GA via longitudinal elliptical incision. Final histopathology was reported as mature adipocyte separated by thin fibrous septa suggestive of lipoma without any evidence of lipoblasts or atypical nuclear cells. Patient does not have any recurrence after one year of follow up. Surgical excision with intact capsule is treatment of choice for lipoma. In giant lipomas malignant transformation to liposarcoma should be suspected. On imaging malignant transformation is suspected with characteristics like solid component, haemorrhage, infiltration into neurovascular structures which is confirmed on final histopathology report after excision.

Quantitative and large-format histochemistry to characterize peripheral artery compositional gradients.

The femoropopliteal artery (FPA) is a long, flexible vessel that travels down the anteromedial compartment of the thigh as the femoral artery andthen behind the kneecap as the popliteal artery. This artery undergoes various degrees of flexion, extension, and torsion during normal walking movements. The FPA is also the most susceptible peripheral artery to atherosclerosis and is where peripheral artery disease manifests in 80% of cases. The connection between peripheral artery location, its mechanical flexion, and its physiological or pathological biochemistry has been investigated for decades; however, histochemical methods remain poorly leveraged in their ability to spatially correlate normal or abnormal extracellular matrix and cells with regions of mechanical flexion. This study generates new histological image processing pipelines to quantitate tissue composition across high-resolution FPA regions-of-interest or low-resolution whole-section cross-sections in relation to their anatomical locations and flexions during normal movement. Comparing healthy ovine femoral, popliteal, and cranial-tibial artery sections as a pilot, substantial arterial contortion was observed in the distal popliteal and cranial tibial regions of the FPA which correlated with increased vascular smooth muscle cells and decreased elastin content. These methods aim to aid in the quantitative characterization of the spatial distribution of extracellular matrix and cells in large heterogeneous tissue sections such as the FPA. RESEARCH HIGHLIGHTS: Large-format histology preserves artery architecture. Elastin and smooth muscle content is correlated with distance from heart and contortion during flexion. Cell and protein analyses are sensitive to sectioning plane and image magnification.