Acute Groin Pain Syndrome Due to Internal Obturator Muscle Injury in a Professional Football Player

Traumatic groin pain syndrome is the result of an acute trauma, usually an indirect muscle injury (i.e., an overstretching of the muscle fibers). The most affected muscles in traumatic groin pain syndrome are rectus abdominis, adductors, and iliopsoas. The internal obturator muscle lesion is very rare. The internal obturator muscle externally rotates the thigh and contributes to the stabilization of the hip joint and its indirect injury may cause the onset of traumatic groin pain syndrome. This case report describes a rare indirect injury of internal obturator in a 29-year-old professional male soccer player.

Effect of pre-operative internal obturator muscle mass index in MRI on biochemical recurrence of prostate cancer patients after radical prostatectomy: a multi-center study

Background Recent reports show that the pre-operative or post-operative skeletal mass index (sarcopenia) affects survival rates for various cancers; however, the link between prostate cancer survival and sarcopenia is unclear. Therefore, this study examined the effect of the pre-operative internal obturator muscle (IOM) mass index on biochemical recurrence (BCR) of prostate cancer (PCa) patients who underwent radical prostatectomy. Methods In total, 222 patients, who underwent open, laparoscopic, or robot-assisted radical prostatectomy at seven centers in 2011 and were followed up for 5 years, were enrolled. BCR was examined in the context of pre-operative IOM mass index and BMI. Results The mean age of the patients was 67.82 ± 6.23 years, and the mean pre-operative prostate-specific antigen (PSA) level was 11.61 ± 13.22 ng/ml. There was no significant difference in baseline characteristics between the low and high IOM mass index groups (p > 0.05). Age, pre-op PSA level, ECE, and T-stage were associated with BCR (p = 0.049, p < 0.001, p = 0.001, p = 0.004, respectively). BMI, prostate volume, Gleason score, resection margin, N-stage, M-stage and IOM mass index was not associated with BCR (p > 0.05). Conclusions Pre-operative IOM mass index was not associated with BCR; however, long-term follow-up is necessary to evaluate cancer-specific and overall survival of PCa patients.

Evaluation of muscle volume and degeneration after total hip arthroplasty: a comparison of the posterolateral approach and the anterolateral supine approach

Background Muscle strength around the hip after total hip arthroplasty (THA) is crucial for preventing dislocation and limping. This study aimed to assess and compare muscle volume and degeneration after THA using the posterolateral (PL) and anterolateral (AL) approaches. Methods Sixty-four hips in 64 patients who underwent primary THA were retrospectively analyzed. Patients were segregated into the PL group (35 hips) and AL group (29 hips) for evaluating pre- and postoperative muscle volumes and degeneration around the hip. Computed tomography (CT) examinations were performed preoperatively and 6 months post THA. The muscle volume and Hounsfield units (HU) of the gluteus maximus (G-max), gluteus medius (G-med), tensor fasciae latae, internal obturator muscle, and external obturator muscle were measured. Results In the PL group, the postoperative muscle volume of the G-max significantly increased than the preoperative muscle volume. In contrast, the postoperative muscle volume of the internal obturator muscle was significantly lower than the preoperative muscle volume. The postoperative HU of the internal and external obturator muscles were significantly lower than the preoperative HU. In the AL group, the postoperative muscle volumes of the G-max, G-med, and tensor fasciae latae significantly increased than their preoperative muscle volumes. The postoperative HU of the G-med and tensor fasciae latae were significantly higher than the preoperative HU values. Conclusion The PL approach can lead to degeneration of the internal and external obturator. The AL approach is more beneficial for recovering the G-med, tensor fasciae latae, and internal obturator muscle than the PL approach.

Effect of Pre-Operative Internal Obturator Muscle Mass Index in MRI on Biochemical Recurrence of Prostate Cancer Patients After Radical Prostatectomy: A Multi-Center Study

Purpose: Recent reports show that the pre-operative or post-operative skeletal mass index (sarcopenia) affects survival rates for various cancers; however, the link between prostate cancer survival and sarcopenia is unclear. Therefore, this study examined the effect of the pre-operative internal obturator muscle (IOM) mass index on biochemical recurrence (BCR) of prostate cancer (PCa) patients who underwent radical prostatectomy.Methods: In total, 222 patients, who underwent open or robot-assisted radical prostatectomy at seven centers in 2011 and were followed up for 5 years, were enrolled. BCR was examined in the context of pre-operative IOM mass index and BMI. Results: The mean age of the patients was 67.82 ± 6.23 years, and the mean pre-operative prostate-specific antigen (PSA) level was 11.61 ± 13.22 ng/ml. There was no significant difference in baseline characteristics between the low and high IOM mass index groups (p > 0.05). Age, pre-op PSA level, ECE, and T-stage were not associated with BCR (p = 0.049, p < 0.001, p = 0.001, p = 0.004, respectively). BMI, prostate volume, Gleason score, resection margin, N-stage, M-stage and IOM mass index was not associated with BCR (p > 0.05). Conclusions: Pre-operative IOM mass index was not associated with BCR; however, long-term follow-up is necessary to evaluate cancer-specific and overall survival of PCa patients.

Preservation technique of the piriformis tendon is superior to reattachment technique in terms of contiguity and muscle atrophy: using magnetic resonance imaging

Purpose: The preservation technique of the piriformis tendon during the posterolateral approach in total hip arthroplasty (THA) is reportedly superior to the reattachment technique in terms of dislocation. However, the long-term effects of preservation of the piriformis tendon during THA remain unknown. In this study, we evaluated the contiguity of the piriformis/conjoined tendon and atrophy of the piriformis/internal obturator muscle during a long-term postoperative follow-up using magnetic resonance imaging (MRI). Methods: We retrospectively evaluated 48 patients with available MRI. The 48 patients were classified into a P group ( n = 29), in which the piriformis tendon was preserved, and an R group ( n = 19), in which the piriformis was reattached after sectioning. The mean follow-up duration was 45.9 months. The contiguity of the piriformis/conjoined tendon and atrophy of the piriformis/internal obturator muscle were evaluated in all patients. Results: The piriformis tendon remained attached to the greater trochanter in all P-group patients and 68.4% of R-group patients. The mean piriformis muscle atrophy ratios were 15.9% ± 21.1% in the P group and 41.6% ± 19.1% in the R group ( p < 0.001). The conjoined tendon repair remained intact in 72.4% of P-group patients and 36.8% of R-group patients ( p < 0.05). The mean internal obturator muscle atrophy ratio was 31.4% ± 26.2% in the P group and 50.4% ± 19.1% in the R group ( p < 0.05). No postoperative pulmonary embolism, wound infection, deep infection, or hip dislocation occurred. Conclusions: In our study, we suggest that the preservation technique of the piriformis tendon is superior to the reattachment technique in terms of contiguity and muscle atrophy.

Perineal Hernia in Dogs: Which Technique Should We Use?

Background: Perineal hernia may be unilateral or bilateral and results from weakening and separation of the pelvic diaphragm muscles, favoring the abdominal viscera herniation into the perineal subcutaneous. The factors described as possible etiology of this affection are prostate hyperplasia, senile muscular atrophy, myopathy and hormonal imbalances. Several herniorrhaphy techniques are available in literature presenting different rates of success leaving the question whether there is any technique that is predominantly better than others are. This case report aims to describe five cases of perineal hernia treated with four different techniques performed by four experienced surgeons.Cases: Case 1. Semitendinous muscle transposition: A 8-year-old intact male Shitzu (6 kg) was referred for the evaluation of a swelling in the right perineal region. The mass was soft and regressed into de pelvic cavity during palpation. Abdominal ultrasound and radiography were taken, which reveled perineal hernia and a mild prostate enlargement. The patient was prepared for hernia repair with semitendinous muscle transposition and orchiectomy. Case 2. Internal obturator muscle transposition: A 9-year-old intact male mixed breed dog (18kg) presenting a two-week long unilateral (right-side) perineral hernia. Ultrasound exam revealed a cystic prostate and adipose tissue as the hernia content. After clinical and image examination the patient was submitted to surgical repair using the internal obturator muscle transposition technique and orchiectomy. Case 3. Internal obturator muscle transposition associated to correction of rectal sacculation: A 12-year-old intact male mixed breed presenting swelling on the right side of the perianal region. The owner reported a 4-day long aquesia, emesis and increased volume in perineum for 6 months. During the rectal palpation, resected fecal content was present and rectal sacculation was suspected. Enema, simple abdominal radiography, contrast radiography and ultrasonography were performed. The exams showed perineal hernia with bowel content and presence of rectal sacculation. The patient was submitted to surgery in order to correct the perineal hernia and rectal sacculation, and to performe orchiectomy. Case 4. Polypropylene mesh: A 13-year-old intact male dachshund dog (8.6 kg) was referred to clinical examination due to a 1-year-history complaint of a mass in the right perineal area. The owner also reported rectal prolapse and stranguria noted two days prior the consultation. Ultrasound and radiography showed bladder, prostate and bowel contained in hernia sac. The patient underwent to hernia repair with polypropylene mesh and castration. Case 5. Bovine pericardium preserved in 4% formaldehyde: A 7-year-old intact male mixed breed dog (14 kg) was presented to clinical evaluation with swelling lateral to the anus and dyschezia. Abdominal radiography and ultrasound revealed images suggestive of perineal hernia with urinary bladder, prostate and bowl content. The patient was referred to surgery.Discussion: Perineal herniations are commonly related to weakness of pelvic diaphragm muscles. However, the etiology involved in this process is undetermined. Success rate of perineal hernia repair techniques vary in literature. It can be speculated that local factors may influence these results, such as the surgeon ability to perform the technique or to recognize components that adversely affects the surgery. The results were considered satisfactory in all cases, which may answer the question: the better technique is the one we perform better.