Blue Boxes Gluteal and Posterior Thigh

Question 1

Trochanteric Bursitis

Answer 1

Inflammation of trochanteric nursa due to repetitive actions such as climbing stairs or running on steep treadmill. Movements use glut max and move fibers repeatedly over the greater trochanter bursa.
Diffuse deep pain in lateral thigh region.

Friction bursitis is point tenderness over great trochanter but pain radiates along the IT band.

Question 2

Ischial Bursitis

Answer 2

Recurrent microtrauma from repeated stress such as cycling, rowing or other things involving repetitive hip ext. while seated.

Friction bursitis from excessive friction btw ischial bursae and ischial tuberosities. Localized pain over bursa and increases with use of glut max. Calcification can occur with chronic bursitis.

Ischial tuberosity bear body weight while sitting so these pressure points lead to pressure sores in debilitated people.

Question 3

Hamstring Injuries:

Tearing, Avulsion, Associations

Answer 3

hamstring strain are common with running jumping and sprinting. Twice as common as quadriceps strains.

Usually accompanied by contusions and tearing of fibers resulting in rupture of blood vessels resulting in hematoma.

Tearing of hamstring fibers is painful usually person falls to ground in pain when they try to stretch or move that leg.

Avulsioin of ischial tuberosity at proximal attachment of biceps fem and semitendinosus from forcible flexion of hip with extended knee.

Question 4

Injury to superior gluteal nerve:

Gluteal gait, how to tell, which muscles

Answer 4

motor loss resulting in gluteus medius limp to try and compensate for weak abduction of thigh by glut med and min. Also can see a gluteal gait leaning of body to weakened side. Medial rotation of thigh is severely impaired as well.

When asked to stand on one leg the pelvis on the unsupported sides falls indicating the glut med and min on the supported side are weak or not functioning. when the pelvis drops the leg on that side becomes longer resulting in not clearing of the foot when walking, so the person has to lean away from the unsupported side raising pelvis to clear their foot during the forward swing phase. Called Waddling or gluteal gait.

Question 5

Anestehetic block of sciatic

Answer 5

Injection few cm inferior to midpoint of line joining the PSIS and superior border of greater trochanter. Paresthesia radiates to foot due to anesthesia of plantar nerves.

Question 6

Injury to Sciatic:

Piriformis syndrome, complete section, incomplete section,

Answer 6

Pain in butt due to compression of sciatic nerve (L4-S3) by piriformis is called piriformis syndrome. Sports with excessive use of gluteal m. Place index fingeron ASIS and m and women are more likely to develop this.

Complete section of sciatic is uncommon but when it happens the leg is useless bc hip ext is impaired and flexion. Ankle and foot movements are also lost.

Incomplete section such as from a stab wound, can involve sciatic as well as inferior gluteal or posterior femoral cutaneous (S1-3)

Question 7

Intragluteal Injections

Answer 7

Penetrates skin fascia and muscles. Only safe in the superolateral quadrant or superior to line extending from PSIS to superior border of greater trochanter.
Also safe in anterolateral part of thigh where the needle would enter gluteus medius or tensor fascia latae

Place index finger on ASIS and spread fingers posteriorly until midle fingers reaches tubercle of iliac crest. Inject in triangle of two fingers.