Posterior Abdominal Region Flashcards
1
Q
Diaphragm
A
- Action: respiration/increase intra-abdominal pressure
- Innervation: phrenic nerves C3-C5
2
Q
Apertures in the diaphragm
A
- caval hiatus: IVC
- esophageal hiatus: esophagus and vagus nerve
- aortic Hiatus: aorta
3
Q
Psoas Major
A
Origin:
1. bodies and intervertebral discs of T12-L5
2. Lumbar TP L1-L5
Insertion:
1. Lesser trochanter of femur
Action:
1. Hip flexion
2. hip ER
3. trunk lateral flexion (ipsilateral)
Innervation:
1. ventral rami L2-L3
4
Q
Iliacus
A
Origin:
1. iliac fossa
Insertion:
1. lesser trochanter
Action:
1. hip flexion
Innervation:
1. Femoral nerve L2-L4
5
Q
Quadratus Lumborum
A
Origin:
1. L5 TP
2. iliac crest
insertion:
1. L1-4 TP
2. rib 12
Action:
1. depresses rib 12
2. ipsilateral trunk lateral flexion
Innervation:
1. T12-L4
6
Q
Lumbar plexus
A
consists of the following nerves:
- iliohypogastric
- ilioinguinal
- genitofemoral
- lateral femoral cutaneous
- obturator
- femoral
7
Q
Femoral nerve
A
- emerges from the lateral surface of psoas major
- travels deep to inguinal ligament
- proceeds to femoral triangle
8
Q
obturator nerve
A
- emerges from medial surfaceof psoas major
- traverses the obturator foramen
9
Q
Path of
abdominal aorta
A
- aortic hiatus of diaphragm at T 12
- anterior surfaces of vertebral bodies
- travels left of IVC
- splits into common iliac arteries (L4)
10
Q
path of
IVC
A
- common iliac veins
- anterior surfaces of vertebral bodies
- travels right of abdominal aorta
- caval hiatus of diaphragm at T8
11
Q
blood supply
of abdominal aorta branches
A
- inferior phrenic arteries = diaphragm
- middle suprarenal arteries = adrenal glands
- gonadal arteries = gonads
- lumbar arteries = abdominal wall
- celiac trunk = liver, gallbladder, pancreas, spleen
- superior mesenteric artery = supplies mid gut
- inferior mesenteric artery =. supplies the hind gut
12
Q
Adrenal glands
A
- located on the superior pole of the kidneys
- regulate stress
- produce glucocorticoids, mineralcorticoids, androgens and catecholamines
13
Q
kidneys
A
- locataed in the retroperitoneal space (T12-L3)
- right kidney lower than left kidney due to liver
- filters blood
- excrete urine through ureters to bladder
14
Q
Iliopsoas tendiopathy
A
- usually an overuse injury from repetitive hip flexion
- most commonly affects its insertion onto the femur
- can become impinged as it passes the front of the hip
15
Q
Iliopsoas tendiopathy
causes
A
- repetitive compression/pinching causes inflammation and bursitis
- ultimately leads to chronic degenerative changes of tendon
- commonly occurs with iliopsoas bursitis, clinical presentation nearly identical
16
Q
Iliopsoas tendiopathy
Etiology
A
- acute trauma: avulsion fx of LT
- overuse injuries: ballet, cycling, running, soccer, gymnastics
17
Q
Iliopsoas tendiopathy
clinical presentation
A
- asymptomatic: palpable or audible snap with hip flexion and extension
- chronic irriation: from degenerative changes
- intermittent groin pain (deep ache) worse with hip flexion, radicular symptoms into anterior thigh, LBP
18
Q
Iliopsoas tendiopathy
diagnostic tools
A
- psoas hypertonicity: pt holds affected hip in flexed and ER position
- anterior plevic tilt
- shortened stride length, increased knee flexion
- palpation of deep iliopsoas palpation within femoral trigangel (lesser trochanter)
- ROM: passive hip extension limited/painful ~15ºresisted hip flexion painful
- thomas/mod thomas test
- iliopsoas MMT ludloff’s sign, stinchfield test
- snapping hip maneuver (anterior labral test)
19
Q
Iliopsoas tendiopathy
interventions
A
- acute phase: PRICE, NSAIDs, gentle stretching
- recovery phase: rectus femoris, stretching, hamstring strengthening - promote posterior pelvic tilt
- abdominal strengthening
- iliopsoas strengthening
20
Q
Quadratus lumborum syndrome
A
- myofascial pain syndrome
- tenderness
- trigger points
- palpable taut bands
21
Q
Quadratus lumborum syndrome
causes
A
- poor posture
- sendentary lifestyle
- overuse
22
Q
Quadratus lumborum syndrome
presentation
A
- LBP, discomfort at rest and with movement
- sharp pain with sneezing
- trigger points highly common
23
Q
Quadratus lumborum syndrome
diagnostic tools
A
- palpable tightness/tenderness
- trigger point identification with common referral patterns
- lack of contralateral SB ROM in sitting
- quadratus lumborum muscle test: hip hike to affect side while in Sidelying, apply opposing foces on 12rib and iliac crest, produce pain/weakness
24
Q
Quadratus lumborum syndrome
interventions
A
- manual trigger point release (low pressure = 90 seconds/high pressure = 30 seconds)
- dry needling
- TENs US
- QL stretching
25
Lumbar plexus entrapment
- formed by the ventral rami of L1-L4, sometimes including T12
- these nerves emerge from the psoas major muscle and proximal sciatic nerve beneath the piriformis
- this is a common problem which can involve significant morbidity
26
# Lumbar plexus entrapment
Causes
- involved of lumbar plexus, lumboscaral trunk and proximal sciatic nerve within psoas major and piriformis
- due to chronic weakness or injury to these muscles
- after abdominal surgeries due to scar tissue formation
- pregnancy
- hematomas, aneurysms, trauma, tumors, abscesses, cysts, cancer, and iatrogenic injury
27
# Lumbar plexus entrapment
findings
- tenderness throughout body (FMS DDX)
- diffuse and non-specific pain patterns throughout the lumbopelvic complex and LE
- myotomal weakness/dermatome symptoms
28
# Lumbar plexus entrapment
treatment
- gentle strengthening of psoas major and piriformis muscles
- slow eccentric exercises
29
Phrenic nerve entrapment
- provides motor supply to the diaphragm primary breathing muscle
- originates from the anterior rami of C3-C5 nerve roots and has motor, sneory and sympathetic fibers
- the phrenic nerves exits the spinal canal and descends caudally to the pericardial sac to innervate the diaphragm
- there is a left and right phrenic nerve each innervating half of the diaphragm
- the risk of this nerve being damaged can be life threatening
30
# Phrenic nerve entrapment
causes
- surgery (runs between pericardium and mediastinal pleura)
- blunt or penetrating trauma
- metabolic disease
- infections
- direct invasion from a tumor
- neurological diseases
- can be post viral
- idiopathic
31
# Phrenic nerve entrapment
findings
- injury can present as diaphragm dysfunction or paralysis to one or both sides of the diaphragm
- scar tissue can compress the nerve and lead to entrapment
- it is rare for this nerve to be entraped
32
# Phrenic nerve entrapment
treatment
- if one side has paralysis no treatment is requied
- the underlying causes should be monitored
- surgery is considered if the patient has symptoms after the underlying cause has been treated
- plication of affected sit for B/L paraylsis
33
imaging for the diaphragm
- disease usually manifestes as asymmetic elevation with chest radiography and magnetic resonance imaging MRI
- fluoroscopy is regarded as gold standard
34
posterior abdominal wall imaging
- CT scan is method most frequently used to provide visual images of abdomen
- MRI is view as superior when differentiation of soft tissues is necessary
35
Neuralgia parasetica
- lateral femoral cuteneous entrapment
- sensory symptoms
- compressed under the inguinal ligament
- can be caused by obesity and pregnancy
36
ilioinguinal
- transverse abdominus and IO entraped between
- if someone had spinal instability the TA can possibel become hypertrophied
37
femoral nerve
| causes of injury
- injured by femoral head fracture
- anterior dislocation
- anterior THA
38
Obturator nerve
- fracture of pelvic often injuries
- sensory: medial thigh
- motor: adductors
