Psoas major muscle injury low back pain

Psoas major muscle injury low back pain Psoas major muscle injury is not uncommon. However, clinical reports of low back pain caused by psoas major muscle injury are not common. Clinical analysis of the causes of 100 cases of low back and leg pain, of which 69 cases of soft tissue injury caused by low back and leg pain cases, but no case of lumbar major muscle injury reported records. Due to the special anatomical location of the psoas major muscle, clinical diagnosis and treatment bring certain difficulties. Low back pain triggered by the psoas major muscle is different from common sciatic nerve low back pain in terms of etiology and clinical symptoms, and is a special type of low back pain. If the pathogenesis is not well understood, it is easy to be misdiagnosed and cannot be cured in time, and some of them may have serious sequelae. For this reason, this paper combines the clinical, the adult male cadaver of the lumbar large muscle and its related structures for anatomy, observation. To provide anatomical basis for the etiology and treatment of psoas major muscle injurious low back pain. 1, materials and methods by 15% formalin solution fixed local anatomy teaching adult male specimens, select 10 total 20 side. The lumbar major muscle and its related structures were dissected and observed. 2.1 Anatomical relationship between lumbar major muscle and lumbar vertebrae Most of the lumbar major muscle is located in the groove between the L1-L4 vertebrae and transverse processes. Its upper muscle fibers can extend to the lowermost part of the posterior mediastinum and the posterior part of the septum. It originates from the vertebral bodies and disc margins of the adjacent vertebrae in the form of myotomes and attaches to the L1-L4 vertebral bodies as well as to the anterior and inferior margins of their transverse processes, respectively. The L5 vertebral body, intervertebral disc, and transverse process did not show any attachment of psoas major muscle fibers in any of the 20 specimens.The L3 transverse process was the longest, and the transverse meridian of the muscle belly was the widest, which was the site of highest concentration of lumbar psoas major muscle fibers.The L1-L4 foramen ovale was situated in the posterior aspect of the muscle attachment and anterior aspect of the transverse process of the lumbar vertebrae, from which the lumbar spinal nerves emanated. 2.2 Relationship between the psoas major muscle and the lumbar plexus and femoral nerve The lumbar plexus mainly consists of the anterior branches of the L1-L4 spinal nerves. Most of them emanate from the intervertebral foramina and pass directly through the psoas major muscle. Some of them form a plexus within the psoas major muscle, and their branches then pass out from the anterior and lateral edges of the muscle. The innervation of the psoas major muscle is provided by the L1-L3 nerve branches that enter the muscle to innervate it. The femoral nerve consists mostly of Ll-L4 (13 sides were observed in this group), followed by L2-L4 nerves (6 sides in this group) with one side consisting of L1-L3. They penetrated into the posterior part of the psoas major muscle fibers and exited at the lateral margin of the psoas major muscle in the L4 plane. Located between the iliacus and psoas major muscles, they travel with them down the pelvis behind the inguinal ligament and through the muscular cavernous space to the femoral region at the root of the thigh. The psoas major and skeletal muscles ultimately converge to form a single unit that crosses the muscular cavernous space in an inward-superior to outward-inferior direction anterior to the extensor carpi radialis brevis muscle and above the pubococcygeus muscle to terminate at the medial femoral tubercle at the root of the thigh. 2.3 Anatomical relationship of muscle and nerve in the muscular cavernous space The muscular cavernous space is a confined osteofascial interval surrounded by the ilium, inguinal ligament, and iliopubic arch. The iliopsoas muscle fibers are located on the lateral side, and the psoas major muscle fibers are located on the medial side. The femoral nerve enters the myofascial space and shifts from being located between the iliacus and psoas major to being located anterior to the psoas major, and is co-wrapped within the iliopubic fascial sheath in close proximity to the iliopubic arch. The lateral femoral cutaneous nerve was located in the outer part of the muscular cavernous space near the medial part of the anterior superior iliac spine, and distributed in the lateral femoral skin after crossing the muscular cavernous space. 3, Discussion The lumbaris major muscle originates from the L1-L4 vertebrae and transverse processes in the form of a muscle tooth, and is wrapped with the iliopsoas muscle in the iliolumbar fascia before it passes through the muscular cavernous space, and then ends in the medial aspect of the thigh root at the lesser trochanter of the femur after it has converged into a tendon. It has a hip flexor, which brings the thigh closer to the pelvis and serves to externally rotate the femur. In the lower extremity fixation, both sides of the muscle contraction at the same time to balance the lumbar spine, so that the spine, the pelvis anterior curvature. Lumbar vertebrae are relatively wide in the transverse direction, the average transverse diameter from L1 to L4 is 3.8~4.7cm, together with the length of transverse protrusion, the width is relatively large, especially the longest transverse protrusion of L3, L3 is located in the center of lumbar vertebrae axis, and it is the most active, so its leverage is the largest, and it is subjected to the largest pulling force. The fascia, tendon membrane, ligaments and muscles attached to it are subject to greater tension. Especially during spinal rotation and lateral curvature activities. Psoas major muscle injury commonly occurs in the position of the sudden change of improper and load overload, such as hurdles, carp tuck and other violent force action, or lumbar repeated force twisting strain. Once the lumbar large muscle injury occurs spasm, swelling, due to its anatomical characteristics, injury mainly occurs in the L4 vertebral body and transverse process, the muscle cavity, the femur small rotor, and its pain also occurs in these three places. The pain mainly occurs at the L3 vertebral body and transverse process. On examination, there may be tenderness, localized tension, and pain along the course of the psoas major muscle all the way to the root of the thigh at the attachment point of the medial tuberosity. The resulting low back pain symptoms are obviously different from sciatica low back pain, the patient in addition to pain radiating to the thigh root, but also with hip and knee straightening, backward extension and other dysfunctions. In addition, the femoral nerve has a close relationship with the psoas major muscle in its journey, especially in the muscle cavity. Once the lumbar muscle spasm, swelling can make the muscle cavity pressure increases, different degrees of extrusion of the femoral nerve in the inguinal ligament so that its embedded pressure, if not treated in time, so that its further development, can occur femoral nerve palsy. Thus, the quadriceps muscle paralysis, atrophy and other serious consequences. Insufficient clinical understanding of this, improper treatment, can produce the above serious consequences.