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Gavin R. Webb - One of the best experts on this subject based on the ideXlab platform.

  • The proximal origin of the hamstrings and surrounding anatomy encountered during repair. Surgical technique.
    Journal of Bone and Joint Surgery American Volume, 2008
    Co-Authors: Suzanne L. Miller, Gavin R. Webb
    Abstract:

    BACKGROUND: Avulsion of the proximal origin of the hamstrings has become a more frequently recognized athletic injury. Most orthopaedic surgeons rarely operate in this anatomic area. The purpose of the present study was to define the anatomy of the proximal origin of the hamstrings and its relationship to neurovascular and muscular structures encountered during a repair of a complete avulsion. METHODS: Fourteen fresh-frozen hip-to-foot human cadaveric specimens were dissected in the prone position. The proximal origin of the hamstrings and its relationship to the surrounding neurologic and muscular structures were documented and measured with use of digital calipers. RESULTS: Six of the fourteen specimens were from female donors. The average age of the donors at the time of death was 68 ± 13 years. The average height of the donors was 66 ± 3.5 in (167 ± 8.9 cm), and the average weight was 142 ± 39 lb (64 ± 17.7 kg). The semitendinosus and biceps femoris have a common tendinous site of origin on the ischium. A number of measurements were obtained. The musculotendinous junctions of the semitendinosus and biceps femoris separated at an average of 9.9 ± 1.5 cm from the most proximal origin site on the ischium. The average distance from the proximal border of the semitendinosus/biceps femoris origin to the Inferior border of the gluteus maximus was 6.3 ± 1.3 cm. At the lateral border of the ischium, the average distance from the Inferior Gluteal Nerve and artery to the Inferior border of the gluteus maximus was 5.0 ± 0.8 cm. The sciatic Nerve was an average of 1.2 ± 0.2 cm from the most lateral aspect of the ischial tuberosity. The site of origin of the semitendinosus/biceps femoris was oval, with average measurements of 2.7 ± 0.5 cm from proximal to distal and of 1.8 ± 0.2 cm from medial to lateral. The site of origin of the semimembranosus was crescent-shaped, with average measurements of 3.1 ± 0.3 cm from proximal to distal and of 1.1 ± 0.5 cm from medial to lateral. CONCLUSIONS: The semitendinosus and biceps femoris have a common tendon of origin on the ischium, and the semimembranosus originates just laterally. The proximal origin of the hamstrings has intimate relationships with the Inferior Gluteal Nerve and artery and the sciatic Nerve, which may be at risk during surgical dissection and retraction. ORIGINAL ABSTRACT CITATION: “The Proximal Origin of the Hamstrings and Surrounding Anatomy Encountered During Repair” (2007;89:44-8).

  • The proximal origin of the hamstrings and surrounding anatomy encountered during repair. Surgical technique.
    The Journal of bone and joint surgery. American volume, 2008
    Co-Authors: Suzanne L. Miller, Gavin R. Webb
    Abstract:

    Avulsion of the proximal origin of the hamstrings has become a more frequently recognized athletic injury. Most orthopaedic surgeons rarely operate in this anatomic area. The purpose of the present study was to define the anatomy of the proximal origin of the hamstrings and its relationship to neurovascular and muscular structures encountered during a repair of a complete avulsion. Fourteen fresh-frozen hip-to-foot human cadaveric specimens were dissected in the prone position. The proximal origin of the hamstrings and its relationship to the surrounding neurologic and muscular structures were documented and measured with use of digital calipers. Six of the fourteen specimens were from female donors. The average age of the donors at the time of death was 68 +/- 13 years. The average height of the donors was 66 +/- 3.5 in (167 +/- 8.9 cm), and the average weight was 142 +/- 39 lb (64 +/- 17.7 kg). The semitendinosus and biceps femoris have a common tendinous site of origin on the ischium. A number of measurements were obtained. The musculotendinous junctions of the semitendinosus and biceps femoris separated at an average of 9.9 +/- 1.5 cm from the most proximal origin site on the ischium. The average distance from the proximal border of the semitendinosus/biceps femoris origin to the Inferior border of the gluteus maximus was 6.3 +/- 1.3 cm. At the lateral border of the ischium, the average distance from the Inferior Gluteal Nerve and artery to the Inferior border of the gluteus maximus was 5.0 +/- 0.8 cm. The sciatic Nerve was an average of 1.2 +/- 0.2 cm from the most lateral aspect of the ischial tuberosity. The site of origin of the semitendinosus/biceps femoris was oval, with average measurements of 2.7 +/- 0.5 cm from proximal to distal and of 1.8 +/- 0.2 cm from medial to lateral. The site of origin of the semimembranosus was crescent-shaped, with average measurements of 3.1 +/- 0.3 cm from proximal to distal and of 1.1 +/- 0.5 cm from medial to lateral. The semitendinosus and biceps femoris have a common tendon of origin on the ischium, and the semimembranosus originates just laterally. The proximal origin of the hamstrings has intimate relationships with the Inferior Gluteal Nerve and artery and the sciatic Nerve, which may be at risk during surgical dissection and retraction.

  • The proximal origin of the hamstrings and surrounding anatomy encountered during repair. A cadaveric study.
    The Journal of bone and joint surgery. American volume, 2007
    Co-Authors: Suzanne L. Miller, Julie Gill, Gavin R. Webb
    Abstract:

    BACKGROUND Avulsion of the proximal origin of the hamstrings has become a more frequently recognized athletic injury. Most orthopaedic surgeons rarely operate in this anatomic area. The purpose of the present study was to define the anatomy of the proximal origin of the hamstrings and its relationship to neurovascular and muscular structures encountered during a repair of a complete avulsion. METHODS Fourteen fresh-frozen hip-to-foot human cadaveric specimens were dissected in the prone position. The proximal origin of the hamstrings and its relationship to the surrounding neurologic and muscular structures were documented and measured with use of digital calipers. RESULTS Six of the fourteen specimens were from female donors. The average age of the donors at the time of death was 68 +/- 13 years. The average height of the donors was 66 +/- 3.5 in (167 +/- 8.9 cm), and the average weight was 142 +/- 39 lb (64 +/- 17.7 kg). The semitendinosus and biceps femoris have a common tendinous site of origin on the ischium. A number of measurements were obtained. The musculotendinous junctions of the semitendinosus and biceps femoris separated at an average of 9.9 +/- 1.5 cm from the most proximal origin site on the ischium. The average distance from the proximal border of the semitendinosus/biceps femoris origin to the Inferior border of the gluteus maximus was 6.3 +/- 1.3 cm. At the lateral border of the ischium, the average distance from the Inferior Gluteal Nerve and artery to the Inferior border of the gluteus maximus was 5.0 +/- 0.8 cm. The sciatic Nerve was an average of 1.2 +/- 0.2 cm from the most lateral aspect of the ischial tuberosity. The site of origin of the semitendinosus/biceps femoris was oval, with average measurements of 2.7 +/- 0.5 cm from proximal to distal and of 1.8 +/- 0.2 cm from medial to lateral. The site of origin of the semimembranosus was crescent-shaped, with average measurements of 3.1 +/- 0.3 cm from proximal to distal and of 1.1 +/- 0.5 cm from medial to lateral. CONCLUSIONS The semitendinosus and biceps femoris have a common tendon of origin on the ischium, and the semimembranosus originates just laterally. The proximal origin of the hamstrings has intimate relationships with the Inferior Gluteal Nerve and artery and the sciatic Nerve, which may be at risk during surgical dissection and retraction.

Suzanne L. Miller - One of the best experts on this subject based on the ideXlab platform.

  • The proximal origin of the hamstrings and surrounding anatomy encountered during repair. Surgical technique.
    Journal of Bone and Joint Surgery American Volume, 2008
    Co-Authors: Suzanne L. Miller, Gavin R. Webb
    Abstract:

    BACKGROUND: Avulsion of the proximal origin of the hamstrings has become a more frequently recognized athletic injury. Most orthopaedic surgeons rarely operate in this anatomic area. The purpose of the present study was to define the anatomy of the proximal origin of the hamstrings and its relationship to neurovascular and muscular structures encountered during a repair of a complete avulsion. METHODS: Fourteen fresh-frozen hip-to-foot human cadaveric specimens were dissected in the prone position. The proximal origin of the hamstrings and its relationship to the surrounding neurologic and muscular structures were documented and measured with use of digital calipers. RESULTS: Six of the fourteen specimens were from female donors. The average age of the donors at the time of death was 68 ± 13 years. The average height of the donors was 66 ± 3.5 in (167 ± 8.9 cm), and the average weight was 142 ± 39 lb (64 ± 17.7 kg). The semitendinosus and biceps femoris have a common tendinous site of origin on the ischium. A number of measurements were obtained. The musculotendinous junctions of the semitendinosus and biceps femoris separated at an average of 9.9 ± 1.5 cm from the most proximal origin site on the ischium. The average distance from the proximal border of the semitendinosus/biceps femoris origin to the Inferior border of the gluteus maximus was 6.3 ± 1.3 cm. At the lateral border of the ischium, the average distance from the Inferior Gluteal Nerve and artery to the Inferior border of the gluteus maximus was 5.0 ± 0.8 cm. The sciatic Nerve was an average of 1.2 ± 0.2 cm from the most lateral aspect of the ischial tuberosity. The site of origin of the semitendinosus/biceps femoris was oval, with average measurements of 2.7 ± 0.5 cm from proximal to distal and of 1.8 ± 0.2 cm from medial to lateral. The site of origin of the semimembranosus was crescent-shaped, with average measurements of 3.1 ± 0.3 cm from proximal to distal and of 1.1 ± 0.5 cm from medial to lateral. CONCLUSIONS: The semitendinosus and biceps femoris have a common tendon of origin on the ischium, and the semimembranosus originates just laterally. The proximal origin of the hamstrings has intimate relationships with the Inferior Gluteal Nerve and artery and the sciatic Nerve, which may be at risk during surgical dissection and retraction. ORIGINAL ABSTRACT CITATION: “The Proximal Origin of the Hamstrings and Surrounding Anatomy Encountered During Repair” (2007;89:44-8).

  • The proximal origin of the hamstrings and surrounding anatomy encountered during repair. Surgical technique.
    The Journal of bone and joint surgery. American volume, 2008
    Co-Authors: Suzanne L. Miller, Gavin R. Webb
    Abstract:

    Avulsion of the proximal origin of the hamstrings has become a more frequently recognized athletic injury. Most orthopaedic surgeons rarely operate in this anatomic area. The purpose of the present study was to define the anatomy of the proximal origin of the hamstrings and its relationship to neurovascular and muscular structures encountered during a repair of a complete avulsion. Fourteen fresh-frozen hip-to-foot human cadaveric specimens were dissected in the prone position. The proximal origin of the hamstrings and its relationship to the surrounding neurologic and muscular structures were documented and measured with use of digital calipers. Six of the fourteen specimens were from female donors. The average age of the donors at the time of death was 68 +/- 13 years. The average height of the donors was 66 +/- 3.5 in (167 +/- 8.9 cm), and the average weight was 142 +/- 39 lb (64 +/- 17.7 kg). The semitendinosus and biceps femoris have a common tendinous site of origin on the ischium. A number of measurements were obtained. The musculotendinous junctions of the semitendinosus and biceps femoris separated at an average of 9.9 +/- 1.5 cm from the most proximal origin site on the ischium. The average distance from the proximal border of the semitendinosus/biceps femoris origin to the Inferior border of the gluteus maximus was 6.3 +/- 1.3 cm. At the lateral border of the ischium, the average distance from the Inferior Gluteal Nerve and artery to the Inferior border of the gluteus maximus was 5.0 +/- 0.8 cm. The sciatic Nerve was an average of 1.2 +/- 0.2 cm from the most lateral aspect of the ischial tuberosity. The site of origin of the semitendinosus/biceps femoris was oval, with average measurements of 2.7 +/- 0.5 cm from proximal to distal and of 1.8 +/- 0.2 cm from medial to lateral. The site of origin of the semimembranosus was crescent-shaped, with average measurements of 3.1 +/- 0.3 cm from proximal to distal and of 1.1 +/- 0.5 cm from medial to lateral. The semitendinosus and biceps femoris have a common tendon of origin on the ischium, and the semimembranosus originates just laterally. The proximal origin of the hamstrings has intimate relationships with the Inferior Gluteal Nerve and artery and the sciatic Nerve, which may be at risk during surgical dissection and retraction.

  • The proximal origin of the hamstrings and surrounding anatomy encountered during repair. A cadaveric study.
    The Journal of bone and joint surgery. American volume, 2007
    Co-Authors: Suzanne L. Miller, Julie Gill, Gavin R. Webb
    Abstract:

    BACKGROUND Avulsion of the proximal origin of the hamstrings has become a more frequently recognized athletic injury. Most orthopaedic surgeons rarely operate in this anatomic area. The purpose of the present study was to define the anatomy of the proximal origin of the hamstrings and its relationship to neurovascular and muscular structures encountered during a repair of a complete avulsion. METHODS Fourteen fresh-frozen hip-to-foot human cadaveric specimens were dissected in the prone position. The proximal origin of the hamstrings and its relationship to the surrounding neurologic and muscular structures were documented and measured with use of digital calipers. RESULTS Six of the fourteen specimens were from female donors. The average age of the donors at the time of death was 68 +/- 13 years. The average height of the donors was 66 +/- 3.5 in (167 +/- 8.9 cm), and the average weight was 142 +/- 39 lb (64 +/- 17.7 kg). The semitendinosus and biceps femoris have a common tendinous site of origin on the ischium. A number of measurements were obtained. The musculotendinous junctions of the semitendinosus and biceps femoris separated at an average of 9.9 +/- 1.5 cm from the most proximal origin site on the ischium. The average distance from the proximal border of the semitendinosus/biceps femoris origin to the Inferior border of the gluteus maximus was 6.3 +/- 1.3 cm. At the lateral border of the ischium, the average distance from the Inferior Gluteal Nerve and artery to the Inferior border of the gluteus maximus was 5.0 +/- 0.8 cm. The sciatic Nerve was an average of 1.2 +/- 0.2 cm from the most lateral aspect of the ischial tuberosity. The site of origin of the semitendinosus/biceps femoris was oval, with average measurements of 2.7 +/- 0.5 cm from proximal to distal and of 1.8 +/- 0.2 cm from medial to lateral. The site of origin of the semimembranosus was crescent-shaped, with average measurements of 3.1 +/- 0.3 cm from proximal to distal and of 1.1 +/- 0.5 cm from medial to lateral. CONCLUSIONS The semitendinosus and biceps femoris have a common tendon of origin on the ischium, and the semimembranosus originates just laterally. The proximal origin of the hamstrings has intimate relationships with the Inferior Gluteal Nerve and artery and the sciatic Nerve, which may be at risk during surgical dissection and retraction.

Marlene M. Corton - One of the best experts on this subject based on the ideXlab platform.

  • Inferior Gluteal and other Nerves associated with sacrospinous ligament: a cadaver study
    American Journal of Obstetrics and Gynecology, 2016
    Co-Authors: Maria E. Florian-rodriguez, Kathryn Chin, John N Phelan, Christopher M Ripperda, Adam M Hare, Marlene M. Corton
    Abstract:

    Background Reported rates of Gluteal pain after sacrospinous ligament fixation range from 12–55% in the immediate postoperative period and from 4–15% 4–6 weeks postoperatively. The source of Gluteal pain often is attributed to injury to the Nerve to levator ani or pudendal Nerve. The Inferior Gluteal Nerve and other sacral Nerve branches have not been examined thoroughly as potential sources of Gluteal pain. Objectives The purpose of this study was to further characterize anatomy of the Inferior Gluteal Nerve and other Nerves that are associated with the sacrospinous ligament from a combined Gluteal and pelvic approach and to correlate findings to sacrospinous ligament fixation. Study Design Dissections were performed in female cadavers that had not been embalmed with Gluteal and pelvic approaches. From a pelvic perspective, the closest structure to the superior border of the sacrospinous ligament midpoint was noted, and the sacral Nerves that perforated the ventral surface of coccygeus muscle were examined. From a Gluteal perspective, the closest distances from ischial spine to the pudendal, Inferior Gluteal, posterior femoral cutaneous, and sciatic Nerves were measured. In addition, the closest distance from the midpoint of sacrospinous ligament to the Inferior Gluteal Nerve and the origin of this Nerve were documented. The thickness and height of the sacrospinous ligament at its midpoint were measured. Sacral Nerve branches that coursed between the sacrospinous and sacrotuberous ligaments were assessed from both a pelvic and a Gluteal approach. Descriptive statistics were used for data analysis. Results Fourteen cadavers were examined. From a pelvic perspective, the closest structure to the superior border of sacrospinous ligament at its midpoint was the S3 Nerve (median distance, 3 mm; range, 0–11 mm). Branches from S3 and/or S4 perforated the ventral surface of coccygeus muscles in 94% specimens. From a Gluteal perspective, the closest structure to ischial spine was the pudendal Nerve (median distance, 0 mm; range, 0–9 mm). Median closest distance from Inferior Gluteal Nerve to ischial spine and to the midpoint of sacrospinous ligament was 28.5 mm (range, 6–53 mm) and 31.5 mm (range, 10–47 mm), respectively. The Inferior Gluteal Nerve arose from dorsal surface of combined lumbosacral trunk and S1 Nerves in all specimens; a contribution from S2 was noted in 46% of hemipelvises. At its midpoint, the sacrospinous ligament median thickness was 5 mm (range, 2–7 mm), and its median height was 14 mm (range, 3–22 mm). In 85% of specimens, 1 to 3 branches from S3 and/or S4 Nerves pierced or coursed ventral to the sacrotuberous ligament and perforated the Inferior portion of the gluteus maximus muscle. Conclusions Damage to the Inferior Gluteal Nerve during sacrospinous ligament fixation is an unlikely source for postoperative Gluteal pain. Rather, branches from S3 and/or S4 that innervate the coccygeus muscles and those coursing between the sacrospinous and sacrotuberous ligaments to supply gluteus maximus muscles are more likely to be implicated. A thorough understanding of the complex anatomy surrounding the sacrospinous ligament, limiting depth of needle penetration into the ligament, and avoiding extension of needle exit or entry point above the upper extent of sacrospinous ligament may reduce Nerve entrapment and postoperative Gluteal pain.

  • Inferior Gluteal and other Nerves associated with sacrospinous ligament: a cadaver study.
    American journal of obstetrics and gynecology, 2016
    Co-Authors: Maria E. Florian-rodriguez, Adam Hare, Kathryn Chin, John N Phelan, Christopher M Ripperda, Marlene M. Corton
    Abstract:

    Reported rates of Gluteal pain after sacrospinous ligament fixation range from 12-55% in the immediate postoperative period and from 4-15% 4-6 weeks postoperatively. The source of Gluteal pain often is attributed to injury to the Nerve to levator ani or pudendal Nerve. The Inferior Gluteal Nerve and other sacral Nerve branches have not been examined thoroughly as potential sources of Gluteal pain. The purpose of this study was to further characterize anatomy of the Inferior Gluteal Nerve and other Nerves that are associated with the sacrospinous ligament from a combined Gluteal and pelvic approach and to correlate findings to sacrospinous ligament fixation. Dissections were performed in female cadavers that had not been embalmed with Gluteal and pelvic approaches. From a pelvic perspective, the closest structure to the superior border of the sacrospinous ligament midpoint was noted, and the sacral Nerves that perforated the ventral surface of coccygeus muscle were examined. From a Gluteal perspective, the closest distances from ischial spine to the pudendal, Inferior Gluteal, posterior femoral cutaneous, and sciatic Nerves were measured. In addition, the closest distance from the midpoint of sacrospinous ligament to the Inferior Gluteal Nerve and the origin of this Nerve were documented. The thickness and height of the sacrospinous ligament at its midpoint were measured. Sacral Nerve branches that coursed between the sacrospinous and sacrotuberous ligaments were assessed from both a pelvic and a Gluteal approach. Descriptive statistics were used for data analysis. Fourteen cadavers were examined. From a pelvic perspective, the closest structure to the superior border of sacrospinous ligament at its midpoint was the S3 Nerve (median distance, 3 mm; range, 0-11 mm). Branches from S3 and/or S4 perforated the ventral surface of coccygeus muscles in 94% specimens. From a Gluteal perspective, the closest structure to ischial spine was the pudendal Nerve (median distance, 0 mm; range, 0-9 mm). Median closest distance from Inferior Gluteal Nerve to ischial spine and to the midpoint of sacrospinous ligament was 28.5 mm (range, 6-53 mm) and 31.5 mm (range, 10-47 mm), respectively. The Inferior Gluteal Nerve arose from dorsal surface of combined lumbosacral trunk and S1 Nerves in all specimens; a contribution from S2 was noted in 46% of hemipelvises. At its midpoint, the sacrospinous ligament median thickness was 5 mm (range, 2-7 mm), and its median height was 14 mm (range, 3-22 mm). In 85% of specimens, 1 to 3 branches from S3 and/or S4 Nerves pierced or coursed ventral to the sacrotuberous ligament and perforated the Inferior portion of the gluteus maximus muscle. Damage to the Inferior Gluteal Nerve during sacrospinous ligament fixation is an unlikely source for postoperative Gluteal pain. Rather, branches from S3 and/or S4 that innervate the coccygeus muscles and those coursing between the sacrospinous and sacrotuberous ligaments to supply gluteus maximus muscles are more likely to be implicated. A thorough understanding of the complex anatomy surrounding the sacrospinous ligament, limiting depth of needle penetration into the ligament, and avoiding extension of needle exit or entry point above the upper extent of sacrospinous ligament may reduce Nerve entrapment and postoperative Gluteal pain. Copyright © 2016 Elsevier Inc. All rights reserved.

Maria E. Florian-rodriguez - One of the best experts on this subject based on the ideXlab platform.

  • Inferior Gluteal and other Nerves associated with sacrospinous ligament: a cadaver study
    American Journal of Obstetrics and Gynecology, 2016
    Co-Authors: Maria E. Florian-rodriguez, Kathryn Chin, John N Phelan, Christopher M Ripperda, Adam M Hare, Marlene M. Corton
    Abstract:

    Background Reported rates of Gluteal pain after sacrospinous ligament fixation range from 12–55% in the immediate postoperative period and from 4–15% 4–6 weeks postoperatively. The source of Gluteal pain often is attributed to injury to the Nerve to levator ani or pudendal Nerve. The Inferior Gluteal Nerve and other sacral Nerve branches have not been examined thoroughly as potential sources of Gluteal pain. Objectives The purpose of this study was to further characterize anatomy of the Inferior Gluteal Nerve and other Nerves that are associated with the sacrospinous ligament from a combined Gluteal and pelvic approach and to correlate findings to sacrospinous ligament fixation. Study Design Dissections were performed in female cadavers that had not been embalmed with Gluteal and pelvic approaches. From a pelvic perspective, the closest structure to the superior border of the sacrospinous ligament midpoint was noted, and the sacral Nerves that perforated the ventral surface of coccygeus muscle were examined. From a Gluteal perspective, the closest distances from ischial spine to the pudendal, Inferior Gluteal, posterior femoral cutaneous, and sciatic Nerves were measured. In addition, the closest distance from the midpoint of sacrospinous ligament to the Inferior Gluteal Nerve and the origin of this Nerve were documented. The thickness and height of the sacrospinous ligament at its midpoint were measured. Sacral Nerve branches that coursed between the sacrospinous and sacrotuberous ligaments were assessed from both a pelvic and a Gluteal approach. Descriptive statistics were used for data analysis. Results Fourteen cadavers were examined. From a pelvic perspective, the closest structure to the superior border of sacrospinous ligament at its midpoint was the S3 Nerve (median distance, 3 mm; range, 0–11 mm). Branches from S3 and/or S4 perforated the ventral surface of coccygeus muscles in 94% specimens. From a Gluteal perspective, the closest structure to ischial spine was the pudendal Nerve (median distance, 0 mm; range, 0–9 mm). Median closest distance from Inferior Gluteal Nerve to ischial spine and to the midpoint of sacrospinous ligament was 28.5 mm (range, 6–53 mm) and 31.5 mm (range, 10–47 mm), respectively. The Inferior Gluteal Nerve arose from dorsal surface of combined lumbosacral trunk and S1 Nerves in all specimens; a contribution from S2 was noted in 46% of hemipelvises. At its midpoint, the sacrospinous ligament median thickness was 5 mm (range, 2–7 mm), and its median height was 14 mm (range, 3–22 mm). In 85% of specimens, 1 to 3 branches from S3 and/or S4 Nerves pierced or coursed ventral to the sacrotuberous ligament and perforated the Inferior portion of the gluteus maximus muscle. Conclusions Damage to the Inferior Gluteal Nerve during sacrospinous ligament fixation is an unlikely source for postoperative Gluteal pain. Rather, branches from S3 and/or S4 that innervate the coccygeus muscles and those coursing between the sacrospinous and sacrotuberous ligaments to supply gluteus maximus muscles are more likely to be implicated. A thorough understanding of the complex anatomy surrounding the sacrospinous ligament, limiting depth of needle penetration into the ligament, and avoiding extension of needle exit or entry point above the upper extent of sacrospinous ligament may reduce Nerve entrapment and postoperative Gluteal pain.

  • Inferior Gluteal and other Nerves associated with sacrospinous ligament: a cadaver study.
    American journal of obstetrics and gynecology, 2016
    Co-Authors: Maria E. Florian-rodriguez, Adam Hare, Kathryn Chin, John N Phelan, Christopher M Ripperda, Marlene M. Corton
    Abstract:

    Reported rates of Gluteal pain after sacrospinous ligament fixation range from 12-55% in the immediate postoperative period and from 4-15% 4-6 weeks postoperatively. The source of Gluteal pain often is attributed to injury to the Nerve to levator ani or pudendal Nerve. The Inferior Gluteal Nerve and other sacral Nerve branches have not been examined thoroughly as potential sources of Gluteal pain. The purpose of this study was to further characterize anatomy of the Inferior Gluteal Nerve and other Nerves that are associated with the sacrospinous ligament from a combined Gluteal and pelvic approach and to correlate findings to sacrospinous ligament fixation. Dissections were performed in female cadavers that had not been embalmed with Gluteal and pelvic approaches. From a pelvic perspective, the closest structure to the superior border of the sacrospinous ligament midpoint was noted, and the sacral Nerves that perforated the ventral surface of coccygeus muscle were examined. From a Gluteal perspective, the closest distances from ischial spine to the pudendal, Inferior Gluteal, posterior femoral cutaneous, and sciatic Nerves were measured. In addition, the closest distance from the midpoint of sacrospinous ligament to the Inferior Gluteal Nerve and the origin of this Nerve were documented. The thickness and height of the sacrospinous ligament at its midpoint were measured. Sacral Nerve branches that coursed between the sacrospinous and sacrotuberous ligaments were assessed from both a pelvic and a Gluteal approach. Descriptive statistics were used for data analysis. Fourteen cadavers were examined. From a pelvic perspective, the closest structure to the superior border of sacrospinous ligament at its midpoint was the S3 Nerve (median distance, 3 mm; range, 0-11 mm). Branches from S3 and/or S4 perforated the ventral surface of coccygeus muscles in 94% specimens. From a Gluteal perspective, the closest structure to ischial spine was the pudendal Nerve (median distance, 0 mm; range, 0-9 mm). Median closest distance from Inferior Gluteal Nerve to ischial spine and to the midpoint of sacrospinous ligament was 28.5 mm (range, 6-53 mm) and 31.5 mm (range, 10-47 mm), respectively. The Inferior Gluteal Nerve arose from dorsal surface of combined lumbosacral trunk and S1 Nerves in all specimens; a contribution from S2 was noted in 46% of hemipelvises. At its midpoint, the sacrospinous ligament median thickness was 5 mm (range, 2-7 mm), and its median height was 14 mm (range, 3-22 mm). In 85% of specimens, 1 to 3 branches from S3 and/or S4 Nerves pierced or coursed ventral to the sacrotuberous ligament and perforated the Inferior portion of the gluteus maximus muscle. Damage to the Inferior Gluteal Nerve during sacrospinous ligament fixation is an unlikely source for postoperative Gluteal pain. Rather, branches from S3 and/or S4 that innervate the coccygeus muscles and those coursing between the sacrospinous and sacrotuberous ligaments to supply gluteus maximus muscles are more likely to be implicated. A thorough understanding of the complex anatomy surrounding the sacrospinous ligament, limiting depth of needle penetration into the ligament, and avoiding extension of needle exit or entry point above the upper extent of sacrospinous ligament may reduce Nerve entrapment and postoperative Gluteal pain. Copyright © 2016 Elsevier Inc. All rights reserved.

Kathryn Chin - One of the best experts on this subject based on the ideXlab platform.

  • Inferior Gluteal and other Nerves associated with sacrospinous ligament: a cadaver study
    American Journal of Obstetrics and Gynecology, 2016
    Co-Authors: Maria E. Florian-rodriguez, Kathryn Chin, John N Phelan, Christopher M Ripperda, Adam M Hare, Marlene M. Corton
    Abstract:

    Background Reported rates of Gluteal pain after sacrospinous ligament fixation range from 12–55% in the immediate postoperative period and from 4–15% 4–6 weeks postoperatively. The source of Gluteal pain often is attributed to injury to the Nerve to levator ani or pudendal Nerve. The Inferior Gluteal Nerve and other sacral Nerve branches have not been examined thoroughly as potential sources of Gluteal pain. Objectives The purpose of this study was to further characterize anatomy of the Inferior Gluteal Nerve and other Nerves that are associated with the sacrospinous ligament from a combined Gluteal and pelvic approach and to correlate findings to sacrospinous ligament fixation. Study Design Dissections were performed in female cadavers that had not been embalmed with Gluteal and pelvic approaches. From a pelvic perspective, the closest structure to the superior border of the sacrospinous ligament midpoint was noted, and the sacral Nerves that perforated the ventral surface of coccygeus muscle were examined. From a Gluteal perspective, the closest distances from ischial spine to the pudendal, Inferior Gluteal, posterior femoral cutaneous, and sciatic Nerves were measured. In addition, the closest distance from the midpoint of sacrospinous ligament to the Inferior Gluteal Nerve and the origin of this Nerve were documented. The thickness and height of the sacrospinous ligament at its midpoint were measured. Sacral Nerve branches that coursed between the sacrospinous and sacrotuberous ligaments were assessed from both a pelvic and a Gluteal approach. Descriptive statistics were used for data analysis. Results Fourteen cadavers were examined. From a pelvic perspective, the closest structure to the superior border of sacrospinous ligament at its midpoint was the S3 Nerve (median distance, 3 mm; range, 0–11 mm). Branches from S3 and/or S4 perforated the ventral surface of coccygeus muscles in 94% specimens. From a Gluteal perspective, the closest structure to ischial spine was the pudendal Nerve (median distance, 0 mm; range, 0–9 mm). Median closest distance from Inferior Gluteal Nerve to ischial spine and to the midpoint of sacrospinous ligament was 28.5 mm (range, 6–53 mm) and 31.5 mm (range, 10–47 mm), respectively. The Inferior Gluteal Nerve arose from dorsal surface of combined lumbosacral trunk and S1 Nerves in all specimens; a contribution from S2 was noted in 46% of hemipelvises. At its midpoint, the sacrospinous ligament median thickness was 5 mm (range, 2–7 mm), and its median height was 14 mm (range, 3–22 mm). In 85% of specimens, 1 to 3 branches from S3 and/or S4 Nerves pierced or coursed ventral to the sacrotuberous ligament and perforated the Inferior portion of the gluteus maximus muscle. Conclusions Damage to the Inferior Gluteal Nerve during sacrospinous ligament fixation is an unlikely source for postoperative Gluteal pain. Rather, branches from S3 and/or S4 that innervate the coccygeus muscles and those coursing between the sacrospinous and sacrotuberous ligaments to supply gluteus maximus muscles are more likely to be implicated. A thorough understanding of the complex anatomy surrounding the sacrospinous ligament, limiting depth of needle penetration into the ligament, and avoiding extension of needle exit or entry point above the upper extent of sacrospinous ligament may reduce Nerve entrapment and postoperative Gluteal pain.

  • Inferior Gluteal and other Nerves associated with sacrospinous ligament: a cadaver study.
    American journal of obstetrics and gynecology, 2016
    Co-Authors: Maria E. Florian-rodriguez, Adam Hare, Kathryn Chin, John N Phelan, Christopher M Ripperda, Marlene M. Corton
    Abstract:

    Reported rates of Gluteal pain after sacrospinous ligament fixation range from 12-55% in the immediate postoperative period and from 4-15% 4-6 weeks postoperatively. The source of Gluteal pain often is attributed to injury to the Nerve to levator ani or pudendal Nerve. The Inferior Gluteal Nerve and other sacral Nerve branches have not been examined thoroughly as potential sources of Gluteal pain. The purpose of this study was to further characterize anatomy of the Inferior Gluteal Nerve and other Nerves that are associated with the sacrospinous ligament from a combined Gluteal and pelvic approach and to correlate findings to sacrospinous ligament fixation. Dissections were performed in female cadavers that had not been embalmed with Gluteal and pelvic approaches. From a pelvic perspective, the closest structure to the superior border of the sacrospinous ligament midpoint was noted, and the sacral Nerves that perforated the ventral surface of coccygeus muscle were examined. From a Gluteal perspective, the closest distances from ischial spine to the pudendal, Inferior Gluteal, posterior femoral cutaneous, and sciatic Nerves were measured. In addition, the closest distance from the midpoint of sacrospinous ligament to the Inferior Gluteal Nerve and the origin of this Nerve were documented. The thickness and height of the sacrospinous ligament at its midpoint were measured. Sacral Nerve branches that coursed between the sacrospinous and sacrotuberous ligaments were assessed from both a pelvic and a Gluteal approach. Descriptive statistics were used for data analysis. Fourteen cadavers were examined. From a pelvic perspective, the closest structure to the superior border of sacrospinous ligament at its midpoint was the S3 Nerve (median distance, 3 mm; range, 0-11 mm). Branches from S3 and/or S4 perforated the ventral surface of coccygeus muscles in 94% specimens. From a Gluteal perspective, the closest structure to ischial spine was the pudendal Nerve (median distance, 0 mm; range, 0-9 mm). Median closest distance from Inferior Gluteal Nerve to ischial spine and to the midpoint of sacrospinous ligament was 28.5 mm (range, 6-53 mm) and 31.5 mm (range, 10-47 mm), respectively. The Inferior Gluteal Nerve arose from dorsal surface of combined lumbosacral trunk and S1 Nerves in all specimens; a contribution from S2 was noted in 46% of hemipelvises. At its midpoint, the sacrospinous ligament median thickness was 5 mm (range, 2-7 mm), and its median height was 14 mm (range, 3-22 mm). In 85% of specimens, 1 to 3 branches from S3 and/or S4 Nerves pierced or coursed ventral to the sacrotuberous ligament and perforated the Inferior portion of the gluteus maximus muscle. Damage to the Inferior Gluteal Nerve during sacrospinous ligament fixation is an unlikely source for postoperative Gluteal pain. Rather, branches from S3 and/or S4 that innervate the coccygeus muscles and those coursing between the sacrospinous and sacrotuberous ligaments to supply gluteus maximus muscles are more likely to be implicated. A thorough understanding of the complex anatomy surrounding the sacrospinous ligament, limiting depth of needle penetration into the ligament, and avoiding extension of needle exit or entry point above the upper extent of sacrospinous ligament may reduce Nerve entrapment and postoperative Gluteal pain. Copyright © 2016 Elsevier Inc. All rights reserved.