Le syndrome du muscle piriforme (SMP) est une entité clinique probablement méconnue et sous-estimée en pratique courante. L'objectif de ce travail est d'apporter des arguments permettant d'aider à concrétiser la réalité de la responsabilité du muscle piriforme dans la souffrance provoquée sur le nerf ischiatique lors de son passage dans le foramen infra-piriforme.A partir de ("évaluation des rapports anatomiques locaux certaines manœuvres susceptibles de provoquer les contraintes du muscle piriforme sur le nerf ischiatique semblent plus sensibles et spécifiques. C'est ce qui est mis en évidence dans ce travail pour les manœuvres de Freiberg, PAIR et de Beatty. Il valide également la manœuvre « TG-CL » que nous mettons en avant.Pour optimiser le diagnostic de SMP, nous avons élaboré un score clinique à partir de 12 items. Ce score a été évalué sur une série personnelle de 250 patients comparés à 30 témoins avec conflit disco-radiculaire et 30 témoins sains. La sensibilité et la spécificité du score étaient respectivement de 96,4% et 100%, alors que la valeur prédictive était de 100% et la valeur prédictive négative de 86,9%. Pour les patients avec SMP nous avons proposé une prise en charge thérapeutique standardisée centrée sur le muscle piriforme. Le protocole médicamenteux et rééducatif permet d'obtenir 51,2% de guérison. Cent vingt deux patients en échec ont bénéficié d'injections de toxine botulinique. Les résultats évalués par l'EVA étaient très bons et bons dans 94 cas (77%), moyens dans 8 cas (7,4%) et mauvais dans 19 cas (15,6%). Quinze des 19 patients en échec ont été pris en charge chirurgicalement avec de très bons et bons résultats dans 12 cas / The piriformis muscle syndrome ( PMS ) has remained an ill-defined entity. It is a form of entrapment neuropathy involving compression of the sciatic nerve in the infrapiriformis canal. Our objective is, on the basis of anatomical descriptions of the piriformis muscle, to provide support for pathophysiological hypotheses. The manoeuvres that we have been reviewed are aimed at putting the piriformis muscle under stress in a variety of situation. We favour the PAIR and Freiberg stretching manoeuvres and Beatty's resisted contraction manoeuvre. When hip flexion surpasses 90°, the piriformis muscle is stretched in lateral rotation, and we have consequently laid emphasis on the manoeuvre we have termed Heel Contra-Lateral Knee (HCLK).To optimize the diagnosis of SMP , we developed a clinical score from 12 items. This score was evaluated on a personal series of 250 patients compared to 30 controls with disco-radicular conflict and 30 healthy controls. Sensitivity and specificity of the score were 96.4 % and 100 %, respectively, while the positive predictive value was 100 % and the negative predictive value of 86.9 %.Therapeutic management consists primarily of rehabilitation, making the patient aware of the benefits of daily self rehabilitation exercises. Combined medication and rehabilitation treatments had a cure rate of 51,2%.Hundred and twenty-two patients (48,8%) were unresponsive to treatment and received OnabotulinumtoxinA. Visual Analogue Scale (VAS) results were Very good/ Good' in 77%, 'Average' in 7,4% and 'Poor' in 15,6%. Fifteen of 19 patients unresponsive to treatment underwent surgery with Very good/ Good' results in 12 cases

Morbus​ ​Perthes​ ​(LCP)​ ​is​ ​an​ ​idiopathic​ ​defect​ ​in​ ​the​ ​blood​ ​flow​ ​of​ ​the​ ​proximal femoral​ ​epiphysis,​ ​where​ ​morphological​ ​and​ ​functional​ ​pathologies​ ​of​ ​the​ ​hip​ ​joint occur.​ ​Unfavorable​ ​prognostic​ ​factors​ ​include​ ​aspheric​ ​and​ ​incongruent​ ​hip,​ ​often manifested​ ​by​ ​the​ ​appearance​ ​of​ ​hinge​ ​abduction.​ ​The​ ​head​ ​is​ ​no​ ​longer​ ​remodeling after​ ​"golden"​ ​period​ ​of​ ​remodellation.​ ​Anteromedial​ ​Wedge​ ​Reduction​ ​Osteotomy (AWRO)​ ​is​ ​a​ ​new​ ​surgical​ ​method​ ​to​ ​improve​ ​the​ ​shape​ ​and​ ​reduce​ ​the​ ​femoral head​ ​and​ ​thus​ ​extend​ ​the​ ​life​ ​of​ ​a​ ​significantly​ ​altered​ ​hip​ ​joint. We​ ​evaluated​ ​10​ ​patients​ ​after​ ​the​ ​AWRO​ ​and​ ​established​ ​3​ ​hypotheses,​ ​in​ ​the clinical​ ​part​ ​of​ ​the​ ​study.​ ​1st​ ​hypothesis​ ​"AWRO​ ​leads​ ​to​ ​the​ ​reshape​ ​of​ ​the​ ​head" was​ ​confirmed​ ​following​ ​the​ ​Stulberg's​ ​classification.​ ​2nd​ ​hypothesis​ ​"AWRO​ ​leads to​ ​a​ ​reduction​ ​in​ ​the​ ​mediolateral​ ​diameter​ ​of​ ​the​ ​head",​ ​was​ ​confirmed​ ​by​ ​measuring the​ ​capitodiaphyseal​ ​index,​ ​which​ ​was​ ​reduced​ ​in​ ​all​ ​femoral​ ​heads​ ​after​ ​AWRO. The​ ​3rd​ ​hypothesis​ ​"Harris​ ​Hip​ ​Score​ ​improved​ ​in​ ​medium-term​ ​follow​ ​up​...

Bibliographical record: KURKOVÁ, Simona. Sonographic evaluation of sciatic nerve in individuals with radicular symptoms S1, Charles University, 2nd Faculty of Medicine, Department of Rehabilitation and Sports Medicine, 2019, p. 99, Thesis Supervisor: Mgr. Stanislav Machač Ph.D. Abstract The thesis deals with radicular symptomatics S1 and sonographic imaging and evaluation of sciatic nerve in individuals with unilateral radicular manifestation. The theoretical part describes anatomy and biomechanics of nerve structures, radicular syndrome and its clinical image, diagnostics and treatment. The theory also includes the less known extraspinal causes manifesting themselves as radicular syndrome, the effects of which may be equally important in differential diagnosis. It describes classical and new possibilities of nerve imaging with emphasis on sonography and approach of new procedures such as MRI tractography. In the practical part, the aim of the thesis is to evaluate morphological changes of sciatic nerve in patients with unilateral symptomatic S1 by sonographic imaging of the nerve during its course, from the subgluteal groove to the popliteal groove. It also examines the relationship between the pathophysiology and symptomatology of these patients, comparing whether changes in nerve size correlate with...

The sciatic nerve is the largest nerve in the human body giving both motor and sensory innervations to the lower limb. It can be affected in chronic diseases, such as diabetes, or compressed anatomically by structures such as piriformis and aneurysms leading to sciatica or paralysis of the lower limb. The current study therefore focuses on the arterial supply of the sciatic nerve as well as its course. Embryologically, the sciatic nerve is supplied via the axial artery during the first trimester. As the axial artery regresses, the iliac system develops. A failure of sciatic artery regression leads to several variations of pelvic and femoral arteries, with a risk of iatrogenic injury/trauma for those patients undergoing pelvic, gluteal and thigh surgical procedures. An understanding of the variability of the pelvic arteries in relation to a coexistent sciatic artery will provide an appropriate background for clinicians. The present study proposes a new theory of sciatic artery development and persistence, as well as new theories for the superior and inferior gluteal, internal pudendal and obturator arteries. The thesis is in two parts: first an anatomical study on the dissection of 171 cadavers including the pelvic, gluteal and thigh regions to observe (i) the patterns of the arteries these regions, and (ii) the course of the sciatic nerve. With variable course of sciatic nerve, there is a variability of its blood supply. Moreover, it includes a new classification of sciatic nerve with respect to clinical implications. The thesis clarifies the origins of the sciatic artery and its course. The second part is a literature review of sciatic artery aneurysm cases in 171 patients, which clarifies the risk of aneurysm, together with its incidence with respect to pathologic finding and associated disorders. Radiologists have to be aware of the internal iliac artery classifications to be able to alert general surgeons, orthopaedic surgeons, obstetricians, gynecologists, and urologists so that they can improve patient management.

Recently, 3D printing has been increasingly used to create physical models of the vocal tract with geometries obtained from magnetic resonance imaging. These printed models allow measuring the vocal tract transfer function, which is not reliably possible in vivo for the vocal tract of living humans. The transfer functions enable the detailed examination of the acoustic effects of specific articulatory strategies in speaking and singing, and the validation of acoustic plane-wave models for realistic vocal tract geometries in articulatory speech synthesis. To measure the acoustic transfer function of 3D-printed models, two techniques have been described: (1) excitation of the models with a broadband sound source at the glottis and measurement of the sound pressure radiated from the lips, and (2) excitation of the models with an external source in front of the lips and measurement of the sound pressure inside the models at the glottal end. The former method is more frequently used and more intuitive due to its similarity to speech production. However, the latter method avoids the intricate problem of constructing a suitable broadband glottal source and is therefore more effective. It has been shown to yield a transfer function similar, but not exactly equal to the volume velocity transfer function between the glottis and the lips, which is usually used to characterize vocal tract acoustics. Here, we revisit this method and show both, theoretically and experimentally, how it can be extended to yield the precise volume velocity transfer function of the vocal tract.

Recently, 3D printing has been increasingly used to create physical models of the vocal tract with geometries obtained from magnetic resonance imaging. These printed models allow measuring the vocal tract transfer function, which is not reliably possible in vivo for the vocal tract of living humans. The transfer functions enable the detailed examination of the acoustic effects of specific articulatory strategies in speaking and singing, and the validation of acoustic plane-wave models for realistic vocal tract geometries in articulatory speech synthesis. To measure the acoustic transfer function of 3D-printed models, two techniques have been described: (1) excitation of the models with a broadband sound source at the glottis and measurement of the sound pressure radiated from the lips, and (2) excitation of the models with an external source in front of the lips and measurement of the sound pressure inside the models at the glottal end. The former method is more frequently used and more intuitive due to its similarity to speech production. However, the latter method avoids the intricate problem of constructing a suitable broadband glottal source and is therefore more effective. It has been shown to yield a transfer function similar, but not exactly equal to the volume velocity transfer function between the glottis and the lips, which is usually used to characterize vocal tract acoustics. Here, we revisit this method and show both, theoretically and experimentally, how it can be extended to yield the precise volume velocity transfer function of the vocal tract.