An appraisal of the short lateral rotators of the hip joint

Yoo, Sarang; Dedova, Irina; Pather, Nalini

doi:10.1002/ca.22568

Cited by 36 publications

(58 citation statements)

References 65 publications

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“…Obturator internus muscle is important in stabilization and external rotation of the hip (Yoo et al ., ; Byrne et al ., ). Its responsiveness to testosterone suggests potential beneficial impact in the elderly by stabilizing the hip during walking.…”

Section: Discussionmentioning

confidence: 99%

Muscles of the trunk and pelvis are responsive to testosterone administration: data from testosterone dose–response study in young healthy men

et al. 2017

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Testosterone dose-dependently increases appendicular muscle mass. However, the effects of testosterone administration on the core muscles of the trunk and the pelvis have not been evaluated. The present study evaluated the effects of testosterone administration on truncal and pelvic muscles in a dose-response trial. Participants were young healthy men aged 18-50 years participating in the 5α-Reductase (5aR) Trial. All participants received monthly injections of 7.5 mg leuprolide acetate to suppress endogenous testosterone production and weekly injections of 50, 125, 300, or 600 mg of testosterone enanthate and were randomized to receive either 2.5 mg dutasteride (5aR inhibitor) or placebo daily for 20 weeks. Muscles of the trunk and the pelvis were measured at baseline and the end of treatment using 1.5-Tesla magnetic resonance imaging. The dose effect of testosterone on changes in the psoas major muscle area was the primary outcome; secondary outcomes included changes in paraspinal, abdominal, pelvic floor, ischiocavernosus, and obturator internus muscles. The association between changes in testosterone levels and muscle area was also assessed. Testosterone dose-dependently increased areas of all truncal and pelvic muscles. The estimated change (95% confidence interval) of muscle area increase per 100 mg of testosterone enanthate dosage increase was 0.622 cm (0.394, 0.850) for psoas; 1.789 cm (1.317, 2.261) for paraspinal muscles, 2.530 cm (1.627, 3.434) for total abdominal muscles, 0.455 cm (0.233, 0.678) for obturator internus, and 0.082 cm (0.003, 0.045) for ischiocavernosus; the increase in these volumes was significantly associated with the changes in on-treatment total and free serum testosterone concentrations. In conclusion, core muscles of the trunk and pelvis are responsive to testosterone administration. Future trials should evaluate the potential role of testosterone administration in frail men who are predisposed to falls and men with pelvic floor dysfunction.

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Section: Discussionmentioning

confidence: 99%

Muscles of the trunk and pelvis are responsive to testosterone administration: data from testosterone dose–response study in young healthy men

et al. 2017

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“…25 The present study utilized this technique with only the piriformis being divided into a superior and inferior section based on the origin location of the anterior surface of the sacrum and greater sciatic notch. 7,18 CONCLUSION While all stretch positions caused a length change for the deep rotators of the hip, the three stretch positions that caused the greatest change in the short external rotators were 30° adduction from 90° of hip and knee flexion, 45° internal rotation from a neutral anatomical position, and 45° external rotation from 90° hip and knee flexion. The piriformis and SG had the greatest length change when adducting the hip 30° from 90° degrees of hip and knee flexion.…”

Section: Discussionmentioning

confidence: 92%

“…7 These postural muscles 18 stabilize the hip in a manner similar to the rotator cuff at the glenohumeral joint. During cutting and propulsion type movements the short external rotators are regularly contracted for dynamic stability of the hip.…”

Section: Discussionmentioning

confidence: 99%

“…The origin and insertions of the superior (SP) and inferior fibers (IP) of the piriformis, superior gemellus (SG), obturator internus (OI), and inferior gemellus (IG) were identified by the primary investigator and secondary investigator to ensure proper location. 18 The primary investigator had one year of dissection experience and the secondary investigator had nine years' experience at the time this study was performed. Polypropylene strings were attached from the insertion to origin sites of each muscle to represent the musculotendinous fibers of the short external rotators.…”

Section: Designmentioning

confidence: 99%

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Length Change of the Short External Rotators of the Hip in Common Stretch Positions: A Cadaveric Study

McGovern

Kivlan

Martin

2017

Intl J Sports Phys Ther

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Background: Stretching of the deep rotators of the hip is commonly employed in patients with lumbosacral, sacroiliac, posterior hip, and buttock pain. There is limited research demonstrating the effectiveness of common stretching techniques on the short external rotators of the hip. Purpose:The objective of this study was to evaluate length change during stretching of the superior and inferior fibers of the piriformis, superior gemellus, obturator internus, and inferior gemellus.Study Design: Repeated-measures laboratory controlled cadaveric study.Methods: Seventeen hip joints from nine embalmed cadavers (5 male; 4 female) with an age between 49-96 years were skeletonized. Polypropylene strings were attached from the origin to insertion sites of the short external rotators. The change of length (mm) noted by excursion of the strings was used as a proxy for change in muscle length, when the hip was moved from the anatomical position to four specific stretch positions: 1) 45° internal rotation from hip neutral flexion/extension, 2) 45° external rotation from 90° hip and knee flexion, 3) 30° adduction from 90° of hip and knee flexion, and 4) 30° of adduction with the hip and knee flexed so the lateral malleolus contacted the lateral femoral epicondyle of the contralateral limb , were recorded. Results:There was a significant effect on string displacement by stretch position, F (15,166) = 14.67, p < .0005; Wilk's ⌳ = .097, partial n2 = .540. The greatest displacement of the strings corresponding to the superior piriformis, inferior piriformis, and the superior gemellus occurred in 30° adduction from 90° of hip and knee flexion. The obturator internus and inferior gemellus had the largest string displacement with 45° internal rotation from neutral flexion/extension. Conclusions:While all stretch positions caused a significant string displacement indicating length changes of the deep rotators of the hip, the three stretch positions that caused the greatest change were: 1) 30° adduction from 90° of hip and knee flexion, 2) 45° internal rotation from neutral flexion/ extension, and 3) 45° external rotation with 90° hip and knee flexion.Clinical Relevance: This study has clinical implications for the effectiveness of specific stretching techniques on the short external rotators of the hip with the potential to improve the validity of stretching protocols for patients with posterior hip or buttock pain. The piriformis and superior gemellus had a larger change in length when adducting the hip from 90° degrees of hip and knee flexion. The obturator internus and inferior gemellus had a greater length change when internally rotating the hip from neutral flexion/extension. Level of Evidence: 3

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“…These muscles are considered short lateral rotators (Stähelin et al, 2002;Yoo et al, 2015) and together are called "rotator cuff of the hip", they act as dynamic stabilizers (Pine et al, 2011) by the positioning of the femoral head in the acetabulum (Moore et al, 2010).…”

Section: Introductionmentioning

confidence: 99%