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Psoas abscess is a collection of pus in the iliopsoas muscle compartment. [ 1 ] [ 2 ] It can be classified into primary psoas abscess (caused by hematogenous or lymphatic spread of a pathogen ) and secondary psoas abscess (resulting from contiguous spread from an adjacent infectious focus).
The psoas sign, also known as Cope's sign (or Cope's psoas test [1]) or Obraztsova's sign, [2] is a medical sign that indicates irritation to the iliopsoas group of hip flexors in the abdomen, and consequently indicates that the inflamed appendix is retrocaecal in orientation (as the iliopsoas muscle is retroperitoneal).
The final structure of the abscess is an abscess wall, or capsule, that is formed by the adjacent healthy cells in an attempt to keep the pus from infecting neighboring structures. However, such encapsulation tends to prevent immune cells from attacking bacteria in the pus, or from reaching the causative organism or foreign object.
In case of appendicitis, signs such as fever, positive psoas sign, migration of pain from umbilicus to the right iliac fossa increases the likelihood of the disease; while signs such as vomiting before the pain reduces its likelihood to occur. [2]
A cold abscess can develop if infection spreads to ligaments and soft tissues. [6] [3] In the lower back, there is a chance the abscess can move down along the psoas muscle to the upper thigh and eventually break through the skin. [3]
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The nerve of the anterior compartment of thigh is the femoral nerve. [2] Innervation for the quadriceps muscles come from the posterior division of the femoral nerve, while the anterior division (which contains cutaneous as well as muscular components) gives a lateral and a medial branch, the second being responsible for the innervation of the sartorius muscle. [4]
Sometimes, with a very flexible patient, the Thomas test will be normal despite a psoas dysfunction being present. However, in the patient with a normal hip joint, a positive test is a good indicator of psoas hypertonicity. [2] Other signs from the Thomas test: opposite/ contralateral hip flexes without knee extension- tight iliopsoas