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Gemelli-obturator complex in the deep gluteal space: an anatomic and dynamic study

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Abstract

Objective

To investigate the behavior of the sciatic nerve during hip rotation at subgluteal space.

Materials and methods

Sonographic examination (high-resolution ultrasound machine at 5.0–14 MHZ) of the gemelli-obturator internus complex following two approaches: (1) a study on cadavers and (2) a study on healthy volunteers. The cadavers were examined in pronation, pelvis-fixed position by forcing internal and external rotations of the hip with the knee in 90° flexion. Healthy volunteers were examined during passive internal and external hip rotation (prone position; lumbar and pelvic regions fixed). Subjects with a history of major trauma, surgery or pathologies affecting the examined regions were excluded.

Results

The analysis included eight hemipelvis from six fresh cadavers and 31 healthy volunteers. The anatomical study revealed the presence of connective tissue attaching the sciatic nerve to the structures of the gemellus-obturator system at deep subgluteal space. The amplitude of the nerve curvature during rotating position was significantly greater than during resting position. During passive internal rotation, the sciatic nerve of both cadavers and healthy volunteers transformed from a straight structure to a curved structure tethered at two points as the tendon of the obturator internus contracted downwards. Conversely, external hip rotation caused the nerve to relax.

Conclusion

Anatomically, the sciatic nerve is closely related to the gemelli-obturator internus complex. This relationship results in a reproducible dynamic behavior of the sciatic nerve during passive hip rotation, which may contribute to explain the pathological mechanisms of the obturator internal gemellus syndrome.

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Acknowledgements

To Iñigo Iriarte (ARS Medica, Bilbao, Spain) for interpreting and doing the drawings and for Luis Vidal PhD for the management of the article.

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Authors and Affiliations

  1. Consell Català de l’Esport, Generalitat de Catalunya, Barcelona, Spain

    Ramon Balius & Montse Pujol

  2. Sports Medicine Department, Clínica Diagonal, Barcelona, Spain

    Ramon Balius

  3. Math Department, UPC-BarcelonaTech, Barcelona, Spain

    Antonio Susín

  4. Anesthesiology, Reanimation and Pain Therapy, Clínica Diagonal, Barcelona, Spain

    Carles Morros & Dolores Pérez-Cuenca

  5. Facultad de Fisioteràpia, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Spain

    Montse Pujol

  6. Anatomy and Embryology Unit, Faculty of Medicine, Universitat of Barcelona, Barcelona, Spain

    Xavier Sala-Blanch

  7. Department of Anesthesiology, Hospital Clínic, Barcelona, Spain

    Xavier Sala-Blanch

Authors
  1. Ramon Balius
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  2. Antonio Susín
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  3. Carles Morros
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  4. Montse Pujol
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  5. Dolores Pérez-Cuenca
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  6. Xavier Sala-Blanch
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Corresponding author

Correspondence to Ramon Balius.

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The authors declare that they have no conflict of interest.

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Balius, R., Susín, A., Morros, C. et al. Gemelli-obturator complex in the deep gluteal space: an anatomic and dynamic study. Skeletal Radiol 47, 763–770 (2018). https://doi.org/10.1007/s00256-017-2831-2

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  • DOI: https://doi.org/10.1007/s00256-017-2831-2

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