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SINDROM MIŠIĆA ILIOPSOASA. FUNKCIONALNI POREMEĆAJI: SKRAĆENJE, SPAZAM
I SLABOST STRUKTURNO NEPROMIJENJENOG MIŠIĆA

ILIOPSOAS MUSCLE SYNDROME. FUNCTIONAL DISORDERS: SHORTENING, SPASM AND WEAKNESS OF A
STRUCTURALLY UNCHANGED MUSCLE

VJEKOSLAV GRGIĆ

Deskriptori: Slabinski mišići; Spazam – etiologija; Mišićna slabost – etiologija; Mišićne bolesti – dijagnostika
Sažetak. Funkcionalni (neorganski) poremećaji mišića iliopsoasa (MIP), tj. skraćenje, spazam i slabost strukturno nepromijenjenog MIP-a, mogu se očitovati trbušnim i/ili zdjeličnim bolima, bolima u području torakolumbalne (ThL) i lumbosakralne (LS) kralježnice, sakroilijakalnog (SI) zgloba, kuka, prepone i prednjeg dijela bedra na strani zahvaćenog mišića, kao i smetnjama hoda (sindrom mišića iliopsoasa). Kliničkim pregledom MIP-a, koji obuhvaća transabdominalnu palpaciju, testove istezanja i testove snage, mogu se dijagnosticirati patološke tvorbe, skraćenje, bolni spazam, slabost i osjetljivost tetive tog mišića. MIP je, kao i drugi posturalni mišići, sklon skraćenju. Slabost MIP-a može biti posljedica oštećenja lumbalnog pleksusa ili femoralnog živca koji oživčavaju MIP te posljedica organskih bolesti MIP-a. Bolni podražaji iz somatskih i visceralnih struktura koje oživčavaju korjenovi Th12-L4, od kojih potječe i segmentna inervacija MIP-a, mogu izazvati refleksni spazam MIP-a. Bolni spazam MIP-a uzrokovan poremećajima ThL i LS kralježnice, SI zgloba i kuka, može oponašati bolesti trbušnih i zdjeličnih organa. U diferencijalnoj dijagnozi bolnog spazma MIP-a na prvome mjestu treba razmotriti organske bolesti tog mišića koje mogu rezultirati spazmom (apsces, hematom, tumor, metastaza), te bolesti trbušnih i zdjeličnih organa koje mogu izazvati refleksni spazam MIP-a. Funkcionalni poremećaji MIP-a, koji nisu rijetki, često se previde tijekom kliničkog pregleda bolesnika. Razlozi previda tih poremećaja jesu: 1. nespecifična i varijabilna klinička slika kojom se funkcionalni poremećaji MIP-a prezentiraju, 2. funkcionalni poremećaji MIP-a zanemareno su izvorište boli, 3. nedostupnost MIP-a inspekciji, 4. nepoznavanje tehnika pregleda MIP-a i 5. funkcionalni poremećaji MIP-a ne mogu se otkriti radiološkim pretragama trbuha. S terapijskoga gledišta važno je prepoznati funkcionalne poremećaje MIP-a budući da ti poremećaji reagiraju vrlo dobro na odgovarajuću terapiju. U članku su opisane etiopatogeneza, klinička slika, dijagnoza, diferencijalna dijagnoza i terapija funkcionalnih poremećaja MIP-a.

Descriptors: Psoas muscles; Spasm – etiology; Muscle weakness – etiology; Muscular diseases – diagnosis
Summary. Functional (non-organic) disorders of the iliopsoas muscle (IPM), i.e. the shortening, spasm and weakness of the structurally unchanged IPM, can be manifested as abdominal and/or pelvic pain, pain in areas of the thoracolumbar (ThL) and lumbosacral (LS) spine, sacroiliac (SI) joint, hip, groin and anterior thigh on the side of the affected muscle as well as gait disturbances (iliopsoas muscle syndrome). By clinical examination of the IPM, including the transabdominal palpation, stretch and strength tests, pathological masses, shortening, painful spasm, weakness and tendon tenderness of that muscle can be diagnosed. The IPM is, like other postural muscles, inclined to shortening. The weakness of the IPM can be a conse-quence of the lesion of the lumbar plexus or femoral nerve that innervate the IPM, as well as a consequence of certain or-ganic diseases of the IPM. Painful stimuli coming from somatic and visceral structures that are innervated from Th12-L4 nerve roots, from which the IPM segmental innervation also originates, can cause a reflex spasm of the IPM. A painful spasm of the IPM caused by disorders of the ThL and LS spine, SI and hip joint, can mimic diseases of the abdominal and pelvic organs. In the differential diagnosis of the IPM painful spasm, organic diseases of that muscle should be considered foremost (abscess, hematoma, tumor, metastase), as they can result in spasm, and the diseases of the abdominal and pelvic organs that can cause an IPM reflex spasm. The IPM functional disorders, which are not rare, are often overlooked during a clinical examination of a patient. Reasons for overlooking these disorders are: 1) a nonspecific and variable clinical picture presenting the IPM functional disorders, 2) the IPM functional disorders are a neglected source of pain, 3) the inaccessibil-ity of the IPM for inspection, 4) the lack of knowledge of the IPM examination techniques and 5) the IPM functional disor-ders cannot be discovered by radiological examinations of the abdomen. From a therapeutic point of view, it is important to recognise the IPM functional disorders since these disorders respond very well to appropriate therapy. Etiopathogenesis, clinical picture, diagnosis, differential diagnosis and therapy of the IPM functional disorders are described in the article.

Liječ Vjesn 2009;131:81–86

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