On sagittal imaging, the body of the lateral meniscus is normally only seen on two adjacent slices. Femoroacetabular impingement alters hip and pelvic biomechanics during gait. Found inside Page 203 hip joint and lies between the hip capsule and the psoas musculotendinous unit . 2. The trochanteric bursa surrounds the gluteal insertions into the greater trochanter . 3. The ischiogluteal bursa separates the gluteus maximus from Those attending the gym three times a week have an increased risk of developing a hip labral tear. AJR Am J Roentgenol. Acetabular labral tears. Kim JG, Han SW, Lee DH. Dysfunction of these muscles (primarily the gluteus medius and minimus) is depicted in an excessive drop of the contralateral (or nonweightbearing swinging) side of the pelvis, or Trendelenburg gait pattern. The hip labrum reconstruction: indications and outcomesa systematic review. Narvani AA, Tsiridis E, Tai CC, Thomas P. Acetabular labrum and its tears. Eur Radiol. It ranges from a well-formed structure in some patients to absent in others (see case 2). A gluteus medius tear is very painful and debilitating. 2011 May; 41(5): 346-353, Lewis CL, Sahrmann SA, Moran DW. Found inside Page 712Under anesthesia the nerve is exposed just below the gluteus maximus muscle may damage its connections with the cord or even tear it away from it . N Am J Sports Phys Ther 2007;2(4):241-250. Pain in the hamstring region can actually originate from the lower back, sacroiliac joints or muscles of the buttocks such as the gluteus maximus and piriformis muscle. Found inside Page 155 by such a tear as lacerates the perneum ) ; c , rectum ; - f , obturator internus ; e , gluteus maximus . SURGICAL ANATOMY OF THE FEMALE PERINEUM ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. You may even need surgery, depending on the severity of the slipped disc. Found inside Page 106Trochanteric bursitis and focal tears of the gluteus medius and minimus tendon can be effectively treated with arthroscopic bursectomy, iliotibial band release, and/or tendon repair to Avulsion of the hamstring from the ischial The Otto E. Aufranc Award: the role of labral lesions to development of early degenerative hip disease. De Smet AA. It helps with motion of the hip, but perhaps more importantly, acts to help stabilize the knee joint. https://www.physio-pedia.com/index.php?title=Hip_Labral_Disorders&oldid=265097. The Diagnostic Accuracy of a Clinical Examination in Determining Intra-articular Hip Pain for Potential Hip Arthroscopy Candidates. The relationship between diagnosis and outcome in arthroscopy of the hip. The gluteus maximus is the main hip extensor and helps keep up the normal tone of the fascia lata or iliotibial (IT) band, which is the long, sheet-like tendon on the side of your thigh. Found inside Page 316Sub ITB bursa (ITB and greater trochanter), piriformis bursa (posterior subgluteus medius bursa) Trochanteric bursa (75) Referral to surgery: disabling pain with failed conservative treatment Bursectomy, gluteus medius repair, A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med 2009;2:105-117, Leibold M, Huijbregts P, Jensen R. Concurrent criterion-related validity of physical examination tests for hip labral lesions: a systematic review. Front of the hip. Epidemiology. July 2006 pg 1448 - 1456. 4. Anatomy The gluteus minimus muscle is triangular in shape and lies underneath the gluteus medius near the rotators of the hip joints. McCarthy JC, Noble PC, Schuck MR, et al. Found insideThirteen male and twelve female college soccer players underwent three-dimensional motion analysis and electromyography of seven muscles (iliacus, gluteus maximus, gluteus medius, vastus lateralis, vastus medialis, hamstrings, Yazbek PM, Ovanessian V, Martin RL, Fukuda TY. Contusion (especially over bony prominences), Referred pain from lumbosacral or sacroiliac regions. Working with a physical therapist (PT) can help you regain maximal knee range of motion and strength and can help you return to your normal optimal level of activity.. Research even shows that participating in physical therapy for a meniscus injury may help you avoid surgery Found inside 147, 148f Gliding zone, 414 Gluteal nerves, 276 Gluteus maximus anatomy of, 306, 306f Gluteus medius anatomy of, 322323, 322f, 323f tears of arthroscopic treatment of, 325331 differential diagnosis of, 324 endoscopic repair of, They occur less frequently in individuals in European countries and the United States, but are more common in individuals from Japan. Davies AM, Cassar-Pullicino VN. Acetabular labral tears. Physical Therapy. Binningsley D. Tear of the acetabular labrum in an elite athlete. Stationary bike without resistance, with seat height that limits the hip to less than 90. (Right) The biceps femoris hamstring muscle travels under the gluteus maximus and can snap as it moves over the ischial tuberosity. Current reviews in musculoskeletal medicine. Gentle stretching of hip muscle groups including piriformis, psoas, quadriceps, hamstring muscles with passive range of motion. Chopra A, Grainger AJ, Dube B, Evans R, Hodgson R, Conroy J et al. 2016;27(1):1-29. Most often the gluteus medius is weak and painful because it is compensating for poor function of other hip muscles, particularly the deep 6 and the gluteus maximus. What is the prevalence of imaging-defined intra-articular hip pathologies in people with and without pain? Lewis CL, Sahrmann SA. Appropriate pain management through medication. Arthroscopy 1999;15:138 141. Trauma , either by a fall or a direct blow to the buttock area, causes most gluteal injuries. Mike S. Nguyen, Valeriy Kheyfits, Brian D. Giordano, Gregory Dieudonne, Johnny U. V. Monu. Additionally, there may be associated hypoplasia of the lateral tibial spine. 199 (3): 481-99. It is a common cause of Greater Trochanteric Pain Syndrome.. Gluteal tendinopathy is an injury to one or all gluteal or buttock tendons in isolation, characterised by the gluteal muscles pain and dysfunction to support daily Porthos Salas A, O'Donnell JM. 2018;52(9):581-593. If you have a knee meniscus tear, you may benefit from a physical therapy exercise program to rehabilitate your knee. Pain often decreases with rest and diminished activity. Found inside Page 176The diagnosis of full-thickness tear was made and the patient was sent home on crutches. On follow-up visit to trauma Surgical repair restored his knee function. The gluteus maximus does not insert on the greater trochanter. MR imaging of the normal hip. Br J Sports Med. except short head which only crosses the knee joint. New York7 Springer Verlag; 2003. p. 113-33. 3. Heerey JJ, Kemp JL, Mosler AB, Jones DM, Pizzari T, Souza RB et al Crossley KM. Clin Orthop 2001;393:2537. The nerve exits the greater sciatic foramen as distinct tibial and peroneal divisions, enclosed in a common nerve sheath. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. Discoid menisciare those that have a body that is too wide,usually affecting the lateral meniscus. during terminal stance in running) can create stress at the chondrolabral junction (typically the 10-12 o'clock position) resulting in microtrauma and eventual labral injury. Arthroscopy 1999;15:132137. Troelsen A, Mechlenburg I, Gelineck J, Bolvig L, Jacobsen S, Sballe K. What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics? Labral lesions: an elusive source of hip pain case reports and literature review. Acetabular and labral pathology. In: McCarthy JC, editor. Discoid menisci are congenital, frequently bilateral (up to 50%) and have been reported in twins, although no genetic locus has been identified 2.There is a higher prevalence in Asians without any gender predilection 7.. Lateral discoid meniscus is far more common than medial discoid meniscus, with the latter being rare. Arthroscopy 2001;17:181188. Found inside Page 469*Gluteus maximus of dominant leg is being exercised Signs and Symptoms of Poor Tolerance during Rotator Cuff Repair. TABLE 20.5 Gluteus medius Gluteus maximus Low-level activation (0 to 20% MVIC) Monster walks with band at Classification is based on the degree of peripheral attachments to the tibial plateau, and the shape of the meniscus itself: Radiographs may well suggest the diagnosis with the widening of the lateral joint space and cupping of the lateral tibial plateau, which is normally flat or even slightly convex. Singh K, Helms CA, Jacobs MT et-al. Repetitive hip hyperextension and external rotation (e.g. Ideally, the meniscus is preserved with conservative management. (B) The gluteus medius: The hip is held at 0 degrees of extension and 45 to 90 degrees of knee flexion. Found inside Page 658Twelve musculotendinous structures (i.e., gluteus medius, gluteus minimus, TFL, ITB, gluteus maximus, the setting of gluteus medius and minimus tears have demonstrated limited efficacy; however, surgery can be effective for patients The physiotherapeutic treatment of acetabular labral tears. cross and act upon 2 joints: the hip and knee. Found inside Page 25The third type of abductor tendon dysfunction occurs with avulsion or failure of repair following THA performed through the The researchers concluded: Reconstruction with a gluteus maximus muscle flap 25 CHAPTER 3 HIP ARTHROPLASTY. Found inside Page 150This article describes the indications, contraindications, surgical technique, and outcomes of hip arthroscopy. Ultrasonography was used to identify gluteus medius tendonopathy and tear in patients with point tenderness over the A systematic review and meta-analysis. External snapping may be a sign that the iliotibial band or gluteus maximus is tight. Discoid menisci are congenital, frequently bilateral (up to 50%) and have been reported in twins, although no genetic locus has been identified 2. Found inside Page 81 (PRP) may be considered for treatment of gluteus minimus and medius tendinopathy and/or partial tears.75 Rarely, surgery can be It is a connective tissue sheath containing the tensor fascia lata (TFL) and gluteus maximus fascia. Found inside Page 225Surgical Technique S T 8-1 Primary Repair of a Proximal Hamstring Avulsion Indications Overview MRI demonstrating bony or tendinous avulsion from the The inferior border of the gluteus maximus is identified and retracted superiorly. Early hip disorders. J Bone Joint Surg Br 1991;73:423 429. Capsular Laxity: This is thought to occur in one of two ways; cartilage disorders (e.g. Anatomy Of Knee Muscles These grades correspond roughly to the approximate severity of symptoms and time frame for healing. The glutes play a very important role in the stability of the knee and in my experience, almost everyone suffering from ongoing knee pain has weak glutes. The greater trochanter is situated on the proximal and lateral side of the femur, just distal to the hip joint and the neck of the femur.. Orbell S, Smith TO. muscle [mus'l] a bundle of long slender cells (muscle fibers) that have the power to contract and hence to produce movement. The gluteus maximus muscle slides over the greater trochanter. The ligamentum teres, also known as the ligamentum capitis femoris or round ligament of the hip, is an intra-articular ligament within the medial hip joint. Reiman MP, Goode AP, Cook CE, Hlmich P, Thorborg K. Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis. This book is aimed at providing an overview of arthroscopic joint surgery involving major joints in the body. Arthroscopy 1996;12:603612. Comparative reliability and diagnostic performance of conventional 3T magnetic resonance imaging and 1.5T magnetic resonance arthrography for the evaluation of internal derangement of the hip. 2. Found inside Page 320(255) used bilateral gluteus maximus transposition to treat seven patients with anal incontinence in whom previous Previous surgery involved postanal repair in four women and secondary overlapping suture for obstetric tear in one. Byrd JW. A discoid meniscus is usually present if the meniscal body is seen on three or more standard sagittal slices - the opposite of the absent bow tie sign. 3. Phase 2 is spent slowly restoring your strength and range of motion, Exercises such as core ball stabilization, golf progression, lunges, Reducing anteriorly directed forces on the hip by addressing the patterns of recruitment of muscles that control hip motion and by correcting movement patterns during exercises such as hip extension and during gait, Instructing patients to avoid pivoting motions, especially under load, since the acetabulum rotates on a loaded femur, thus increasing force across the labrum. 1. Exercises such as: water walking, piriformis stretch, ankle pumps. Classification. Lippincott Williams & Wilkins. The gluteal strain can be graded as minimal, moderate or severe. {"url":"/signup-modal-props.json?lang=us\u0026email="}. Br J Sports Med 2003;37:8488. 30(2009) 41-44. 2006;86:11021. Chatha D, Chatha AR, Chatha. The sites for intramuscular medications are the gluteus maximus, the deltoid muscle, the vastus lateralis, the rectus femoris muscle, and the ventrogluteal muscle. These prevent rubbing of the muscle during movements. 5. Acta Orthop 2009 Jun;80(3):314-8. Degenerative or traumatic tears of the hip abductor tendons, so-called rotator cuff tears of the hip, are seen in older patients w They also protect the contents of the abdomen against injury and help support the body. Found inside Page 536Superior retraction of the gluteus maximus should be performed with caution as the inferior gluteal nerve can also be injured. If there is adequate residual stump at the proximal tendon, a direct repair is performed. On coronal imaging, meniscal body width of 15 mm or more is typically considered diagnostic of discoid morphology. Flexibility exercises involving the piriformis, adductor group, psoas/rectus femoris should continue, Sidestepping with an abductor band for resistance, Exercises such as wall sits with abductor band, two leg bridging, Manual therapy should be performed as needed, Flexibility and passive ROM interventions should become slightly more aggressive if the limitations persist (if the patient has reached his full ROM or flexibility, terminal stretches should be initiated). Gluteal Tendinopathy Hip Tendinopathy / Hip Tendonitis What is Gluteal Tendinopathy? 2006;187 (2): 384-7. The tendons of the gluteus medius (GMed), gluteus minimus (GMin), gluteus maximus (GMax) and the tensor fascia lata (TFL) attach onto this bony outgrowth (apophysis). A large submuscular bursa, the trochanteric bursa, is found at the lateral hip, between the greater trochanter of the femur and the overlying gluteus maximus muscle. Found inside Page 612010;26(12):1697705. 66. Davies JF, Davies DM. Surgical technique for the repair of tears to the gluteus Medius and Minimus tendons of the hip. JBJS Essent Surg Tech. 2014;4(2):e11. 67. Whiteside LA. Surgical technique: gluteus maximus The Journal of Arthroscopic and Related Surgery. Gait Posture. A systematic review. A strain or tear of the gluteus maximus can occur during athletic activities, most likely while playing dynamic sports that require running, jumping and quick accelerations. Found inside Page 375FIGURE 6-43 Open repair of gluteus medius tear. (EXTERNAL COXA SALTANS) Snapping of a thickened posterior edge of the iliotibial band or anterior edge of the gluteus maximus over the greater trochanter during flexion and extension Discoid menisci have decreased collagen fibers and loss of normal collagen orientation, which predisposes them to intrameniscal mucoid degeneration 7. Schmerl M, Pollard H, Hoskins W. Labral injuries of the hip: a review of diagnosis and management. J Manipulative Physiol Ther. Learn how to tell if that could be what you are experiencing, and the available treatment options. The ligament is lined by synovium. Found inside Page 181Iliotibial Band The ITB is an aponeurosis formed from the more proximal tensor fascia lata, gluteus maximus muscle, Common multiligament knee injury patterns include ACL tear with posterolateral corner injury with or without an MCL Found inside Page 65Zur Verth believes that a contracted gluteus maximus prevents hanche a ressort , " but that if paralysis weakens the muscle , if a tear separates its Found inside Page 167The skin and subcutaneous tissue being divided , separate in the same direction the fibres of the gluteus maximus ; divide or tear with the fingers the (2013) American Journal of Roentgenology. 2010 Oct; 32(4): 603-607, Kennedy MJ, Lamontagne M, Beaule PE. 2009 Jun 1;2(2):105-17. hamstring origin on ischial tuberosity is ~6 cm proximal to inferior border of overlying gluteus maximus. How I diagnose meniscal tears on knee MRI. Following surgery, the hip labral tear treatment is typically divided into four phases, according to a 2016 clinical review published in Sports Health. ACL Tear PCL Injury World Series of Surgery Greater Trochanteric Pain Syndrome - Shane Nho, MD (CSMS #91, 2017) Knee & Sports Just Open It: Open Gluteus Medius Repair or Gluteus Maximus Transfer - Geoffrey S. Van Thiel, MD, MBA (CSMS #86, 2016) Muscles are responsible for locomotion and play an important part in performing vital body functions. Hip arthroscopy for acetabular labral tears. sciatic nerve is 1.2 cm from lateral bony aspect of hamstring origin. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 2 (3): 258-64. Found inside Page iThe BioMechanics Method for Corrective Exercise enables health and fitness professionals to identify common musculoskeletal imbalances in their clients and apply appropriate corrective exercises to swiftly eliminate muscle and joint pain Check for errors and try again. Ideal for orthopaedic surgeons who need a practical resource covering the top procedures in the field, Campbells Core Orthopaedic Procedures utilizes a succinct format that focuses solely on the surgical techniques critical in helping (2014) Radiographics : a review publication of the Radiological Society of North America, Inc. 34 (4): 981-99. Rehabilitation after arthroscopy of an acetabular labral tear. People with external snapping hip syndrome may notice: The snapping typically occurs during hip flexion and extension, such as when running and climbing stairs. 2018 Mar;28(3):963-971. They are incidentally found in 3-5% of knee MRI examinations. If this is unsuccessful, then partial or total resection may be carried out. Ligamentum teres injuries - an observational study of a proposed new arthroscopic classification. 2008;(52225):1-6. Diagnosis and Treatment of Discoid Meniscus. Biomechanics. Found insideThe purpose of this book is to review the state of the art of the actual knowledge on muscle tears in athletes, in particular for what concern the biology of muscle healing, the conservative and surgical treatments and the preventive A comprehensive review of hip labral tears. Alternatively, a ratio of the minimal meniscal width to the maximal tibial width of more than 20% may be used 7,8. posterior suprapatellar (prefemoral or supratrochlear) fat pad, anterior suprapatellar (quadriceps) fat pad, accessory anterior inferior tibiofibular ligament, superficial posterior tibiotalar ligament, superficial posterior compartment of the leg (calf), accessory extensor digiti secundus muscle, descending branch of the lateral circumflex, 80% coverage of the tibial plateau is often used as the cut-off between incomplete and complete, stable: normal peripheral attachments with an intact posterior, unstable (also known as a Wrisberg variant): lack or tear of a posterior meniscocapsular (in particular meniscopopliteal)ligaments with an attachment only from the meniscofemoral ligament of Wrisberg. Another group of muscles not to be overlooked with knee problems is the glutes, or buttock muscles, gluteus maximus, gluteus medius and gluteus minimus. Nguyen JC, De Smet AA, Graf BK, Rosas HG. Found inside Page 180Br J Surg 91:1485-1492 Fleshman JW, Dreznik Z, Fry RD, Kodner IJ (1991) Anal sphincter repair for obstetric injury: manometric Sinsel NK (1996) Conventional and dynamic anal sphincter plasty using the gluteus maximus muscle. Groh M,Herrera J. (2008) ISBN:0781783143. The resulting tear is easily visible, (located behind your gluteus maximus), says Pagliano. The scope of this book covers the basic science of hip pathology, anatomy, biomechanics, pathology, and treatment. It has put together up-to-date research and has invited opinion leaders in the field to contribute to the text. Hip Anatomic Variants That May Mimic Pathologic Entities on MRI: Nonlabral Variants. The ligamentum teres, also known as theligamentum capitis femorisor round ligament of the hip,is an intra-articular ligament within the medial hip joint. Another tendon that could cause a snapping hip runs from the front of the thigh up to the pelvis (rectus femoris tendon). J of Ortho Sports PT. A gluteal muscle strain is a stretch or partial tear of the muscle or tendon. Samoto N, Kozuma M, Tokuhisa T, Kobayashi K. Diagnosis of discoid lateral meniscus of the knee on MR imaging. (2015) Journal of hip preservation surgery. (2003) ISBN:3540002502. Found inside Page iiThis book offers practical guidance on all procedures that may be performed within the field of hip preservation surgery, arthroscopy, and endoscopy. More than 2,600 illustrations complement the text. This edition has new chapters on minimally invasive surgery of the hip. 2006 Jan 1;86(1):110-21. Physical therapy. Found inside Page 5275263-83: Long-axis ultrasound image of a partial proximal hamstring tendon tear. The gluteus maximus covers the posterior aspect of the gluteus medius tendon and attaches to the iliotibial band, which lies superficial to the gluteus Groh MM, Herrera J. 2014 Jan 1;89(1):27-34. Br J Sports Med 2003;37:207-211. Found inside Page 430Posterior view demonstrating gluteal line incision for left sided open hamstring repair Axial (left) and coronal (right) Gluteus Avulsion Description: Avulsion of the gluteus could compromise the gluteus maximus, medius, or minimus; Found inside Page 253Fourth degree: A third degree tear with disruption of anal epithelium. RCOG classifies anal sphincter damage as follows: 3a: Less than 50 percent of external anal sphincter is torn. Bulbospongiosis Levator ani Gluteus maximus Fig. 2005;28(8):632. 20 (1): 59-64. 1. Found insideDIFFERENTIAL. DIAGNOSIS. FAI Labral tear Hip dysplasia SCFE Acetabular retroversion The abductors and gluteus maximus musclescan be spared byperforming a Gibson approach, which proceeds between the gluteus medius and maximus (FIG. J Manual Manip Ther 2008;16:24-41. The pain will generally be more consistent and is situated on the anterior hip (anterosuperior quadrant) or at the groin. The gluteus medius and minimus muscle-tendon complex is crucial for gait and stability in the hip joint. This is a comprehensive guide to the evaluation and treatment of failed total hip replacements. Found inside Page 245There is no evidence that a defunctioning colostomy at the time of sphincter repair improves outcome [9]. Unilateral and bilateral gluteoplasty (utilizing gluteus maximus) or graciloplasty were the most common non-stimulated options most common, disruption of free margin of the labrum, fraying of the free margin, associated with degenerative joint disease, Hip labral tears commonly occur between 8 to 72 years of age and on average during the fourth decade of life, 22-55% of patients that present with symptoms of hip or groin pain are found to have an acetabular labral tear, Up to 74.1% of hip labral tears cannot be attributed to a specific event or cause, Hyperabduction, twisting, falling or a direct blow from a car accident were common mechanisms of injury in patients who identified a specific mechanism of injury. Ayeni, O. R., Alradwan, H., de Sa, D., & Philippon, M. J. The minimal meniscal width to the text inserts into the femur stabilize the knee.. Nguyen JC, Noble PC, Schuck M, Tokuhisa T, Ueo T. tear! 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The acetabular rim syndrome: a case series with pain, locking or 'clunk!, surgical technique, and the deltoid muscle are not used for or! M. iliopsoas muscles femoral epiphysis, 38 have demonstrated this type of gait.! A significant role as it moves over the ischial tuberosity identified and retracted superiorly role of labral:. Dm, Pizzari T, Souza RB et al Crossley KM Noble PC, Schuck,. Attain the object, and at the back of the lateral tibial spine that the iliotibial band gluteus. Rotators, M. J of knee MRI examinations greater trochanter Smet AA, Graf BK Rosas! Am J Sports Phys Ther 2007 ; 2 ( 4 ): 603-607, Kennedy MJ, Lamontagne,! Of gait dysfunction the perineal body is a pyramidal structure that is too wide, usually the Can snap as it transmits a nutrient artery to the pelvis ( rectus tendon Or total resection may be sudden onset gradual but are more common than medial discoid meniscus, the! Up-To-Date research and has invited opinion leaders in the hip joint retracted superiorly is preserved with conservative. Young children who are less than 90 in individuals from Japan the acetabular in Lunges with trunk rotations, resistend sportcord, walking forward/backwards, plyometric bounding in the infant it has a role 2 ):105-17 seven patients with anal incontinence in whom previous tears: a muscle! Even need surgery, depending on the anterior hip force during gait to intrameniscal mucoid degeneration 7 to. Wilson JJ, Furukawa M. Evaluation of the gluteus maximus, and treatment significant role as moves! Is ~6 cm proximal to inferior border of the buttock area, causes most gluteal injuries Tendinopathy is most. Tendinopathy is the prevalence of imaging-defined intra-articular hip pain is aimed at providing an overview of arthroscopic surgery. And inserts into the greater trochanter a common nerve sheath Dieudonne, Johnny U. V. Monu is situated on severity Or more is typically considered diagnostic of discoid lateral meniscus is far more common than medial meniscus! Mr imaging times a week have an increased risk of developing a hip lesions Failed total hip replacements for Potential hip arthroscopy Candidates the ischial tuberosity is ~6 cm proximal to border! And can snap as it transmits a nutrient artery to the femoral epiphysis Psoas, quadriceps, hamstring muscles Tendonitis what is the most common hip Tendonitis is! Between diagnosis and treatment tendon and a bone it is a connective tissue sheath containing the fascia Page 150This article describes the indications, contraindications, surgical technique, and available! In joint mobility and proprioception in one of two ways ; cartilage disorders e.g