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Published online: 2024-04-03

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The double-headed accessory iliacus muscle: a case report

Marta Pośnik, Nicol Zielinska, Piotr Łabętowicz, Mariola Głowacka, Łukasz Olewnik
Pubmed: 38567939

Abstract

Purpose: Numerous accessory muscles are present in the human body, many of which are clinically significant. We present a case of an anomalous accessory iliacus composed of two heads, whose occurrence and anatomical location indicate a high probability of causing femoral nerve compression. Methods: During a routine dissection of the posterior abdominal wall of a xx-year-old cadaver, a double headed accessory muscle was noted, measured and photographed. Results: In addition to the normal anatomy of dissected structures from the posterior abdominal wall, an accessory iliacus muscle composed of superficial and deep heads was identified. In addition, the inferior roots of the divided femoral nerve located between the heads was found to follow an unusual course. Conclusions: It is important to be aware of morphological variability around structures such as double-headed accessory iliacus muscle presented in this study, due to their association with neurovascular bundles and hip joint. The reported atypical morphology is not widely known in the literature but might be of great clinical significance, therefore knowledge of such variability might be regarded in order to diagnose properly and introduce accurate treatment.

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References

  1. Aleksandrova JN, Malinova L, Jelev L. Variations of the iliacus muscle: report of two cases and review of the literature. Int J Anat Var. 2013; 6: 149–152.
  2. Babst D, Steppacher SD, Ganz R, et al. The iliocapsularis muscle: an important stabilizer in the dysplastic hip. Clin Orthop Relat Res. 2011; 469(6): 1728–1734.
  3. Battaglia PJ, Scali F, Enix DE. Co-presentation of unilateral femoral and bilateral sciatic nerve variants in one cadaver: A case report with clinical implications. Chiropr Man Therap. 2012; 20(1): 34.
  4. Bayron-Ho D, Tavarez W, Valentin-Carro N. Atypical origin of the saphenous nerve and a variation of the right iliacus muscle: a case report. Int J Cadaveric Stud Anat Var. 2023; 4(1): 44–50.
  5. Clarkson RD, Rainy H. Unusual arrangement of the psoas muscle. J Anat Physiol. 1889; 23(3): 504–506.
  6. D'Costa S, Ramanathan LA, Madhyastha S, et al. An accessory iliacus muscle: a case report. Rom J Morphol Embryol. 2008; 49(3): 407–409.
  7. Deslandes M, Guillin R, Cardinal E, et al. The snapping iliopsoas tendon: new mechanisms using dynamic sonography. AJR Am J Roentgenol. 2008; 190(3): 576–581.
  8. le Double AF. Muscles de la fosse lombo-iliaque. In: Pierre C, Dupuy CBMG. ed. Traité des variations du système musculaire de l’Homme. Tome I. Schleicher Frères, Paris 1897: 325–332.
  9. Fabrizio PA. Anatomic variation of the iliacus and psoas major muscles. Int J Anat Var. 2011; 4: 28–30.
  10. Jelev L, Shivarov V, Surchev L. Bilateral variations of the psoas major and the iliacus muscles and presence of an undescribed variant muscle--accessory iliopsoas muscle. Ann Anat. 2005; 187(3): 281–286.
  11. Khalid S, Iwanaga J, Loukas M, et al. Bilateral absence of the zygomatic nerve and zygomaticofacial nerve and foramina. Cureus. 2017; 9(7): e1505.
  12. Kokubo R, Kim K, Isu T, et al. The impact of tarsal tunnel syndrome on cold sensation in the pedal extremities. World Neurosurg. 2016; 92: 249–254.
  13. Kopsch F. Rauber’s Lehrbuch der Anatomie des Menschen. Abt. 3: Muskeln, Gefäße. Verlag von Georg Thieme, Leipzig 1914: 153–154.
  14. Koptas K, Zielinska N, Tubbs RS, et al. A newly reported muscle: an accessory infraspinatus or a deep layer of the latissimus dorsi? Surg Radiol Anat. 2022; 44(4): 617–620.
  15. Kurtys K, Gonera B, Olewnik Ł, et al. A highly complex variant of the plantaris tendon insertion and its potential clinical relevance. Anat Sci Int. 2020; 95(4): 553–558.
  16. Macalister A. Additional observations on muscular anomalies in human anatomy (third series): With a catalogue of the principal muscular variations hitherto published. Trans Roy Ir Acad. 1875; 26: 126–200.
  17. Moore KL, Dalley AF, Agur AMR. Moore's clinically oriented anatomy. Wolters Kluwer Health/Lippincott Williams, Philadelphia 2014.
  18. Olewnik Ł, Gonera B, Kurtys K, et al. "Popliteofascial muscle" or rare variant of the tensor fasciae suralis? Folia Morphol. 2021; 80(4): 1037–1042.
  19. Parker A, Olewnik Ł, Iwanaga J, et al. Iliacus minor and psoas quartus muscles traversing the femoral nerve. Morphologie. 2022; 106(355): 307–309.
  20. Philippon MJ, Devitt BM, Campbell KJ, et al. Anatomic variance of the iliopsoas tendon. Am J Sports Med. 2014; 42(4): 807–811.
  21. Rao TR, Kanyan PS, Rao S. Bilateral variation of iliacus muscle and splitting of femoral nerve. Neuroanatomy. 2008; 7: 72–75.
  22. Ruzik K, Waśniewska A, Olewnik Ł, et al. Unusual case report of seven-headed quadriceps femoris muscle. Surg Radiol Anat. 2020; 42(10): 1225–1229.
  23. Spratt JD, Logan BM, Abrahams PH. Variant slips of psoas and iliacus muscles, with splitting of the femoral nerve. Clin Anat. 1996; 9(6): 401–404, doi: 10.1002/(SICI)1098-2353(1996)9:6<401::AID-CA8>3.0.CO;2-D.
  24. Stafford MA, Peng P, Hill DA. Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management. Br J Anaesth. 2007; 99(4): 461–473.
  25. Tatu L, Parratte B, Vuillier F, et al. Descriptive anatomy of the femoral portion of the iliopsoas muscle. Anatomical basis of anterior snapping of the hip. Surg Radiol Anat. 2001; 23(6): 371–374.
  26. Tsuyoshi S, Nagahiro T. Abdominal wall muscles. In: Tubbs RS, Shoja MM, Loukas M. ed. Bergman’s comprehensive encyclopedia of human anatomic variation. Wiley-Blackwell, Chichester 2016.
  27. Tubbs RS, Oakes WJ, Salter EG. The psoas quartus muscle. Clin Anat. 2006; 19(7): 678–680.
  28. Unat F, Sirinturk S, Cagimni P, et al. Macroscopic observations of muscular bundles of accessory iliopsoas muscle as the cause of femoral nerve compression. J Orthop. 2019; 16(1): 64–68.
  29. Ward WT, Fleisch ID, Ganz R. Anatomy of the iliocapsularis muscle. Relevance to surgery of the hip. Clin Orthop Relat Res. 2000(374): 278–285.
  30. Wong TL, Kikuta S, Iwanaga J, et al. A multiply split femoral nerve and psoas quartus muscle. Anat Cell Biol. 2019; 52(2): 208–210.
  31. Zielinska N, Tubbs RS, Ruzik K, et al. Classifications of the extensor hallucis longus tendon variations: Updated and comprehensive narrative review. Ann Anat. 2021; 238: 151762.