val_therapeute

𝑴𝒐𝒓𝒆𝒍-𝑳𝒂𝒗𝒂𝒍𝒍é𝒆 𝑳𝒆𝒔𝒊𝒐𝒏: 𝑻𝒉𝒆 𝑻𝒓𝒐𝒄𝒉𝒂𝒏𝒕𝒆𝒓𝒊𝒄 𝑩𝒖𝒓𝒔𝒊𝒕𝒊𝒔 𝑰𝒎𝒑𝒐𝒔𝒕𝒐𝒓

​Following a heavy fall onto the hip or a severe tackle, a patient presenting with a massive, swollen lump on the side of their thigh is universally diagnosed with a severe contusion (bruise) or Greater Trochanteric Bursitis. But when the swelling persists for months and feels like a waterbed under the skin, a hidden internal degloving injury has occurred.

​Current trauma and surgical reviews emphasize that Morel-Lavallée Lesions (MLLs) are severely underrecognized in sports medicine, increasing the risk of delayed diagnosis, chronic infection, and long-term tissue necrosis.

​👉 What Is A Morel-Lavallée Lesion?

​An MLL is a closed soft tissue degloving injury. The skin on the outside looks completely intact, but internally, the tissue layers have been violently ripped apart.

​👉 Pathophysiology

​These injuries are caused by massive, tangential shearing forces (like sliding on artificial turf, a violent rugby tackle, or a blunt crush against a wall).

​This force physically separates the skin and subcutaneous fat from the underlying rigid deep fascia. This violent separation ruptures the perforating microvasculature and lymphatic channels, creating a massive internal "dead space". Because the fluid has nowhere to go, blood, lymph, and liquefied necrotic fat pool inside this cavity, eventually forming a thick, fibrous pseudo-capsule that prevents it from ever reabsorbing.

​👉 Typical Pain Distribution & Clinical Signs

​Most commonly present over the greater trochanter (hip), lateral thigh, pelvis, or prepatellar (knee) regions, perfectly mimicking standard bursitis.

​The Fluctuance Sign: The skin overlying the injury feels extraordinarily soft, "boggy," or fluctuant.

​Skin Hypermobility: Because the skin is completely unanchored from the fascia below it, the examiner can physically slide the patch of skin back and forth over the fluid cavity with disturbing ease.

​Imaging: MRI is the absolute best modality for evaluating the composition, chronicity, and extent of the encapsulated fluid cavity to differentiate it from a simple hematoma.

​👉 Evidence-Based Treatment Approaches

​Applying a standard ice pack and waiting for a massive MLL to heal will often result in a permanent, disfiguring fluid pocket.

​Conservative: Acute, small lesions caught immediately may be managed with strict, high-pressure compression wrapping or ultrasound-guided aspiration.

​Interventional: Chronic MLLs develop a fibrous capsule that essentially waterproofs the cavity. These require percutaneous sclerodesis (injecting a chemical irritant to glue the layers together), minimally invasive debridement, or open surgical excision of the capsule to permanently obliterate the dead space and allow the skin to re-adhere.

​✅ References

​Clinical Presentation, Imaging Features, and Management of Morel-Lavallee Lesions: A Scoping Review. (Published: March 2026, The American Surgeon).

𝙋𝙞𝙨𝙤𝙩𝙧𝙞𝙦𝙪𝙚𝙩𝙧𝙖𝙡 𝙅𝙤𝙞𝙣𝙩 𝘼𝙧𝙩𝙝𝙧𝙞𝙩𝙞𝙨: 𝙏𝙝𝙚 𝙁𝘾𝙐 𝙏𝙚𝙣𝙙𝙞𝙣𝙤𝙥𝙖𝙩𝙝𝙮 𝙄𝙢𝙥𝙤𝙨𝙩𝙤𝙧

​Deep, aching pain on the pinky-side (ulnar aspect) of the palm that worsens when chopping vegetables or swinging a racket is constantly misdiagnosed as Flexor Carpi Ulnaris (FCU) tendinopathy or a Triangular Fibrocartilage Complex (TFCC) tear. But when eccentric wrist curls make the pain sharper, a tiny, hidden joint is undergoing mechanical bone-on-bone destruction.

​Recent hand surgery literature highlights that Pisotriquetral Joint dysfunction is a massively overlooked etiology of ulnar-sided wrist pain, trapping patients in useless tendon rehabilitation when the true pathology is articular.

​👉 What Is Pisotriquetral Joint Arthritis?

​It is a highly localized, degenerative (or inflammatory) condition of the articulation between the pisiform bone and the triquetrum bone in the wrist.

​👉 Pathophysiology

​The pisiform is unique; it is a sesamoid bone embedded entirely within the Flexor Carpi Ulnaris (FCU) tendon.

​During forceful wrist flexion and ulnar deviation, the FCU tendon violently contracts. This massive contraction drives the pisiform backward, grinding its cartilage directly into the triquetrum bone. Over time, or due to rare inflammatory conditions like synovial chondromatosis, this repetitive shear force shreds the cartilage between the two bones, resulting in localized osteoarthritis.

​👉 Typical Pain Distribution & Clinical Signs

​Deep, localized pain precisely over the volar-ulnar aspect (the fleshy base of the palm, just below the pinky).

​The Pisiform Shear Test: The clinician stabilizes the patient's wrist in a neutral position, grasps the pisiform bone firmly with their thumb and index finger, and forcefully rocks it back and forth against the triquetrum. A positive test elicits a sharp, grinding pain and noticeable crepitus (bone-grinding).

​The Tendon Differentiator: Because the pain occurs during FCU contraction, it is almost always mistaken for tendinitis. However, in true FCU tendinopathy, the tendon above the wrist joint is tender. In pisotriquetral arthritis, the tendon is fine, but the bone itself is exquisitely painful when shifted.

​👉 Evidence-Based Treatment Approaches

​Strengthening the FCU tendon will only drive the arthritic pisiform harder into the triquetrum, accelerating the cartilage wear.

​Conservative: Immobilization in a wrist splint positioned in 30 degrees of flexion (to completely slacken the FCU tendon and mechanically un-weight the joint) combined with localized anti-inflammatories.

​Interventional: Fluoroscopy or ultrasound-guided corticosteroid injections directly into the pisotriquetral joint can provide profound diagnostic and therapeutic relief. If pain is severely recalcitrant, a surgical pisiformectomy (complete excision of the pisiform bone) permanently cures the arthritis while surprisingly preserving the full strength and function of the FCU tendon.

​✅ References

​Pisotriquetral synovial chondromatosis: a rare inflammatory presentation. (Published: July 2026, Journal of Hand and Microsurgery).

​Etiologies of Wrist Arthritis in the Young Patient. (Published: May 2026, Hand Clinics).

𝗢𝗯𝘁𝘂𝗿𝗮𝘁𝗼𝗿 𝗜𝗻𝘁𝗲𝗿𝗻𝘂𝘀 / 𝗚𝗲𝗺𝗲𝗹𝗹𝗶 𝗖𝗼𝗺𝗽𝗹𝗲𝘅 𝗦𝘆𝗻𝗱𝗿𝗼𝗺𝗲: 𝗧𝗵𝗲 𝗣𝗶𝗿𝗶𝗳𝗼𝗿𝗺𝗶𝘀 𝗜𝗺𝗽𝗼𝘀𝘁𝗼𝗿

​Deep gluteal pain radiating down the back of the leg is almost universally labeled as Piriformis Syndrome or L5–S1 radiculopathy. But when traditional piriformis stretches (hip flexion with adduction) yield zero progress, a lower, deeper rotator complex is trapping the sciatic nerve against the ischial pelvis.

​Recent laterature of deep gluteal space literature shows that the Obturator Internus (OI) and Gemelli muscles account for a substantial percentage of non-piriformis sciatic nerve entrapments.

​👉 What Is OI-Gemelli Complex Syndrome?

It is a sciatic nerve compression disorder occurring lower in the deep gluteal space, specifically at the level of the lesser sciatic notch where the Obturator Internus muscle and the superior/inferior gemelli frame the nerve.

​👉 Pathophysiology

The tendon of the Obturator Internus makes a dramatic 90-degree right-angle turn over the lesser sciatic notch, acting like a pulley. Chronic overuse, pelvic floor dysfunction, or trauma causes spasm or hypertrophy in the OI muscle belly and inflammation in its underlying bursa. As the sciatic nerve passes directly over this pulley, it is dynamically compressed or frictionally sheared against the bony ischial rim during seated or rotated movements.

​👉 Typical Pain Distribution & Clinical Signs

​Deep, painful focal tenderness located lower than the piriformis muscle—specifically over the lesser sciatic notch (medial to the ischial tuberosity).

​Seated Internal Rotation Test: Pain and paresthesia are provoked when performing passive internal rotation while sitting in 90 degrees of hip flexion (putting the OI tendon under maximal stretch and pressing it against the nerve).

​Active External Rotation: Resisted active external rotation in a seated position reproduces the deep gluteal ache as the contracture clamps down on the adjacent sciatic nerve.

​👉 Evidence-Based Treatment Approaches

​Conservative: Targeted dry needling or manual release of the deep gluteal rotators, accompanied by pelvic floor motor control retraining to reduce hypertonicity in the deep hip rotators.

​Interventional: Diagnostic/therapeutic ultrasound-guided anesthetic or corticosteroid injection into the obturator internus bursa. If recalcitrant, endoscopic release of the obturator internus tendon restores sciatic nerve mobility.

​✅References

​Deep Gluteal syndrome: An underestimated cause of posterior hip pain. (Published: February 2024, Turkish Journal of Physical Medicine and Rehabilitation).

𝐅𝐚𝐛𝐞𝐥𝐥𝐚 𝐒𝐲𝐧𝐝𝐫𝐨𝐦𝐞: 𝐓𝐡𝐞 𝐏𝐨𝐬𝐭𝐞𝐫𝐨𝐥𝐚𝐭𝐞𝐫𝐚𝐥 𝐂𝐨𝐫𝐧𝐞𝐫 𝐈𝐦𝐩𝐨𝐬𝐭𝐨𝐫

​Posterolateral knee pain in runners and cyclists is routinely diagnosed as an LCL sprain or IT Band Syndrome. But when the knee joint line is pristine and foam rolling yields zero relief, a tiny sesamoid bone embedded in the calf tendon is grinding against the thigh bone.

​Recent sports surgery literature highlights Fabella Syndrome as an under-recognized mechanical driver of posterolateral knee pain and common peroneal nerve irritation.

​👉 What Is Fabella Syndrome?

It is a painful posterolateral knee condition caused by the mechanical friction or impingement of a fabella—a congenital sesamoid bone embedded within the lateral head of the gastrocnemius muscle—against the posterior lateral femoral condyle.

​👉 Pathophysiology

Present in approximately 10% to 30% of the population, the fabella normally glides harmlessly. However, under high-volume knee flexion-extension cycles, the fabella compresses the underlying articular cartilage of the lateral femoral condyle. This creates micro-grooving, localized osteoarthritis, and in severe cases, directly pinches the adjacent common peroneal nerve as it wraps around the fibular neck.

​👉 Typical Pain Distribution & Clinical Signs

​Focal Posterolateral Pain: Exquisite tenderness isolated to the posterior aspect of the lateral femoral condyle (distinct from the LCL or lateral joint line).

​Extension-Flexion Catching: A painful "catching" or grinding feeling during full knee extension or loaded deep knee flexion.

​Peroneal Nerve Symptoms: Occasional radiating numbness or burning down the dorsum of the foot if the fabella mechanically impinges the nerve.

​👉 Evidence-Based Treatment Approaches

​Conservative: Manual mobilization of the fabella, targeted gastrocnemius lengthening, and biomechanical footwear modifications to reduce posterolateral loading.

​Interventional: Local anesthetic/corticosteroid injections into the fabella-femoral articulation. If conservative care fails over 6 months, arthroscopic or open fabellectomy (surgical excision of the sesamoid) provides definitive pain relief without compromising calf function.

​✅ References

​Treatment of Fabella syndrome with arthroscopic fabellectomy: A case report and literature review. (Published: December 2021, Orthopaedics & Traumatology: Surgery & Research) .

​Open Excision of a Painful Fabella. (Published: March 2022, Arthroscopy Techniques) .

​Fabella Syndrome and Common Peroneal Neuropathy following Total Knee Arthroplasty. (Published: September 2021, Case Reports in Orthopedics) .

MERIDIANTERAPI – EN BALANCEMETODE. 18.-20.november med opfølgningsdag den 13. januar.
Når meridianerne går fra at være en forståelsesmodel til at være aktive kræfter i genopretningen af balance
Vi spejler meridianerne og vi spejler Dr. Tan´s akupunktur metode og forståelse til anvendelse på fødderne for dermed at give mulighed for hurtig og effektiv understøttelse af din zoneterapi. Kurset er åbent for alle zoneterapeuter, og passer desuden perfekt som overbygning til din uddannelse som Muskulær Zoneterapeut.
Billedet herunder illustrerer GB´s meridian spejling til foden. Meridianen giver en forklaring på hvorfor den har så stor indflydelse på hoften og musklerne i området. Bemærk forløb over Gluteus Maximus, Medius og over hofterotatorerne herunder Pirifomis. Bemærk også det indre forløb til Sacroiliacaleddet.
In English below…
The image illustrates the meridian mirroring of GB to the foot. The meridian provides an explanation for why it has such a strong influence on the hip and muscles in the area. Note the course passing Gluteus Maximus, Medius and the hip rotators including the Pirifomis. Also note the internal course of the GB to the Sacroiliac joint.

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