The presence of a cam deformity represents a significant risk factor for the development of hip pain. An elevated alpha angle at the 1:30 clock position and decreased internal rotation are associated with an increased risk of developing hip pain. However, not all patients with a cam deformity develop hip pain, and further research is needed to better define those at greater risk of developing degenerative symptoms.

Biopsies of metastatic tissue are increasingly being performed. Bone is the most frequent site of metastasis in breast cancer patients, but bone remains technically challenging to biopsy. Difficulties with both tissue acquisition and techniques for analysis of hormone receptor status are well described. Bone biopsies can be carried out by either by standard posterior iliac crest bone marrow trephine/aspiration or CT-guided biopsy of a radiologically evident bone metastasis. The differential yield of these techniques is unknown. Results from three prospective studies of similar methodology were pooled. Patients underwent both an outpatient posterior iliac crest bone marrow trephine/aspiration and a CT-guided biopsy of a radiologically evident bone metastasis. Samples were assessed for the presence of malignant cells and where possible also for estrogen (ER) and progesterone receptor (PgR) expression. 40 patients were enrolled. Bone marrow aspiration/trephine biopsy was completed in 39/40 (97.5%) and CT-guided biopsy was completed in 34/40 (85%) of patients. Sufficient tumor cells for hormone receptor analysis were available in 19/39 (48.8%) and 16/34 (47%) of and bone marrow aspiration/trephine and CT-guided biopsies, respectively. Significant discordance in ER and PgR between the primary and the bone metastasis was also seen. Nine patients had tissue available from both bone marrow and CT-guided bone biopsies. ER and PgR concordance between these sites was 100 and 78%, respectively. Performing studies on human bone metastases is technically challenging, with relatively low yields regardless of technique. Given resource issues and similar success rates when comparing both techniques, bone marrow examination may be utilized first and if inadequate tissue is obtained, CT-guided biopsies can then be used.

Purpose: To report a case of iliopsoas haematoma after resection of an abdominal aortic aneurysm which resulted in a lumbosacral plexopathy. Clinical features: An 81-yr-old man presented with an abdominal aortic aneurysm for aneurysmectomy and tube grafting. An epidural catheter was placed at the Ll_ 2 spinal level and combined epidural-general anaesthesia was provided for surgery, The surgery was complex and a suprarenal clamp was necessary to obtain proximal control. A continuous infusion of demerol through the epidural catheter was prescribed for postoperative analgesia. On the first postoperative day, examination revealed a paretic, pulseless right leg and he was returned to the operating room for femoral-femoral bypass. By the following day, the motor and sensory impairment had progressed to complete paralysis with loss of all deep tendon reflexes and absent sensation below L~, despite palpable pulses in the leg. ACT of the abdomen demonstrated a right iliopsoas haematoma. There was no evidence of either disc herniation or an epidural haematoma. A diagnosis of lumbosacral plexopathy secondary to a iliopsoas haematoma was made. Conclusion: Iliopsoas haematoma is a rare cause of postoperative neurological deficit following aortic vascular surgery. The haematoma results in compression of the lumbosacral neural elements and typically presents as a femoral neuropathy. The diagnosis is clinical and can be readily validated with computed tomography.Objectif: Rapporter un hEmatome du psoas-iliaque compliquE d'une plexopathie Iombosacr& survenue apt& la resection d'un anEvrisme de I'aorte abcIominale. ]~l&nents cliniques : II s'agit d'un homme de 81 ans affligE d'un anEvdsme de I'aorte abdominale programmE pour une resection d'an~vrisme avec greffe. Une association anesthEsie ~pidurale-gEnErale a ErE administrEe avec I'installation d'un catheter Epidural ~ L~_ 2. La chirurgie &ait complexe et on a dfi utiliser un clamp suprar& nal pour le contr61e proximal. EanalgEsie postopEratoire Etait assurEe par une perfusion pEridurale continue de dEmErol. Le lendemain de rintervention, rexamen rEvElait une parEsie avec absence de pouls au membre infErieur clroit nEcessitant une rEintervention pour derivation fEmoro-fEmorale. Le jour suivant, I'atteinte motrice et sensorielle droite Evoluait vers la paralysie complete avec perte de tousles reflexes tendineux profonds et absence de sensation sous le niveau L, malgrE la presence de pouls palpables ~ la jambe. Une tomographie axiale de I'abdomen dEmontrait un hEmatome du psoas-iliaque droit. On n'a pu mettre en Evidence de hernie discale ou d'hEmatome Epidural, On portait le diagnostic de plexopathie IombosacrEe secondaire ~ un hEmatome du psoas-iliaque. Conclusion : I'hEmatome du psoas-iliaque constitue une cause rare de deficit neurologique aprEs une chirurgie vasculaire majeure. I'hEmatome provoque une compression des ElEments nerveux Iombosacr& et se pr&ente typiquement comme un neuropathie fEmorale. Ce diagnostic clinique peut &re validE rapidement par tomographie axiale.

This study suggests that non-traumatic SLAC does exist. We believe that non-traumatic SLAC begins with abnormal wrist kinematics and that the dorsal radiolunate ligament restricts lunate flexion but not scaphoid flexion, leading to increased SL angles and, with years, eventual attrition of the SL ligament.