Anterior superior iliac spine

The child is encouraged to lie on the table in a supine position. The older child s mid-sagittal plane should run parallel with the long axis of the examination table if the bucky is to be used. The legs should be straightened and internally rotated from the hips until both knees are supported in the AP position with the patella lying in a central position over the femoral condyles this often results in the big toes touching. The anterior superior iliac spines should be equidistant from the film to prevent rotation of the pelvis (Fig. 2.1). 

Fig. 2.1. AP pelvis and hip. Centre. Pelvis Two child s fingers width above the symphysis pubis along the mid-sagittal line. Hips at the level of the femoral pulse along the mid-sagittal line. Hip joint directly over the femoral pulse. Area imaged. Pelvis To include the iliac crests superiorly, the full width of the pelvis and the femoral greater trochanter interiorly. Hips To include the anterior superior iliac spine superiorly, the full width of the pelvis and the femoral greater trochanter interiorly. Hip To include the anterior superior iliac spine superiorly, the symphysis pubis to the lateral wall of the pelvis and the femoral greater trochanter interiorly...

Anterior superior iliac spine (ASIS) Sartorius, tensor fascia lata... 

These are incomplete fractures with no disruption of the pelvic ring. Type A1 are avulsion fractures which commonly occur in athletic teenagers. The avulsion may be from the anterior-superior iliac spine, caused by sudden contraction of Sartorious, anterior-inferior ischial spine (rectus femoris insertion), and the pubic tubercle (pectineus insertion). 

In the pelvis, avulsion occurs primarily at six sites, which not surprisingly are the sites of the major muscle attachments. The three commonest sites are the anterior superior iliac spine (ASIS) (the origin of sartorius), the anterior inferior iliac spine (AIIS) (the rectus femoris origin) and the ischial tuberosity (the origin of the hamstring group). With these fractures acutely there is a clinical history of severe exertion, followed by pain and reduced function (Wootton et al. 1990) (Fig. 12.23). 

Fig. 12.24. Sites of pelvic avulsion injuries. A, iliac crest (abdominal muscle insertion). B, anterior superior iliac spine (sartorious muscle origin). C, anterior inferior iliac spine (rectus femoris origin). D, greater trochanter (gluteal insertions). Ey Lesser trochanter (illiopsoas). F, ischial tuberosity (hamstring muscle). G, body of pubis and inferior pubic ramus (adductors and gracillis)...

Palpate the anterior superior iliac spines and note their heights and anterior posterior orientation (examiner s eyes at that level). 

Physician places one hand under the patient s heel. The physician s other hand is at the ipsi-laterai anterior superior iliac spine. 

Physician passively raises the fully extended leg off the table until rotary motion is felt at the anterior superior iliac spine. 

The physician places his hands flat on the top if the patient s iliac crests with his fingers monitoring the anterior superior iliac spines (ASIS) and his thumbs monitoring the posterior superior iliac spines (PSIS). 

Scoliosis is often discovered during a routine physical examination. It must be determined if the scoliosis is caused by a short leg (functional) or is developmental in origin (structural). A structural examination for asymmetry may yield important clues to solving the problem. A difference in leg length is estimated by measuring with a tape measure from the anterior superior iliac spine to the medial malleolus of each leg. This method is less accurate than a standing postural x-ray. 

The diagnosis of pelvic dysfunction concentrates on two aspects of the innominate the ilium and the pubic components. Generally, the landmarks of the posterior superior iliac spine (PSIS), anterior superior iliac spine (ASIS), pubic rami, and their other relative structures can give some static findings as to the diagnosis. As with other regions of the body, motion testing indicates the side of the dysfunction. 

FIG. 59-5 Relationship of anterior superior iliac spines to other pelvic structures. 

The muscle tissue of the tensor fascia lata is palpated starting at the anterior superior iliac spine (ASIS) and descending downwards for approximately 4 to 6 inches. It will feel like a firm rope and be tender to the touch when hypertonic. 

The physician s cephalad hand is placed on the patient s anterior superior iliac spine of the side to be treated. 

The hip bones give rise to many muscular attachments. Cranial to the acetabulum, the ilium also has two prominent projections on its anterior margin the anterior superior iliac spine, which may easily be visible through the skin of slender subjects, and the anterior inferior iliac spine (Fig. 12.1a). The first gives insertion to the tensor fasciae latae and sartorius, the second to the rectus femoris. Medially, the iliac fossa... 

In the superficial group, the sartorius and tensor fasciae latae arise from the anterior and lateral aspect of anterior superior iliac spine respectively (Fig. 12.2). The sartorius, the longest muscle of the human body, crosses the midline overlying the deep... 

Fig. 12.2. Anatomy of the anterior muscles and tendons of the hip. Schematic drawing of an anterior view through the hip illustrates the relationships of the anterior muscles to each other. The superficial tensor fasciae latae (Tfl) and sartorius (Sfl) arise from the anterior superior iliac spine (straight arrow). On a deeper plane, the rectus femoris (Rf) originates from the anterior inferior iliac spine (arrowhead). Observe the iliacus and the psoas muscles which join distally to insert through a common tendon onto the lesser trochanter (curved arrow). Medially to the iliopsoas tendon, the pectineus muscle (Pe) can be seen arising from the anterior aspect of the superior ramus of the pubis (Pb)...

The lateral femoral cutaneous nerve courses more lateral relative to the femoral nerve. It arises from the L2 and L3 spinal nerve roots, emerges from the lateral border of the psoas muscle and crosses the iliacus muscle passing through a tunnel formed by a small split in the lateral end of the inguinal ligament in close proximity with the anterior superior iliac spine (Fig. 12.10b). This nerve is purely sensory and supplies the skin of the anterior and lateral aspects of the thigh. 

Fig. 12.15a,b. Tensor fasciae latae muscle. Sagittal 12-5 MHz US images obtained in a healthy subject over the proximal (a) and distal (b) insertion of the tensor fasciae latae muscle (Tfl). a The proximal tendon (arrow) of the tensor fasciae latae muscle can be appreciated as it inserts into the anterior superior iliac spine (ASIS). In the same plane, the belly of the gluteus minimus (GMi) is seen deeply to the tensor fasciae latae muscle. In b, the distal myotendinous junction of the tensor fasciae latae muscle (Tfl) exhibits a typical pointed appearance as a result of the convergence of its muscle fibers into the fasciae latae (arrowheads). At this level, the muscle belly of the vastus lateralis (VL) is found between the tensor fasciae latae muscle and the femur (arrow). The photograph at the left side of the figure indicates probe positioning... 

Fig. 12.16. Lateral femoral cutaneous nerve. Transverse 12-5 MHz US image obtained over the anterior superior iliac spine (ASIS) in a healthy subject depicts the nerve (arrow) as it passes through the tunnel formed by a split in the lateral end of the inguinal ligament (arrowheads)...

After that, the probe should be positioned around the anterior inferior iliac spine. This apophysis can easily be identified as a linear bright structure with posterior acoustic shadowing, located in a more caudal and deep position relative to the anterior superior iliac spine. The direct tendon of the rectus femoris takes its origin from the anterior inferior iliac spine. A careful scanning technique based on short-... 

Fig. 12.42. Lateral femoral cutaneous neuropathy in a patient with chronic sensory symptoms irradiated over the anterolateral region of the thigh. Long-axis 12-5 MHz US image of the lateral femoral nerve (arrows) demonstrates a fusiform hypoechoic swelling (asterisks) of the nerve at the point where it crosses the anterior superior iliac spine (ASIS) below the inguinal ligament...

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