GOIC Syndrome in Skeletal Radiology!

12/10/2017

Dear Colleague:

The following paper represents positive advance for our profession.

Balius R, Susín A, Morros C, Pujol M, Pérez-Cuenca D, Sala-Blanch X. Gemelli-Obturator Complex In The Deep Gluteal Space: An Anatomic And Dynamic Study. Skeletal Radiol. 2017 Dec 7. Doi: 10.1007/s00256-017-2831-2. [epub ahead of print] pmid: 29218390

Perhaps you will remember the GOIC syndrome paper from 2005 written with Barclay Bakkum at National University of Health Sciences’ anatomy laboratory? Skeletal Radiology just published a paper referencing our paper.  I will share this as the lead paper for the December 2017 Cox Research Pearls, and I want to share it here.

Astounding when I look back historically and remember being told by Skeletal Radiology when I submitted a paper to them for publication that they only accepted high level research. Also Terry Yochum and I were both told in the 1980’s by Saunders Medical Publishers that they only published books written by doctors. Wonder how they feel about that statement today?

Anatomist Dr. Barclay Bakkum and I wrote a paper - Cox J, Bakkum B: Possible Generators Of Retrotrochanteric Gluteal And Thigh Pain: The Gemelli Obturator Internus Complex. Journal Of Manipulative And Physiological Therapeutics Volume 28 Number 7, September, 2005.  Note the following paper uses our named condition – The GOIC Syndrome – and did an ultrasound study of the anatomy. It Is Reference 25.

This paper by Balius et al studied the GOIC anatomy with ultrasound of the retrotrochanteric bursa and revealed the presence of connective tissue attaching the sciatic nerve to the structures of the gemellus-obturator system at deep subgluteal space. The amplitude of the nerve curvature during rotating position was significantly greater than during resting position. During passive internal rotation, the sciatic nerve of both cadavers and healthy volunteers transformed from a straight structure to a curved structure tethered at two points as the tendon of the obturator internus contracted downwards. Conversely, external hip rotation caused the nerve to relax. The conclusion is that the sciatic nerve is closely related to the gemelli-obturator internus complex. This relationship results in a reproducible dynamic behavior of the sciatic nerve during passive hip rotation, which may contribute to explain the pathological mechanisms of the obturator internal gemellus syndrome.

I point out that at least a chiropractic paper led to publication in a major medical journal, even though it is somewhat skewed in its course. Nevertheless, our treatment of the GOIC syndrome as delivered in didactic and hand on lecture is a great benefit in relieving sciatic pain. Perhaps these studies will direct chiropractors to study the GOIC syndrome with us.

Following is an anatomical illustration of the GOIC anatomy from Cox J, Bakkum B: Possible Generators Of Retrotrochanteric Gluteal And Thigh Pain: The Gemelli Obturator Internus Complex. Journal Of Manipulative And Physiological Therapeutics Volume 28 Number 7, September, 2005.

 
 

Submitted by James M. Cox, DC, DACBR



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