tensor fasciae latae muscle

These typically arise in patients who lie strictly in the lateral decubitus position, often because they have severe neurological spasticity or bilateral hip flexion contractures that physically prevent them from lying flat on their back.

The classic, heavily tested reconstruction for a trochanteric ulcer is the tensor fasciae latae, or TFL, flap.

The TFL is uniquely suited because it provides a dense, durable fascial layer combined with a large skin paddle, and it sits immediately adjacent to the defect.

It can be designed in multiple geometries, a V2Y advancement, a transposition, or a hatchet flap.

What if the cavity is really deep?

If the trochanteric cavity is incredibly deep, perhaps requiring trochanteric bone resection for osteomyelitis, you might need more bulk than the TFL can provide.

In that case, you extend your dissection distally and raise a pedicled anterolateral thigh or ALT flap, incorporating a large segment of the vastus lateralis muscle to thoroughly plug the dead space.

What happens when the situation deteriorates to the absolute worst case scenario? The trochanteric ulcer goes neglected, the joint capsule is breached, and the patient develops a fulminant purulent infection of the actual hip joint.

To be taught limber, we bend in the womb-like black box, our bodies made to obey.

Humorous through the eye of a needle, gracilis on tensor fasciae latae, then lunge.

After stripping sports bra, the belief we might be more than our sweat.

I palm your silver hemostat to slot into your earlobe flesh, tiny bullet-like studs that fall through fingers.

Our muscles already have trigger points in them, especially muscles that are on all the time, like hip muscles.

So we develop these tight bands in our gluteus medius especially, and sometimes in the gluteus minimus, and sometimes in the TFL.

But the gluteus medius very much so will have lots of trigger points.

And those trigger points can be completely pain-free, maybe a little sore on palpation or if you're using a massage gun, but nothing that needs to really be addressed as an acupuncturist working with people who have trigger points and their glute medias.

And...

But I wanted to talk about the injuries that I was seeing, the muscular injuries that happened.

So one of the players had low back pain on the left side and a lot of pain on the hip and really hypertonicity in the hip area, like TFL, glute min, glute med, all had turned into a rock.

And of course, that's not flexible.

And those are innervated by the femoral nerve.

Then laterally, you have the tensor fasciae latae or TFL.

and the gluteus medius, which are innervated by the superior gluteal nerve.

Ah, I see.

So you are incising the fascia over the TFL and slipping right between those two distinct innervated territories to reach the anterior capsule of the hip joint.

So unlike a standard approach where you might be splitting a muscle belly or fully detaching a tendon from bone, you're theoretically just sliding between these intact structures.

Precisely.

In the DAA, the theoretical appeal is that you are not releasing any major muscles critical for gait or dynamic pelvic stability.