Embedded Files
2/7/2015
Knochenhauer roots
bone cutter
A funny thing happened last week when I opened my email. Got an eLetter from a second cousin I never knew (a Steiger) who had somehow seen my Chapter 240 on Grandpa Kanches where I mentioned my maternal Grandmother Olga Marie "Nana" Knockenhauer b 1893 had come from Lyck Poland. That was the emailer's great aunt. The picture above is my great grandpa Adolph Joseph Knochenhauer on my mother's side. He was born 1865 in Germany and died April 26, 1950 in Buffalo, N.Y. Emigrated 1902 married 1889 Emma Anna Deglau (Polish). I know very little about this subject.
A statue and house with notable Knochenhauer (meaning bone cutter/ butcher) [name in Lich, Hessia part of Prussia in 1901 Knochenauer Guild house in Hildesheim, Germany. Relative way back met nurse and married while injured on battlefield in Napoleonic Wars 1803-1815 according to Uncle Dick Schmidt? Hermann Knochenhauer was a butcher who served with the Hessian soldiers in our Revolutionary War.
This group I know. My grandparents Raymond "Gump" Schmidt b NY 1897-1962 (head down by rear quarter) and Olga Marie Knockenhauer b 1893 Prussia Poland (far right) at Schmidt family reunion early 1950's. I'm standing at rear of car. Lt to Rt: Joanie, Mikey, Sonny, Peg, Dale, Kathy, Terry, Gene, Millie, Gump, Carol Lee, Dick, Mom Marie Schmidt, Dale, Nana.
Brother Bill remembers going to Uncle Joe's farm ( Wellsville?) for Khochenhauer reunions with Mom.
Adolph Joseph Knochenhauer had married Emma Anna Deglau. They had ten children including Olga Marie Knockenhauer b 1893. Adolph's parents were my Great Great grandparents Joseph Knockenhauer b 1832 d1872 Germany and Wilhelmina Krieger b1836 d 1922 Germany
more bone cutting- is this in my future? this week's psychic connection or random?: I composited these images to help solve my leg problem- documentation for myself-might be useful to some. If I store on internet I'll find it better than in my paper files. I'm sort of an internet doctor. I remember when I removed an RPG from a guy's abdomen back at Fort Gordon. Wait that was somebody else.
The three white (high signal, high intensity white, high T2 weighted, fluid) blobs on my upper left thigh on this front coronal view are not supposed to be there. They cause a small swelling bump and pain to this iliopsoas muscle which raises the leg interiorly. The pain makes you think the muscles are about to break apart so you stop exercising. OK, my symptoms are minor, less than 1 of 10 pain scale and they've been there over a year. Can feel it all the while, getting out of chair, shifting clutch on the car etc. They occurred from repetitive overuse (iliopsoas syndrome) after doing a 5K race and probably walking too much 25 miles one week, on top of my usual 3 miles a day walk. I've given it intermittent rest and workout routines for a year and finally saw a doctor for what can be complex and not well understood. Never very concerned as my lower back has been a more limiting factor.
For my own edification composited a few (from the 537) to show in this view of how the synovial fluid might ooze effuse out of the hip ball and socket joint labrum engorging the bursa sacs at the muscle / tendon interface.The axial (cross section) slices show these sacs as solid white. Bursitis. Like having a bad rear main seal in a V-8 engine. It's a cheap simple part that leaks important fluid that can incapacitate the motor, but the fix can be involved and costly. Sometimes you just hope it stays a slow leak and will get you to the end of your journey. Maybe should start to take it more easy on the machinery?
I'm getting some contradictory opinions from specialists. They mean well and I'm making progress getting to the root of the problem I think. They are all about triage. I'm low priority, understandably. I'm in the upper 90% good health category of my age group, but this is inhibitory. Doctor 1 GP says probably not hernia (indirect inguinal nor femoral). Refers for MRI evaluation. Doctor 2 MRI Radiologist says all symptoms from degenerative hip. GP refers to doctor 3 Orthopedist. Orthopedist says "we don't usually evaluate for bumps on a leg"! He gives cursory 20 second look at a hand full of the two thousand dollar 537 MRI images. I've spent hours reviewing the pictures. He won't even look at an image that I think shows abnormal steel wool looking structure at interface of iliopsoas and iliofemoral ligament which covers the hip capsule, says that's for soft tissue people. I'm thinking a bone does not exist in a vacuum, there is connective tissue holding everything together. He does quick Xray. Says hip joint not degenerated, have GP check for hernia? Already did, and wasn't that purpose of MRI? I reiterate the Radiologists conclusions. Then he goes back in his office then returns and says we don't usually see the 3 white spots (bursa sacs) and refers me to doctor 4 Orthopedic pain guy for hip aspiration and injection.
So doc 4 Orthopedic pain guy listened to my concerns and responded nicely. But says the bursa are much closer to the attachment with the lower trochanter. [Not from what I can determine from the NIH]. He not sure what steel wool structure might be. He says bursa not interconnected/ communicate with hip capsule, but would believe it if I substantiated with a solid reference. He does the$2500 joint draining (from anterior) , corticosteroids procedure under fluoroscope [simple, easy & helps some] and I get anti inflammatory meds prescription. I'm saying perhaps the bursa are the problem. He says do hip first to "rule it out".
This is what I read and makes the most sense at the National Institute of Health . The bursa are interconnected with the hip capsules occurring in 15% of individuals. Their documented MRI's appear just like my images. Another source. This seems to fall in agreement with what I thought the Radiologist's evaluation was indicating. The 3 white thingies seem to be multiple ganglion cysts of the iliopsoas bursa. Maybe the corizone will clear them up. Perhaps they will need aspiration drainage / cortisone injection / or surgical removal? But you can't send the doctors a web page or images- just not their protocol.
In couple days I can feel the cortisone spreading to shrink some swelling and soften the discomfort. Leg lifts (adducted & hip flex) are less painful. Had thought it was from weakness, but seems to be more involved with the pain sensors. Time will tell. For sure, Time Wounds All Heels.
After one week the bursa lump has shrunk 50% as well as lessened pain there. I've cut exercise down 90% but added leg specific strengthening motions and stretching. There is less pain surrounding the whole hip capsule, but was that secondary issue to the iliopsoas from the beginning? Perhaps an injection into the bursa would have been the better choice initially and still may be needed. In my opinion, seems like the primary problem has been overuse of the bursa not a hip joint dysfunction per se. Why do the bursa become swollen? Does that result from irritation in the steel wool area? Is that meaningless? In the weeks ahead will try to increase exercise up to a level without pain.
After one month, virtually no walking exercise hopefully to let tissues (tendon) heal. Walk half mile on snowshoes. Pain and some swelling reoccur on left side. Right side no problem.
Side sagittal view: the white blob shouldn't be there in front of my hip ball joint. Muscle strain striations.
Steel wool like structure unknown under different MRI settings. Like your fishing reel on a backlash with the line all tangled up- yikes. Thinking maybe frayed tendon- just doesn't look right, more research. Perhaps frayed iliofemoral ligament between the iliospoas bursa and the hip capsule. Acetabular labral tears? No one seems to care to look at the MRI pictures very much except the Radiologist whose opinion is then just not given very much weight by some of the follow ups?
What is the primary cause of symptoms or is it a combination? What lead to the breakdown? Is it avoidable in the future? Do we expect too much from doctors?
Bursitis : three D overview schematic physiopedia nerve palsy
Cortisone injection with ultrasound two NIH USArmy chronic calcifitic bursa with direct cortisone injection
PT How much is too much, too little?
Arthroscopic procedure. two three four five How dysfunctional do you have to be to be a candidate?
Hip replacement. Are we all doomed to end up here? I wonder how many hog hip joints my Knochenhauer ancestors chopped off with their meat cleavers?
Think we've ruled out life threatening cancer or aneurysms for now. Like my swap drives that started this whole web book, I think we have to continually self-evaluate and reflect on where we have come from, where we are at now, in order to know where we are going.
3/25/15 6wks post cortisone. Still pain and swelling. Do more walking, stretching. Suddenly swelling shrinking, pain lessening. At 7 wks I'm isolating pain to Pectineus or Adductor Brevis via cross leg test, external leg rotation. Doing muscle specific stretch and strengthening resulting in less swelling and less pain point.
Seems like an object, blood, cyst? from ruptured bursa of iliopsoas and muscle strain trauma striations below as it attaches to femur. Also striations seen above in sagittal 9-21. Although radiologist called me and insists it's hip. Bursa inflammation can mimic joint or muscle abnormality, so why blame it on the hip joint when I tell them I have over used these muscles. Appointment with renowned orthopedist #4 in a month for second opinion.
Good 3D images of normal hip.
Obturator Internus internal hip rotation myofacial stretch
Adductor muscle origins RT pelvis
medial adductors brevis muscles
pectineus adductor rotation origin superior rambus of pubis inserts on lesser trochanter and pectineal line or linea aspera of femur dry needling pectinous
pectinous between adductor longs and iliopsoas near adductor braves
adductor brevis origin inferior ramus of pubis of tuberosity of ischium inserts lineal aspera femur
THR THA total hip replacement arthroplasty
Dr Fletcher NYORTHO THR NYORTHO MIS
HHSS Hip replacement animation anterior approach (3 to) 6 inch single incision minimally invasive surgery, cut some muscles, between tensor fascia late and sartorial. (MIS-2 two small 3inch incisions cut no muscle.) Traditional 10-12 inch cut many muscles.
Hip replacement components: Stryker acetabular components-titanium socket sleeve, polyethylene cup insert UHMWPE ultra high molecular weight polyethylene- highly cross linked polyethylene- or regular polyethlyene, femoral prosthesis-titanium (chromium-cadmium alloy). 132degree neck, 34mm head
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