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Lower Limb Muscles
Published in Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Handbook of Muscle Variations and Anomalies in Humans, 2022
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Malynda Williams
Articularis genus may blend with vastus intermedius (Macalister 1875; du Plessis and Loukas 2016; Standring 2016; Grob et al. 2017). Articularis genus may be reduced, absent, or divided (Macalister 1875; du Plessis and Loukas 2016). It is also variable in shape and size (e.g., DiDio et al. 1967, 1969; Toscano et al. 2004). Its insertion onto the suprapatellar bursa and the knee joint capsule can vary in its specific location (DiDio et al. 1967; Grob et al. 2017). In addition to its typical insertion into the upper portion of the synovial membrane, it can insert onto either side of the knee (Macalister 1875; du Plessis and Loukas 2016).
Hip and knee
Published in Ian Mann, Alastair Noyce, The Finalist’s Guide to Passing the OSCE, 2021
The fluid displacement test is better for smaller effusions. Again, expel fluid from the suprapatellar bursa, and gently expel fluid from the medial side of the joint. Stroke the lateral side of the joint and observe the medial aspect for fluid filling.
Examination of Knee Joint in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
There are several bursae around the knee (Figure 10.4). The semimembranosus bursa lies between the medial head of the gastrocnemius muscle and the knee joint capsule. The overlying gastrocnemius and semimembranosus muscle may compress the communication of this bursa to the joint resulting in a one-way valve mechanism. The resulting enlargement of this bursa in diseases such as rheumatoid arthritis presents as a lump in the popliteal region (Baker’s cyst), which cannot be pushed into the joint. The suprapatellar bursa lies beneath the deep surface of the quadriceps muscle and the anterior surface of the lower femur. It may extend up to approximately 5 cm or more above the upper margin of the patella with the knee in extension. It has communication with the knee joint. The prepatellar bursa (sometimes called housemaid’s knee bursa) covers the anterior surface of the lower patella and upper patellar tendon. The infrapatellar bursa is present between the skin and the lower part of the tibial tuberosity. The bursa may get enlarged and inflamed in children who keep their knees flexed and have predominant floor-sitting. The pes anserine (also known as subsartorial) bursa is present on the medial aspect of the tibial tubercle beneath the tendinous insertion of the sartorius, gracilis, and semitendinosus.
In response to: Ersatz ultrasonographic measurements for the knee joint
Published in The Physician and Sportsmedicine, 2019
Myriam D. Stern, Itzhak Siev-Ner, Shay Tenenbaum, Alexander Blankstein, Aviva Zeev, Nili Steinberg
1. Unfortunately, it was not clearly clarified in the “materials and methods” that while US examination of the trochlea was evaluated in full knee flexion (with 110 knee flexion) (see Figure 1(a)), the evaluation of the anterior, medial and lateral ligaments of the knee and of the intra-articular effusion in the supra patellar bursa was performed in mild flexion. That was performed with a 14.5 cm diameter cylinder placed under the knee as shown in Figure 1(b), corresponding to knee flexion of about 25 (and not in a 110-degree flexion as erroneously written). We regret this unintentional omission. The squeeze/shift effect is well recognized. This knee flexion is routinely used in clinical practice for this purpose [3], allowing for stretching of the extensor mechanism without squeezing the suprapatellar bursa.
Is synovitis detected on non-contrast-enhanced magnetic resonance imaging associated with serum biomarkers and clinical signs of effusion? Data from the Osteoarthritis Initiative
Published in Scandinavian Journal of Rheumatology, 2018
LA Deveza, VB Kraus, JE Collins, A Guermazi, FW Roemer, MC Nevitt, DJ Hunter
MRIs of all participants in the FNIH OA Biomarkers Consortium study were scored paired and unblinded to time-point using the MRI Osteoarthritis Knee Score (MOAKS) method at baseline, and 12 and 24 months (23). According to MOAKS, synovitis is assessed semi-quantitatively using two different markers: Hoffa synovitis and effusion synovitis. Hoffa synovitis has been used as a proxy for synovitis as it was found to be correlated to chronic synovitis on histology (24), although its specificity was low compared to CE MRI (25). It is defined as a diffuse hyperintense signal on T2-, proton-density, or intermediate-weighted fat-suppressed sequences within the Hoffa’s fat pad, and is scored on sagittal images. A score was given for assessment of degree of hyperintensity in Hoffa’s fat pad: 0 = normal; 1 = mild; 2 = moderate; 3 = severe. Effusion synovitis represents a composite of effusion and synovial thickening and was determined by the presence and amount of intra-articular hyperintensity on axially reformatted dual echo at steady state (DESS) and sagittal intermediate-weighted fat-suppressed images. Effusion synovitis was scored based on maximum distension of the synovial capsule due to intra-articular joint fluid: 0 = physiological amount; 1 = small – fluid continuous in the retropatellar space; 2 = medium – with slight convexity of the suprapatellar bursa; 3 = large – evidence of extensive capsular distension. Changes in Hoffa and effusion synovitis were calculated as the difference between each synovitis score at 12 and 24 months and the respective score at baseline, and further classified into improvement, no change, or worsening.
Ultrasonography findings and physical examination outcomes in dancers with and without patellofemoral pain
Published in The Physician and Sportsmedicine, 2018
Itzhak Siev-Ner, Myriam D Stern, Shay Tenenbaum, Alexander Blankstein, Aviva Zeev, Nili Steinberg
In the anterior part of the knee: Effusion in suprapatellar bursa (intra-articular fluid) was graded: 0 = no fluid, 1 = presence of fluid on sagittal, medial sagittal, or lateral sagittal views, with minimal width of the collection being 2 mm (see Figure 1).Quadriceps tendon (grade 0 or 1).Patellar tendon: The patellar tendon was evaluated at its insertion to the patella (proximal insertion), along the patellar tendon’s body and at its insertion to the tibia (distal insertion) (grade 0 or 1).Width of the growth plate of the anterior tibial tuberosity: Measurement of the width between osseous margins at the anterior tibial tuberosity secondary ossification center in the sagittal plane. When already closed, it is described as closed; when detached into the tendon (Osgood–Schlatter), it is described as detached (see Figure 2).Medial retinaculum at the level of the medial patellofemoral ligament (MPFL) (grade 0 or 1).Trochlear groove: The trochlear groove was entirely screened with the knee in full flexion. Trochlear groove cartilage appearance (a) was graded 0 when normal or 1 if there was at least a spot of cartilage hyper-echogenicity associated with subchondral bone irregularity. Then, a transverse view of the groove was taken in the upper part of the trochlea with the probe perpendicular to the main axis of the femur, as soon as both epicondyles were seen. On this view, bony trochlear groove angle, cartilage trochlear groove angle, bony trochlear groove depth, cartilage trochlear groove depth, and cartilage thickness were measured. Cartilage thickness was measured at the middle of each lateral and medial facet, and the smallest measurement was recorded (see Figure 3).Lateral distance between the inferior tip of the patella and trochlear groove position was measured (in millimeter) on a transverse view taken with the knee fully extended at the inferior margin of the patella, with the probe axis perpendicular to the femur axis; attention was given not to press on the patella, in order not to move it aside (see Figure 4).