The anterior approach to the hip for a minimally invasive prosthesis
K. Mohan Iyer in Hip Preservation Techniques, 2019
Digital mobilization is easy, so the tensor fascia lata can be pushed laterally. It is important that the split in the aponeurosis of this muscle be carried well proximally and distally beneath the skin, so that the retractors will not damage the muscle. A Beckmann retractor is inserted to hold the tensor, and the aponeurosis covering the rectus femoris is visualized. The rectus femoris muscle can be seen below its aponeurosis. It is possible to see three colors that identify different areas: white, red, and yellow areas representing the aponeurosis, muscle, and fat above the joint capsule, respectively. The thin aponeurosis covering the red area is incised. Here again, some hemostasis is often required. It is now possible to retract the muscle medially using the Beckmann retractor. Furthermore, placing this retractor between the lateral side of the rectus femoris and the medial side of the tensor fascia lata, an unnamed pearly aponeurosis is seen, which represents the only structure standing in the way of the capsule (Figure 28.12f).
Examination of Knee Joint in a Child
Nirmal Raj Gopinathan in Clinical Orthopedic Examination of a Child, 2021
Begin by comparing the quadriceps muscle in both limbs. The musculature should be symmetrical bilaterally. Variations may be obvious in affections, e.g., chronic post-traumatic affection of the extremity, chronic osteomyelitis femur, etc. The muscle girth can be recorded by measuring it in reference to a fixed bony landmark such as the upper pole of the patella or above the knee joint line. Look at and palpate any gaps or defects in the rectus femoris muscle and patellar tendon that feel as soft yields in these otherwise firm structures. Examine the tone of the quadriceps muscle by palpating it after asking the patient to actively contract it. The patient can be helped in this maneuver by placing a hand or rolled towel in the posterior knee region and instructing the patient to press against it. The vastus medialis component can be selectively examined by asking the patient to dorsiflex the inverted foot while attempting a knee extension. Surface electromyography (EMG) studies have shown that the muscle is facilitated by knee extension in an inverted dorsiflexed ankle. Much of the patella’s articular surface is accessible to palpation if the patella is first pushed medially and then laterally in a relaxed knee. The undersurface of the patella may be tender in chondromalacia patellae or retropatellar arthritis. Point tenderness should also be sought over the quadriceps tendon (e.g., quadriceps tendinitis), anterior surface of the patella (e.g., fractures), and lower pole (e.g., Sinding–Larsen–Johansson disease), patellar tendon (e.g., strains), and tibial tubercle (e.g., Osgood–Schlatter disease in children and adolescents).
Nina: The Use of Potent Opioids in a Complex Chronic Pain Patient
Michael S. Margoles, Richard Weiner in Chronic PAIN, 2019
Pinprick sensation testing was carried out using a pinwheel and standardizing at C4 on both sides. She had hypesthesia to pinprick in the right upper extremity at C5, C6, C7, C8, and Tl. Pinprick sensation testing in the left upper extremity was normal from C5 to Tl. In the lower extremities, on the right side there was hypesthesia to pinprick in L4, L5, and SI. On the left side, L4 and L5 were normal and there was pinprick hypesthesia at S1. The patient was then placed in the prone position and the following muscles were palpated for the presence of taut bands, tenderness, and jump signs. On both sides, there were taut bands, tenderness, and jump signs in the trapezius, sternocleidomastoids, pectoralis major, and latissimus dorsi bilaterally, with the only exception being a negative jump sign in the right pectoralis major muscle. (Note: Tenderness is reported by the patient. A taut band is found by the examiner. The jump sign is observed by the examiner and can sometimes be felt by the patient.) The jump sign is defined as an involuntary withdrawal response of the patient to a painful stimulus which comes on suddenly and is significantly painful (can be caused by physical examination or myofascial trigger point injections). Straight leg raising was 75 degrees on the right and 85 degrees on the left. On the right side, she felt tightness and pain in the posterior thigh. The rectus femoris muscle was checked for taut bands, tenderness, and jump signs bilaterally. Taut bands, tenderness, and jump signs were positive on the right side and just taut band and tenderness were present on the left side. The right knee could be passively flexed to 120 degrees and the left knee could be passively flexed to 115 degrees with the patient’s leg hanging over the edge of the table. Manual muscle testing was carried out to some muscles of the lower extremities (right/left): EHL 4/4+, ankle dorsiflexion 4+ to 5-/5-.
Comparison of the Upper and Lower Extremity and Trunk Muscle Masses between Children with Down Syndrome and Children with Typical Development
Published in Developmental Neurorehabilitation, 2022
Mitsuhiro Masaki, Seina Maruyama, Yukika Inagaki, Yukine Ogawa, Yoshino Sato, Minori Yokota, Moeka Takeuchi, Maki Kasahara, Kota Minakawa, Kana Kato, Kenji Sakaino
The rectus femoris muscle thickness was significantly lower in the DS group than in the TD group. The rectus femoris muscle performs hip joint flexion and knee joint extension and is activated not only in the stance phase of gait requiring knee extension movement but also in the initial swing, which requires a swing of the lower extremities during the walking motion.28 Delayed acquisition of independent walking29 and decreased activities in daily living30 in children with DS compared to those in children with TD leads to decreased opportunities to perform the walking motion. Furthermore, decreased activity of the rectus femoris muscle due to decreased opportunities to perform the walking motion may lead to decreased muscle thickness in children with DS. Decreased knee extensor muscle strength in children with DS compared to that in children with TD has been reported,15 a finding consistent with that of the present study showing reduced knee extensor muscle in the DS group than in the TD group, although the measurement methods in the present study (muscle thickness) differed from those in the previous study (muscle strength).
The effect of rectus femoris muscle modelling technique on knee joint kinematics: a preliminary study
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
E. Elyasi, A. Perrier, Y. Payan
A biomechanical model of the lower limb of a volunteer subject has been created in ArtiSynth which is a free 3 D modelling platform supporting the combined simulation of multibody and finite element models and provides support for both multipoint 1 D and 3 D active muscles (www.artisynth.org. . . . . . . . . . ). This model includes the joint constraining ligaments, the hamstring muscle group (biceps femoris, semimembranosus and semitendinosus) and the quadriceps femoris muscle group (rectus femoris, vastus lateralis, vastus medialis and vastus intermedius). The Rectus Femoris muscle is modelled using three different techniques. In the first case, it is modelled using a 1 D muscle model defined between the muscle insertions on the patellar and femoral bones while respecting the muscle moment arm. In the second case, it is modelled as a 1 D multipoint muscle that has to pass through multiple via points defined based on the 3 D geometry of the patient’s muscle and it can wrap around the femur bone when it comes to contact with it. In the third case, the muscle is modelled as an active 3 D FE model which is in contact with the surrounding passive muscles (assumed as rigid bodies in this preliminary study). The hamstring muscle group is modeled as 1 D in all the cases. The flexion of the joint is simulated (forward dynamics) and the kinematics of the tibiofemoral joint is compared between the three different cases to evaluate the effect of these different techniques on the kinematics.
Reliability of pressure pain, vibration detection, and tactile detection threshold measurements in lower extremities in subjects with knee osteoarthritis and healthy controls
Published in Scandinavian Journal of Rheumatology, 2018
P Jakorinne, M Haanpää, J Arokoski
QST measurements were made at three sites on the knee and thigh: (i) the bony prominence of the medial tibial condyle approximately 1 cm below the medial joint line (TDT, VDT, and PPT measurements); (ii) the medial tibiofemoral joint line approximately 1 cm medial to the patellar tendon (TDT and PPT measurements); and (iii) the rectus femoris (TDT and PPT measurements). The measurement point on the rectus femoris muscle was at the upper border of the lowest quarter section of the distance between the anterior superior iliac spine and the medial femoral condyle (5, 31) (Figure 1). The side to be tested first was randomized for each participant. The order of the testing areas was also randomized for each participant, but the measurements were repeated in the same order in the following study sessions. At the first visit, participants were given 10–15 min rest between measurements taken by each observer, which has previously been shown to be sufficient in QST (32). Participants kept their eyes closed during the testing.
Related Knowledge Centers
- Quadriceps Tendon
- Thigh
- Vastus Intermedius Muscle
- Vastus Lateralis Muscle
- Vastus Medialis
- Aponeurosis
- Patella
- Quadriceps
- Body
- Hip