VASTUS LATERALIS MUSCLE IMBALANCE in PATELLOFEMORAL PAIN SYNDROME (PFPS) PATIENTS a Thesis Submitted

Total Page:16

File Type:pdf, Size:1020Kb

VASTUS LATERALIS MUSCLE IMBALANCE in PATELLOFEMORAL PAIN SYNDROME (PFPS) PATIENTS a Thesis Submitted VASTUS MEDIALIS OBLIQUE – VASTUS LATERALIS MUSCLE IMBALANCE IN PATELLOFEMORAL PAIN SYNDROME (PFPS) PATIENTS A thesis submitted to the University of Manchester for the degree of the Doctor of Philosophy in the Faculty of Medical & Human Sciences 2013 Panagiotis Nikolaos Trigkas School of Medicine List of Contents Page 1 Title page 2 List of contents 3 Table of contents 8 Table of tables 15 Table of figures 16 Abstract 17 Declaration of Authorship and Copyright 18 Acknowledgements 19 Dedication 20 The Text ii Table of Contents 1. INTRODUCTION ............................................................................................................. 2 1.1. PATELLAR TRACKING AND PATELLOFEMORAL PAIN ............................................................. 4 1.2. QUADRICEPS FEMORIS MUSCULAR DYSFUNCTION AND PATELLAR TRACKING ........................ 5 1.3. PHYSIOTHERAPY TREATMENT FOR PFPS ............................................................................. 6 2. THE PATELLOFEMORAL JOINT ....................................................................................... 9 2.1. ANATOMY OF THE PATELLOFEMORAL JOINT ....................................................................... 9 2.1.1. The patella and the femoral trochlea .......................................................... 9 2.2. ANATOMY OF THE QUADRICEPS FEMORIS MUSCLE ........................................................... 11 2.2.1. Anatomy of Vastus Medialis and Vastus Lateralis ...................................... 13 2.3 PHYLOGENETICAL EVOLUTION OF THE VASTUS MEDIALIS AND VASTUS LATERALIS ................ 18 2.4 BIOMECHANICS ............................................................................................................. 18 2.4. 1 Patellofemoral joint reaction forces ............................................................ 19 2.4. 2 Patellofemoral joint contact areas ............................................................ 21 2.4. 3 Quadriceps angle – Q angle ....................................................................... 22 3. PATELLOFEMORAL PAIN SYNDROME ......................................................................... 26 3.1 NOMENCLATURE............................................................................................................ 26 3.2 PREVALENCE & CHARACTERISTICS ................................................................................... 27 3.3 CONTRIBUTING FACTORS OF PFPS AETIOPATHOGENESIS ................................................... 30 3.3.1 Muscular Dysfunction .................................................................................... 31 3.3.2 Structural and Postural Alterations of the Lower Extremity ......................... 38 4. BACKGROUND LITERATURE REVIEW ........................................................................... 42 4.1.1 Review Search Strategy ................................................................................ 42 4.1.2 DETERMINING THE QUALITY OF THE PAPERS REVIEWED ............................... 43 4.1.3 IMPLICATIONS OF THE MODIFICATION OF THE QUALITY SCALE .................. 46 4. 1. 4 INTRARRATER RELIABILITY OF THE QUALITY RATING .................................... 47 4.2 STUDIES IN RELATION TO VMO-VL AMPLITUDE & RATIO IN PFPS PATIENTS .......................... 48 4. 2.1 STUDIES IN FAVOUR OF VMO-VL AMPLITUDE & RATIO MUSCLE IMBALANCE IN PFPS PATIENTS ..................................................................................................... 48 iii 4.2.2 STUDIES NOT IN FAVOUR OF VMO-VL AMPLITUDE & RATIO MUSCLE IMBALANCE IN PFPS PATIENTS ................................................................................ 54 4.2. STUDIES IN RELATION TO VMO – VL ONSET TIME & REFLEX RESPONSE IN PFPS .................. 63 PATIENTS ............................................................................................................................. 63 4.2.1 STUDIES IN FAVOUR OF VMO-VL ONSET TIME & REFLEX RESPONSE MUSCLE IMBALANCE IN PFPS PATIENTS ................................................................................ 63 3.3.2 STUDIES NOT IN FAVOUR OF VMO-VL TIME ONSET & REFLEX RESPONSE MUSCLE IMBALANCE IN PFPS PATIENTS ................................................................. 69 IMBALANCE IN PFPS PATIENTS ............................................................................................... 74 4.4.1 STUDIES IN FAVOUR OF VMO-VL FATIGUE CHARACTERISTICS MUSCLE IMBALANCE IN PFPS PATIENTS ................................................................................ 74 4.4 DOES THE VMO – VL MUSCLE IMBALANCE EXIST? ........................................................... 76 4.4.1 METHODOLOGY ............................................................................................. 77 4.4.2 MEASURES AND CLINICAL SIGNIFICANCE .................................................... 81 4.4.3 SAMPLE SIZE & HOMOGENEITY ..................................................................... 83 4.4.4 ANATOMICAL AND BIOMECHANICAL CHARACTERISTICS .......................... 85 4.4.5 Summary ........................................................................................................ 86 5. OVERVIEW OF THE QUADRICEPS FEMORIS MUSCULAR PERFORMANCE OF THE HEALTHY POPULATION ................................................................................................... 88 5.1 INTRODUCTION .............................................................................................................. 88 5.2 RESULTS OF THE CONTROL HEALTHY SUBJECTS OF THE REVIEWED PFPS STUDIES 94 5.3 DOES THE VMO-VL MUSCLE IMBALANCE ALSO EXIST IN THE HEALTHY POPULATION? ................................................................................................................. 97 6. AIM – HYPOTHESIS – OBJECTIVES – EXPERIMENTAL DESIGN .................................. 103 6.1 AIM OF THE STUDY ................................................................................................... 103 6.2 OBJECTIVES: ............................................................................................................ 103 6.3 NULL HYPOTHESES TO TEST OBJECTIVE 1: .............................................................. 104 6.3.1 PLAN OF INVESTIGATIONS & PROCEDURES ................................................ 104 6.3.2 EXPERIMENTAL DESIGN TO TEST OBJECTIVE 1 ............................................. 107 6.4 NULL HYPOTHESES TO TEST OBJECTIVE 2 ............................................................... 117 6.4.1 EXPERIMENTAL DESIGN TO TEST OBJECTIVE 2 ............................................. 117 iv 6.5 NULL HYPOTHESES TO TEST OBJECTIVE 3 ............................................................... 128 6.5.1 EXPERIMENTAL DESIGN TO TEST OBJECTIVE 3 ............................................. 128 7. STUDY I: MEASURES OF MUSCLE FUNCTION ............................................................ 133 7.1 DESCRIPTIVE STATISTICS OF THE SUBJECTS ....................................................................... 133 7.2 OVERALL MUSCULAR PERFORMANCE ANALYSIS .............................................................. 133 7.3 OVERALL MUSCULAR PERFORMANCE ANALYSIS BY TASK .................................................. 137 7.3.1 Functional tasks ........................................................................................... 137 7.3.2 Experimental tasks ....................................................................................... 154 8. STUDY II: MEASURES OF CLINICAL SYMPTOMS ........................................................ 163 8.1 ASSESSMENT OF PAIN AND FUNCTION ............................................................................ 163 8.1.1 Overall assessment of pain, duration of symptoms and function ........... 163 8.1.2 Correlations of the pain level with measures of muscle function ............ 166 8.1.3 Correlations of the duration of symptoms with measures of muscle function ................................................................................................................. 172 8.1.4 Correlations of the Anterior Knee Pain Scale (AKPS) score with measures of muscle function ................................................................................................ 175 8.2 ASSESSMENT OF MUSCULAR FLEXIBILITY ........................................................................... 180 8.3 ASSESSMENT OF BIOMECHANICAL CHARACTERISTICS ...................................................... 183 9. STUDY III: REPETETIVE LOAD TASKS ........................................................................... 186 9.1 OVERALL MUSCULAR ANALYSIS PERFORMANCE OF THE REPETITIVE LOADS TASK .................. 186 9.1.1 Time onset differences ................................................................................ 186 9.1.2. VMO & VL normalised EMG RMS amplitude ............................................ 188 10. DISCUSSION ............................................................................................................ 191 10.1 NOVELTY CHARACTERISTICS ........................................................................................ 191 10.2 SYNOPSIS OF THE FINDINGS ......................................................................................... 192 10.3 CLINICAL IMPLICATIONS OF THE FINDINGS .................................................................... 195 10.4 LIMITATIONS OF THE STUDY & RECOMMENDATIONS FOR FUTURE RESEARCH ...................... 200 10.5 CONCLUSIONS .........................................................................................................
Recommended publications
  • An Intramuscular Injection Is an Injection Given Directly Into The
    Depo Lupron and Testosterone are both given by intramuscular injection. The following is a guideline on their administration. Eileen Durham, RN, NP Version 12 Jan 2010 Description Intramuscular (IM) injections are given directly into the central area of selected muscles. There are a number of sites that are suitable for IM injections; there are three sites that are most commonly used in this procedure described below. The volume of viscosity of the medication to be injected determines the site that should be used. IM injections cause stretching of the muscle fiber so the larger the muscle used the less discomfort. Intramuscular Injection Sites Depo Lupron Depo Lupron 3 month preparation should only be injected into the Gluteus medius due to the viscosity and volume of the medication approx. 1.5 – 2 cc. Depo Lupron 1 month preparation can be injection into the vastus lateralis or the gluteus medius. Testosterone Testosterone administered to adolescents and adults can be injected into any of the sites listed below, as long as the volume is 1 cc or less. For a volume of 1.5 use the vastus lateralis or Gluteus medius, if the volume is 2 cc you must you the largest muscle the Gluteus medius. If the volume is greater then 2 cc you must divide the dose and give 2 injections as the maximum volume in the Gluteal muscle is 2 cc. Testosterone administered to infants and toddlers use only the anteriolateral aspect of the thigh. Deltoid muscle The deltoid muscle located laterally on the upper arm can be used for intramuscular injections.
    [Show full text]
  • Vastus Medialis: a Reappraisal of VMO and VML
    J. Phys. Ther. Sci. 24: 475–479, 2012 Vastus Medialis: a Reappraisal of VMO and VML EMILY J SKINNER1), PHILIP J ADDS1) 1) Division of Biomedical Sciences (Anatomy), St. George’s, University of London: Cranmer Terrace, London SW17 0RE, U.K. TEL: +44 208-7255208, E-mail: [email protected] Abstract. [Purpose] The morphology and innervation pattern of the vastus medialis (VM) were investigated to determine if there was an anatomical distinction between the oblique (VMO) and longus (VML) parts. [Subjects and Methods] Forty lower limbs were dissected. The innervation pattern was observed in 39 specimens. Muscle length and fibre angles of 14 specimens were recorded. [Results] In 22 specimens there was a distinct separation between the VML and VMO (change in fibre angle, fibrofascial plane, vasculature or nerve branch). The mean fibre angle of VMO was 52°, and the mean VML fibre angle was 5° (relative to the shaft of the femur). Ten limbs (25.6%) had separate innervation to the VML. The separation between VMO and VML was found to be more proximal than expected, with the VMO on average accounting for 70% of the VM, in contrast to the much more distal point of separation reported elsewhere, leading us to raise the possibility that VML and vastus intermedius may have been misidentified in some previous studies. [Conclusions] In conclusion the VML/VMO division (when present) is much more proximal than has been previously reported, and there is no consistent pattern of innervation to the two parts of the muscle. Key words: Fibre angle, Vastus medialis, VML, VMO (This article was submitted Nov.
    [Show full text]
  • Bacterial Meningitis and Multiple Abscess Formation in the Iliopsoas
    Yamada et al. Renal Replacement Therapy (2018) 4:22 https://doi.org/10.1186/s41100-018-0163-x CASEREPORT Open Access Bacterial meningitis and multiple abscess formation in the iliopsoas, erector spinae, and vastus lateralis muscle in a maintenance hemodialysis patient treated with continuous epidural anesthesia for herpes zoster-related pain control: a case report and review of the literature Shunsuke Yamada1, Narihito Tatsumoto1, Noriko Nakamura1, Kosuke Masutani1, Toshiro Maeda2, Takanari Kitazono1 and Kazuhiko Tsuruya1,3* Abstract Background: Infection is the second leading cause of mortality in patients who undergo maintenance hemodialysis. In this population, impairment in both cellular and humoral immunity contributes to the increased incidence of infection and infection-related hospitalization. However, these artificial devices occasionally enhance the risk of deep organ infection including muscle abscess, frequently leading to disability and mortality in hemodialysis patients. Case presentation: A 54-year-old male undergoing maintenance hemodialysis was hospitalized because of the acute onset pain in the back and bilateral legs and declining consciousness which started at 7 days after the treatment of herpes zoster-related neuralgia with continuous epidural anesthesia. Physical examination revealed purulent discharge from the insertion site of the catheter. Serum biochemical tests showed increased inflammatory response and malnutrition. Magnetic resonance imaging revealed meningitis and multiple abscesses in the iliopsoas, erector spinae, gluteus medius, and vastus lateralis muscles, where conventional antibiotic treatment often fails to cure. Staphylococcus aureus was detected in the cerebrospinal fluid. Combination of intravenous antibiotics treatment and aggressive open surgical drainage of the muscle abscesses finally cured meningitis and multiple deep muscle abscesses in this patient.
    [Show full text]
  • Applications of the Pedicled Vastus Lateralis Flap for Patients with Complicated Pressure Sores
    Spinal Cord (1997) 35, 437 ± 442 1997 International Medical Society of Paraplegia All rights reserved 1362 ± 4393/97 $12.00 Applications of the pedicled vastus lateralis ¯ap for patients with complicated pressure sores AB Schmidt1, G Fromberg1 and M-H Ruidisch2 1Abt. fuÈr Plastische-, Hand-, Kiefer- und rekonstruktive Mikrochirurgie, BG Unfallklinik Murnau; 2Abt. fuÈr RuÈckenmark- und WirbelsaÈulenverletztungen, BG Unfallklinik Murnau, Germany The vastus lateralis muscle- or musculocutaneous ¯ap is a well established tool in the surgery of pressure sores of the pelvic region. Its size, its constant large axial vascular pedicle originating from the lateral circum¯ex femoral artery, and its ability to carry quite a large skin island from the distal lateral region of the upper thigh makes this ¯ap a very versatile one in the management of dicult situations. The vastus lateralis ¯ap allows the simultaneous closure of defects in the trochanteric and sacral region, a technique which has not been described previously. A pedicled vastus lateralis ¯ap may be the only remaining local salvage procedure for defects due to obstruction of internal and external iliac arteries and aortobifemoral bypass surgery. This is another application which has not yet been described in the medical literature. The outcome of a series of 38 vastus lateralis ¯aps and the complications are shown. The follow-up period ranged from 3 months to 4 years. One ¯ap was lost. More complications were seen at the donor site than at the reconstructed defect. In patients who may be able to walk or stand at a later date, potential impairment of these functions has to be considered.
    [Show full text]
  • Muscle Activation and Kinematic Analysis During the Inclined Leg Press Exercise in Young Females
    International Journal of Environmental Research and Public Health Article Muscle Activation and Kinematic Analysis during the Inclined Leg Press Exercise in Young Females Isabel Martín-Fuentes 1 , José M. Oliva-Lozano 1 and José M. Muyor 1,2,* 1 Health Research Centre, University of Almería, 04120 Almería, Spain; [email protected] (I.M.-F.); [email protected] (J.M.O.-L.) 2 Laboratory of Kinesiology, Biomechanics and Ergonomics (KIBIOMER Lab.), Research Central Services, University of Almería, 04120 Almería, Spain * Correspondence: [email protected]; Tel.: +34-950214429 Received: 24 October 2020; Accepted: 20 November 2020; Published: 23 November 2020 Abstract: Knee joint muscle activation imbalances, especially weakness in the vastus medialis oblique, are related to patellofemoral pain within the female population. The available literature presents the leg press as an exercise which potentially targets vastus medialis oblique activation, thus reducing imbalances in the quadriceps muscles. The main aim of the present study was to compare thigh muscle activation and kinematic parameters under different conditions during the inclined leg press exercise in a young female population. A cross-sectional study was conducted on 10 young, trained females. Muscle activation of the vastus medialis oblique, vastus lateralis, rectus femoris and gluteus medialis was analyzed under five different inclined leg press conditions, modifying the feet rotation (0–45◦ external rotation) and the stance width (100–150% hip width) on the footplate. All the conditions were performed at two different movement velocities: controlled velocity (2” eccentric–2” concentric) and maximal intended velocity. Mean propulsive velocity, maximum velocity and maximum power were also assessed. The results show that both controlled velocity conditions and maximal intended velocity conditions elicited a similar muscle activation pattern with greater activation during the concentric phase (p < 0.001, ηp2 = 0.96).
    [Show full text]
  • The Role of and Relationship Between Hamstring and Quadriceps Muscle Myofascial Trigger Points in Patients with Patellofemoral Pain Syndrome
    The role of and relationship between Hamstring and Quadriceps muscle myofascial trigger points in patients with patellofemoral pain syndrome. By Karen Louise Frandsen Smith A mini-dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic at the Durban University of Technology I, Karen Louise Frandsen Smith, declare that this dissertation is representative of my own work in both conception and execution (except where acknowledgements indicate to the contrary). _______________________ ________________ Karen Louise Frandsen Smith Date Approved for Submission _______________________ ________________ Dr Brian Kruger (supervisor) Date M. Tech. Chiro., C.C.S.P. Dedication I dedicate this work to everyone who loves me and have supported me throughout these years of studying and all the difficult times. It is thanks to you that I have reached my dream. Dad, you would be so proud. i Acknowledgements Thank you to the DUT staff, patients, and supervisor, Dr Brian Kruger for making this happen. Thanks to my class mates for making the years fly by, and creating lifelong memories. This dissertation would not have been completed without supportive, generous and helpful people. Special thanks to you, Dr Danella Lubbe for motivating me and thank you so much Dr Charmaine Korporaal for “picking me up” and helping me finish. Endless gratitude goes to you Damon, Cherine, Mom and Viggo. You are / were all my anchors in the storm, and without your belief in me, I would be nowhere. ii Abstract Purpose: Patellofemoral Pain Syndrome is a common condition in all age groups, with a multi- factorial etiology.
    [Show full text]
  • Quadriceps and Hamstrings Coactivation in Exercises Used in Prevention And
    bioRxiv preprint doi: https://doi.org/10.1101/574210; this version posted March 11, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license. 1 Quadriceps and hamstrings coactivation in exercises used in prevention and 2 rehabilitation of hamstring strain injury in young soccer players 3 Gonzalo Torres1¶; David Chorro1¶; Archit Navandar2¶; Javier Rueda1¶; Luís 4 Fernández3¶; Enrique Navarro1*¶ 5 6 1Faculty of Sport Sciences, Universidad Politécnica de Madrid, Madrid, Madrid, Spain. 7 2Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Madrid, Spain. 8 3Medical Services of Atlético de Madrid, Club Atlético de Madrid, Madrid, Madrid, 9 Spain. 10 11 12 *Corresponding author 13 E-mail: [email protected] (EN) 14 15 ¶These authors contributed equally to this work. 16 17 18 19 20 21 22 23 24 bioRxiv preprint doi: https://doi.org/10.1101/574210; this version posted March 11, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license. 25 Abstract 26 This study aimed to study the co-activation of hamstring-quadriceps muscles 27 during submaximal strength exercises without the use of maximum voluntary isometric 28 contraction testing and compare (i) the inter-limb differences in muscle activation, (ii) the 29 intra-muscular group activation pattern, and (iii) the activation during different phases of 30 the exercise.
    [Show full text]
  • Chapter 10 the Knee Joint
    The Knee Joint • Knee joint – largest joint in body Chapter 10 – very complex The Knee Joint – primarily a hinge joint Manual of Structural Kinesiology Modified for Prentice WE: Arnheim’s principles of athletic training , ed 12, New R.T. Floyd, EdD, ATC, CSCS York, 2006, McGraw-Hill; from Saladin, KS: Anatomy &physiology: the unity of forms and function , ed 2, New York, 2001, McGraw- Hill. © 2007 McGraw-Hill Higher Education. All rights reserved. 10-1 © 2007 McGraw-Hill Higher Education. All rights reserved. 10-2 Bones Bones • Enlarged femoral condyles articulate on • Fibula - lateral enlarged tibial condyles – serves as the attachment for • Medial & lateral tibial condyles (medial & knee joint lateral tibial plateaus) - receptacles for structures femoral condyles – does not articulate • Tibia – medial with femur or patella – bears most of weight – not part of knee joint Modified from Anthony CP, Kolthoff NJ: Textbook of anatomy and physiology , ed 9, St. Louis, 1975, Mosby. © 2007 McGraw-Hill Higher Education. All rights reserved. 10-3 © 2007 McGraw-Hill Higher Education. All rights reserved. 10-4 Bones Bones • Patella • Key bony landmarks – sesamoid (floating) bone – Superior & inferior patellar poles – imbedded in quadriceps – Tibial tuberosity & patellar tendon – Gerdy’s tubercle – serves similar to a pulley – Medial & lateral femoral in improving angle of condyles pull, resulting in greater – Upper anterior medial tibial mechanical advantage in surface – Head of fibula knee extension Modified from Anthony CP, Kolthoff NJ: Textbook of anatomy and physiology , ed 9, St. Louis, 1975, Mosby. © 2007 McGraw-Hill Higher Education. All rights reserved. 10-5 © 2007 McGraw-Hill Higher Education. All rights reserved.
    [Show full text]
  • A Thesis Entitled Relationship Between Hamstring Strength And
    A Thesis entitled Relationship Between Hamstring Strength and Agonist-Antagonist Co-Activation by Meghan Gregoire Submitted to the Graduate Faculty as partial fulfillment of the requirements for the Master of Science Degree in Exercise Science with a Concentration in Athletic Training ___________________________________________ Grant Norte, PhD, AT, ATC, CSCS, Committee Chair ___________________________________________ Neal Glaviano, PhD, AT, ATC, Committee Member ___________________________________________ Amanda Murray, PT, DPT, PhD, Committee Member ___________________________________________ Lucinda Bouillon, PT, DPT, PhD, Committee Member ___________________________________________ Cyndee Gruden, PhD, Dean College of Graduate Studies The University of Toledo May 2019 Copyright 2019, Meghan Gregoire This document is copyrighted material. Under copyright law, no parts of this document may be reproduced without the expressed permission of the author. An Abstract of Relationship Between Hamstring Strength and Agonist-Antagonist Co-Activation by Meghan Gregoire Submitted to the Graduate Faculty as partial fulfillment of the requirements for the Master of Science Degree in Exercise Science The University of Toledo May 2019 Introduction: Anterior cruciate ligament (ACL) injury is common among females due to several neuromuscular risk factors. Decreased hamstrings to quadriceps (H:Q) ratio is one neuromuscular factor that place females at an increased risk of ACL injury. Increased activation of the hamstrings during functional tasks help assist the static stabilizes of the knee, decrease strain on the ACL and reduce anterior tibial translation. Objectives: The objective of this study was to (1) identify the relationship between H:Q strength and co- activation ratio in the medial and lateral compartments of the knee during the stance phase of walking gait as well as (2) compare H:Q ratio between high and low groups.
    [Show full text]
  • Reviewing Morphology of Quadriceps Femoris Muscle
    Review article http://dx.doi.org/10.4322/jms.053513 Reviewing morphology of Quadriceps femoris muscle CHAVAN, S. K.* and WABALE, R. N. Department of Anatomy, Rural Medical College, Pravara Institute of Medical Sciences, At.post: Loni- 413736, Tal.: Rahata, Ahmednagar, India. *E-mail: [email protected] Abstract Purpose: Quadriceps is composite muscle of four portions rectus femoris, vastus intermedius, vastus medialis and vatus lateralis. It is inserted into patella through common tendon with three layered arrangement rectus femoris superficially, vastus lateralis and vatus medialis in the intermediate layer and vatus intermedius deep to it. Most literatures do not take into account its complex and variable morphology while describing the extensor mechanism of knee, and wide functional role it plays in stability of knee joint. It has been widely studied clinically, mainly individually in foreign context, but little attempt has been made to look into morphology of quadriceps group. The diverse functional aspect of quadriceps group, and the gap in the literature on morphological aspect particularly in our region what prompted us to review detail morphology of this group. Method: Study consisted dissection of 40 lower limbs (20 rights and 20 left) from 20 embalmed cadavers from Department of Anatomy Rural Medical College, PIMS Loni, Ahmednagar (M) India. Results: Rectus femoris was a separate entity in all the cases. Vastus medialis as well as vastus lateralis found to have two parts, as oblique and longus. Quadriceps group had variability in fusion between members of the group. The extent of fusion also varied greatly. The laminar arrangement of Quadriceps group found as bilaminar or trilaminar.
    [Show full text]
  • The Nerves of the Adductor Canal and the Innervation of the Knee: An
    REGIONAL ANESTHESIA AND ACUTE PAIN Regional Anesthesia & Pain Medicine: first published as 10.1097/AAP.0000000000000389 on 1 May 2016. Downloaded from ORIGINAL ARTICLE The Nerves of the Adductor Canal and the Innervation of the Knee An Anatomic Study David Burckett-St. Laurant, MBBS, FRCA,* Philip Peng, MBBS, FRCPC,†‡ Laura Girón Arango, MD,§ Ahtsham U. Niazi, MBBS, FCARCSI, FRCPC,†‡ Vincent W.S. Chan, MD, FRCPC, FRCA,†‡ Anne Agur, BScOT, MSc, PhD,|| and Anahi Perlas, MD, FRCPC†‡ pain in the first 48 hours after surgery.3 Femoral nerve block, how- Background and Objectives: Adductor canal block contributes to an- ever, may accentuate the quadriceps muscle weakness commonly algesia after total knee arthroplasty. However, controversy exists regarding seen in the postoperative period, as evidenced by its effects on the the target nerves and the ideal site of local anesthetic administration. The Timed-Up-and-Go Test and the 30-Second Chair Stand Test.4,5 aim of this cadaveric study was to identify the trajectory of all nerves that In recent years, an increased interest in expedited care path- course in the adductor canal from their origin to their termination and de- ways and enhanced early mobilization after TKA has driven the scribe their relative contributions to the innervation of the knee joint. search for more peripheral sites of local anesthetic administration Methods: After research ethics board approval, 20 cadaveric lower limbs in an attempt to preserve postoperative quadriceps strength. The were examined using standard dissection technique. Branches of both the adductor canal, also known as the subsartorial or Hunter canal, femoral and obturator nerves were explored along the adductor canal and has been proposed as one such location.6–8 Early data suggest that all branches followed to their termination.
    [Show full text]
  • Chapter 9 the Hip Joint and Pelvic Girdle
    The Hip Joint and Pelvic Girdle • Hip joint (acetabular femoral) – relatively stable due to • bony architecture Chapter 9 • strong ligaments • large supportive muscles The Hip Joint and Pelvic Girdle – functions in weight bearing & locomotion • enhanced significantly by its wide range of Manual of Structural Kinesiology motion • ability to run, cross-over cut, side-step cut, R.T. Floyd, EdD, ATC, CSCS jump, & many other directional changes © 2007 McGraw-Hill Higher Education. All rights reserved. 9-1 © 2007 McGraw-Hill Higher Education. All rights reserved. 9-2 Bones Bones • Ball & socket joint – Sacrum – Head of femur connecting • extension of spinal column with acetabulum of pelvic with 5 fused vertebrae girdle • extending inferiorly is the coccyx – Pelvic girdle • Pelvic bone - divided into 3 • right & left pelvic bone areas joined together posteriorly by sacrum – Upper two fifths = ilium • pelvic bones are ilium, – Posterior & lower two fifths = ischium, & pubis ischium – Femur – Anterior & lower one fifth = pubis • longest bone in body © 2007 McGraw-Hill Higher Education. All rights reserved. 9-3 © 2007 McGraw-Hill Higher Education. All rights reserved. 9-4 Bones Bones • Bony landmarks • Bony landmarks – Anterior pelvis - origin – Lateral pelvis - for hip flexors origin for hip • tensor fasciae latae - abductors anterior iliac crest • gluteus medius & • sartorius - anterior minimus - just superior iliac spine below iliac crest • rectus femoris - anterior inferior iliac spine © 2007 McGraw-Hill Higher Education. All rights reserved. 9-5 © 2007 McGraw-Hill Higher Education. All rights reserved. 9-6 1 Bones Bones • Bony landmarks • Bony landmarks – Medially - origin for – Posteriorly – origin for hip hip adductors extensors • adductor magnus, • gluteus maximus - adductor longus, posterior iliac crest & adductor brevis, posterior sacrum & coccyx pectineus, & gracilis - – Posteroinferiorly - origin pubis & its inferior for hip extensors ramus • hamstrings - ischial tuberosity © 2007 McGraw-Hill Higher Education.
    [Show full text]