Next: Clinical Conditions. License Advanced Anatomy 2nd. Share This Book Share on Twitter. It is a one joint muscle and contributes to knee extension. This is the superficial part of Vastus Medialis. Rectus Femoris. Rectus Femoris is the central of the 3 superficial quadriceps, originating on the Anterior Inferior Iliac Spine and inserting onto the tibial tuberosity and the patella.
It is a two joint muscle, contributing to hip flexion, and knee extension. To palpate, have the patient press their knee into the bed, and the tendon of Rectus Femoris becomes highly visible superior to the knee.
This can then be palpated into the muscle belly as it move up the middle of the upper leg. Sartorius is a long strap like muscle, on the medial part of the thigh, which acts as a divider for the Quadriceps and the Hamstrings. It originates on the Anterior Superior Iliac Spine, and inserts on the medial part of the tibia, near the tibial tuberosity. It is a two joint muscle, acting on the hip and knee.
At the hip it flexes, abducts and externally rotates, and at the knee it flexes and internally rotates. To palpate the muscle, it is most obvious when the knee is slightly flexed, and there is slight external rotation at the hip. It then becomes obvious as a strap running from the medial part of the knee, curving up across the thigh into the ASIS. Popliteus is a triangular muscle, situated deep in the posterior aspect of the knee. It originates on the lateral condyle of the femur, and inserts onto the posterior surface of the tibia.
It is a flexor and internal rotator of the knee, and due to its deep location cannot be palpated. Gracilis is a long thin muscle, situated on the medial side of the thigh. It originates on the pubic symphasis and inserts onto the media surface of the tibia. It is a synergist in adduction and flexion of the hip, and a flexor and internal rotator of the knee. The tendon can be palpated on the posteromedial side of the knee when the foot is planted flat on the floor, being the upper of the two obvious tendons.
The muscle belly can then be carefully palpated to its insertion. Search this site. Anatomy of the Knee The Knee is a synovial hinge joint, which takes a lot of weight through it, but also offers movement in 1 plane, Sagittal which are Flexion and Extension.
Palpation Due to the bulky musculature surrounding it, the femur is difficult to palpate. The Patella The Patella is a small bone on the front of the knee, sitting in between the Condyles of the Femur.
Palpation To palpate the base of the patella, run your palm down the quadriceps to the knee, and the bony ridge that you will hit is the base of the patella. The Tibia The Tibia is the second largest and strongest bone in the body, receiving and transmitting the body weight from the femur down to the foot.
Palpation The tibial condyles can be palpated at the top of the tibia, slightly below the patella. The Fibula The Fibula is a long, straight bone, with slightly wider ends. Palpation Due to it sitting slightly deeper, below muscles such as Peroneus Brevis and Longus, it is hard to palpate the shaft, although the fibula notch can be felt on the lateral side of the leg, slightly inferior to the condyles of the tibia.
Ligaments There are four main ligaments in the knee, 2 that can be palpated, and 2 that sit inside the joint capsule. If the patella cannot be palpated immediately, it can be located by following the patellar ligament proximally from its distal attachment on the tibial tuberosity. Grade I: The patella can be luxated with manual pressure, but immediately reduces when pressure is released.
Grade II: The patella can be luxated with manual pressure, and spontaneously luxates during ambulation. It easily reduces by extending the stifle or by manual pressure, and resides in the trochlear groove a majority of the time. Grade III: The patella resides outside of the trochlear groove a majority of the time.
It can be reduced by manual pressure. Grade IV: The patella resides outside of the trochlear groove continually, and cannot be reduced. If the patella is found to be luxated, attempt to reduce it by extending the stifle and moving the patella medially or laterally with the thumb or index finger. If the patella is found to be reduced, its stability is best evaluated by extending the stifle and attempting to force the patella medially or laterally.
With the patella in its most mediolaterally displaced position, the stifle can now be flexed. The normal patella will track back into the trochlear groove, while a luxating patella will remain deviated. In addition, internally or externally rotating the tibia can aid in luxating or reducing the patella. For example, internal rotation of the tibia facilitates medial patella luxation, while external rotation facilitates reduction of a medial luxation.
The degree of patella luxation is associated with differing degrees of lameness. Dogs with a grade I luxation most often are asymptomatic. Dogs with grade II luxation may be asymptomatic, or may present with a complaint of an intermittent "skipping" lameness. Owners often report that these episodes resolve after the dog "stretches his leg out behind him".
It may be worse after exercise or inactivity, but unlike grade II dogs, the lameness does not resolve. These dogs often appear bowlegged and may seem to walk in a crouched position, due to their inability to extend the stifle completely. A complete orthopedic examination is essential in these patients, as concurrent disease may be present. In particular, young small breed dogs with MPL and hindlimb lameness may also be affected by Legg-Perthes disease- aseptic necrosis of the femoral head.
Older dogs with acute onset of lameness and patella luxation should be closely examined for ruptured cranial cruciate ligament. Standard larteral and cranial-caudal radiographs of the stifle should be taken, to rule out concurrent orthopedic conditions and evaluate conformation.
A luxated patella may be visible on radiographs, however grade I and II luxations are intermittent and the patella may be reduced at the time of radiography. Varying degrees of joint effusion and degenerative joint disease may also be seen. A V-D pelvic radiograph, including the stifles and proximal tibiae can help to evaluate femoral conformation.
This will take the knee flexion contractures out of the picture. The above examination is not the medical school Inspection, palpation, range of motion exam. Instead it incorporates all of these maneuvers into 4 positions Standing, Walking, Sitting, and Lying to make things flow and ease the patient. Royal college exams are all OSCE format so they just tick boxes.
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