Cheatography
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Upper leg muscles - Hamstrings, Adductors, Abductors, Quads
This is a draft cheat sheet. It is a work in progress and is not finished yet.
Hamstrings
Consists of: |
- Bicep Femoris |
- Semimembranosus |
-Semitendinosus |
Bicep Femoris
Origin: Long head: inferomedial upper area of the ischial tuberosity and sacrotuberous ligament
Short head: lateral lip of linea aspera
Insertion: Head of the fibula
NS: Long head: Tibial nerve Short head: Common fibular nerve
Action: Flexes know joint, laterally rotates knee joint when knee is flexed, long head extends hip joint
Semimembronous
Origin: Ischial Tuberosity
Insertion: Medial condyle of femur
NS: Tibial part of sciatic nerve (L5 -S2)
Actions: Extends hip and flexes knee
Semitendinosus
Origin: Tuberosity of the ischium
Insertion: Per anserinus
NS: Sciatic (tibial L5-S2)
Action: Flexion of knee, extension of the hip joint
Sartorius
Origin: ASIS
Insertion: Anteromedial surface of the proximal tibia (pes anserinus)
NS: Femoral nerve L2-L3
Action: Flexion, Abduction and lateral rotation of the hip and flexion of the knee
Sartorius TrPs
- Usually superficial sharp/tingling pain
- Rarely seen alone as a myofascial pain producer
- Sleeping/lying with hips and knees flexed can cause TrPs in this muscle
- Active during seated cycling
- Consider this muscle in patients with meralgia paraesthetica along with quads and iliacus
Tensor Fascia Lata (TFL)
Origin: ASIS
Insertion: Iliotibial tract
NS: Superior Gluteal nerve (L4-S1)
Action: Hip - Flexion, medial rotation, abduction Knee- Lateral rotation Torso - Stabilisation
TFL TrP
- Can be misdiagnosed as tronchanteric bursitis
- Running/walking on sloped surfaces increase risk of TrPs
- Tightness of TFL can lead to a short leg when prone/supine
- TrPs in anterior glut mini can lead to TrPs in TFL
- Tight QL, TFL overpower weak/inhibited Glut med - leads to lumbar lordosis - deal with tight muscles first before strengthening glut med
Quadriceps
Consists of: |
- Rectus Femoris |
- Vastus Intermedius |
- Vastus Lateralis |
- Vastus medialis |
Rectus Femoris
Origin: AIIS and bony ridge
Insertion: Patellar tendon
NS: Femoral nerve L2-L4
Action: Knee extension, Hip flexion
Rectus Femoris TrPs
- Felt deep in knee joint
- Wakes pt up at night - pain infront of patella and lower anterior thigh
- Knee pain + sense of weakness going down stairs
- Can diminishe the L4 reflex
- Secondary TrPs in other quad muscles and iliopsoas major
Vastus Intermedius
Origin: Anteriolateral femur
Insertion: Patella tendon
NS: Femoral nerve L2-L4
Action: Extension of the knee
Articulus genu - small muscle , usually blends in VI, thought to retract synovial suprapatellar bursa proximal during extension
Vastus Intermedius TrPs
- TrPs cause difficulty straightening the knee
- Buckling knee can be TrPs in vastus intermedius and 2 heads of gastrocnemius
Vastus Lateralis
The largest of the quads
Origin: GT, intertrochanteric line and linea aspera of the femur
Insertion: Patella tendon
NS: Femoral nerve L2-L4
Action: Extends and stabilise knee
Vastus Lateralis TrP
- Lying on affected side can disturb sleep
- TrP can cause stuck patella syndrome (patella loses all passive movement - stiff leg and dragging foot)
- Anterior fibres of Glut mini can cause satellite Trps in VL
Vastus Medialis
Origin: Medial side of femur
Insertion: Quads tendon
NS: Femoral Nerve L2-L4
Action: Extends knee
Vastus Medialis TrP
- Produce toothache like pain deep in the knee joint that interrupts sleep, pain fades over weeks and then buckling and weakness occurs
- Excessive pronation of the foot and Morton's foot can lead to TrPs in this muscle
Pectineus
Location of the Pectineus (black)
Origin: Pectineal line of the pubic bone
Insertion: Pectineal line of the femur
NS: Femoral Nerve L2-L3 and accessory obturator L3
Action: Adduction and flexion of the thigh
Pectineus - Palpation
- Hip slightly flexed and lateral rotated
- Pt adducts hip slightly
- Slide off adductor tendon laterally
Pectineus TrP
- Should be checked for TrPs after treating ilipsoas and adductor TrPs
Adductor Brevis
Origin: Anterior surface of inferior Ramus and body of the pubis
Insertion: Lesser tronchanter and linea aspera
NS: Obturator nerve L2-L3
Action: Adducts thigh, controls leg swing through gait cycle and postural control
Adductor Longus
Origin: Pubic body, below pubic crest
Insertion: Middle 1/3 of linea aspera
NS: Anterior branch obturator nerve L2-L4
Action: Adduction of hip, flexion of hip joint
Adductor Longus TrPs
Same as Adductor Brevis |
- Common cause of groin pain |
- Adductor longus bilateral TrPs can occur in horse riders - check for lumbar lesions |
Adductor Magnus
Origin: Pubis, tuberosity of ischium
Insertion: Linea Aspera and adductor tubercle of femur
NS: Posterior branch of obturator nerve and sciatic nerve (L2-L4)
Action: Both portions adduct hip, hip flexion (adductor portion) , Ext hip (Hamstring portion)
Adductor magnus TrPs
- TrP below pubic bone can refer pain into rectum, pubic bone, vagina or bladder - pain is sharp and shooting
- Adductor Magnus active when climbing stairs, inactive when descending
Gracilis
Origin: Ischiopubic Ramus
Insertion: Tibia (pes anserinus)
NS: Anterior branch of obturator nerve L2-L3
Action: Flexes, medially rotates and adducts hip
Gracillis TrPs
- Can be hot/stinging pain that travels along inside of thigh
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