Manual muscle test Hip and knee Examination Methods in Rehabilitation (18.10.2021) Mgr. Veronika Mrkvicová, Ph.D. (physiotherapist) http://www.drlox.com/wp-content/uploads/2013/04/hip-and-knee.jpg Hip joint https://www.urmc.rochester.edu/Encyclopedia/GetImage.aspx?ImageID=125403 Hip joint movements • Image result for hip movements Hip joint muscles • http://www.ephysiologix.com/wp-content/uploads/2015/04/muscles-of-hip.jpg Hip flexion •Iliopsoas http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/psoas/atlasIm age_large M. iliopsoas •Origin •Upper 2/3 of iliac fossa of ilium, internal lip of iliac crest, lateral aspect of sacrum, ventral sacroiliac ligament, and lower portion of iliolumbar ligament • •Insertion •Lesser trochanter • •Action •Flex the torso and thigh with respect to each other • •Innervation •Muscular branch of femoral nerve (L1, L2, L3) Hip flexion – grade 5,4 •Position: lying supine, arms along body side, uninvolved lower limb flexed in hip and knee, foot on the table, tested lower limb in 90° flexion in knee joint, foot free, hanging from the table •Fixation: pelvis on the tested side •Movement: hip flexion in full range of motion •Resistance: at the lower part of thigh (arched) • C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_067.jpg Hip flexion – grade 3 C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_068.jpg Position: lying supine, arms along body side, uninvolved lower limb flexed in hip and knee, foot on the table, tested lower limb in 90° flexion in knee joint, foot free, hanging from the table Fixation: pelvis on the tested side Movement: hip flexion in full range of motion Hip flexion – grade 2 •Position: lying on the tested side, tested lower limb in central position of the hip, 90° flexion in the knee joint •Fixation: PT supports with one hand the uninvolved lower limb, which is extended in the knee and central position in the hip joint, PTs´ other hand fix the pelvis on the untesded side •Movement: flexion of the tested lower limb by pushing on the table in full range of motion • C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_069.jpg Hip flexion – grade 1,0 •Position: patient lying supine •Fixation: PT supports patients tested lower limb in semiflexion in the knee and semiflexion and a slight external rotation in hip joint •Attempt to move: PT palpates a trace of contraction during the patients´ attempt to flex the hip – in the inguinal area (groin) • C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_070.jpg Hip flexion – notes: •The movement should be done in exact sagital plane (no rotation of the hip joint) • •No swing during the movement • • No extension of the knee joint or lumbar hyperlordosis (substitution of rectus femoris muscle) • •No elevation of the pelvis (substitution of quadratus lumborum) Hip extension •Gluteus •maximus Biceps femoris (long head) Semitendinosus Semimembranosus http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/gluteus-maxim us/atlasImage_large http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/biceps-femori s-long-head/atlasImage_large http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/semitendinosu s/atlasImage_large http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/semimembranos us/atlasImage_large Gluteus maximus •Origin •Posterior aspect of dorsal ilium posterior to posterior gluteal line, posterior superior iliac crest, posterior inferior aspect of sacrum and coccyx, and sacrotuberous ligament • •Insertion •Primarily in fascia lata at the iliotibial band •also into the gluteal tuberosity on posterior femoral surface • •Action •Major extensor of hip joint, assists in laterally rotating the thigh •upper and middle third section of the muscle are abductors • •Innervation •Inferior gluteal nerve (L5, S1, S2) (L5, S1, S2) Biceps femoris (long head) •Origin •Common tendon with semitendinosus from superior medial quadrant of the posterior portion of the ischial tuberosity • •Insertion •Primarily on fibular head •also on lateral collateral ligament and lateral tibial condyle • •Action •Flexes the knee, and also rotates the tibia laterally •long head also extends the hip joint • •Innervation •Tibial nerve (L5, S1, S2) Semitendinosus •Origin •From common tendon with long head of biceps femoris from superior medial quadrant of the posterior portion of the ischial tuberosity • •Insertion •Superior aspect of medial portion of tibial shaft • •Action •Extends the thigh and flexes the knee •rotates the tibia medially, especially when the knee is flexed • •Innervation •Tibial nerve (L5, S1, S2) Semimembranosus •Origin •Superior lateral quadrant of the ischial tuberosity • •Insertion •Posterior surface of the medial tibial condyle • •Action •Extends the thigh, flexes the knee •rotates the tibia medially, especially when the knee is flexed • •Innervation •Tibial nerve (L5, S1, S2) Hip extension – grade 5,4 •Position: patient lying prone, arms along body side, head lying on the forehead, lower limbs extended, foot away from the table (the abdomen underlaid with the pillow to ensure lumbar aplanation) •Fixation: the pelvis on the tested side •Movement: hip extension (in 10° range of motion) •Resistance: on the lower part of the thigh (arched) C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_071.jpg Hip extension – grade 3 Position: patient lying prone, arms along body side, head lying on the forehead, lower limbs extended, foot away from the table (the abdomen underlaid with the pillow to ensure lumbar aplanation) Fixation: the pelvis on the tested side Movement: hip extension (in 10° range of motion) C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_072.jpg Hip extension – grade 2 C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_073.jpg Position: lying on the tested side, the uninvolved lower limb is supported by PT in slightly flexion and abduction in the hip and slighly flexed in the knee joint, the tested lower limb extended in the knee joint, central position of the hip Fixation: the pelvis on the untested side Movement: hip extension (in 10° range of motion) Hip extension – grade 1,0 •Position: patient lying prone, arms along body side, head lying on the forehead, lower limbs extended, foot away from the table (the abdomen underlaid with the pillow to ensure lumbar aplanation) •Attempt to move: PT palpates a trace of contraction during patients attempt to extend the hip joint C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_074.jpg Hip extension (gluteus max.) – grade 5,4 •Position: patient lying prone, arms along body side, head lying on the forehead, lower limbs extended (except 90° flexion in the knee of the tested side), foot away from the table (the abdomen underlaid with the pillow to ensure lumbar aplanation) •Fixation: the pelvis on the tested side •Movement: hip extension (in 10° range of motion) •Resistance: on the lower part of the thigh (arched) C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_076.jpg Hip extension (gluteus max.) – grade 3 Position: the same as grade 5,4 Fixation: the pelvis on the tested side Movement: hip extension (in 10° range of motion) C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_077.jpg Hip extension (gluteus max.) – grade 2 Position: lying on the tested side, the uninvolved lower limb is supported by PT in slightly flexion and abduction in the hip and slighly flexed in the knee joint, the tested lower limb flexed in the knee joint, central position of the hip Fixation: the pelvis on the untested side Movement: hip extension (in 10° range of motion) C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_078.jpg Hip extension – notes: •The pelvis has to be fixed by PT (no extension of the lumbal spine as a substitution of hip extension) •No external rotation or adduction or abduction of the hip joint •Foot should be away from to table • Hip adduction •Adductor •magnus http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/adductor-magn us/atlasImage_large http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/adductor-long us/atlasImage_large Adductor longus http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/adductor-brev is/atlasImage_large Adductor brevis Gracilis Pectineus Adductor magnus •Origin •Inferior pubic ramus, ischial ramus, and inferolateral area of ischial tuberosity • •Insertion •Gluteal tuberosity of femur, medial lip of linea aspera, medial supracondylar ridge, and adductor tubercle • •Action •Powerful thigh adductor •superior horizontal fibers also help flex the thigh •vertical fibers help extend the thigh • •Innervation •Posterior division of obturator nerve innervates most of the adductor magnus; vertical or hamstring portion innervated by tibial nerve (L2, L3, L4) Adductor longus •Origin •Anterior surface of body of pubis, just lateral to pubic symphysis • •Insertion •Middle third of linea aspera, between the more medial adductor magnus and brevis insertions and the more lateral origin of the vastus medialis • •Action •Adducts and flexes the thigh • helps to laterally rotate the hip joint • •Innervation •Anterior division of obturator nerve (L2, L3, L4) Adductor brevis •Origin •Anterior surface of inferior pubic ramus, inferior to origin of adductor longus • •Insertion •Pectineal line and superior part of medial lip of linea aspera • •Action •Adducts and flexes the thigh •helps to laterally rotate the thigh • •Innervation •Anterior or posterior division of obturator nerve (L4, L2, L3) Gracilis •Origin •Inferior margin of pubic symphysis, inferior ramus of pubis, and adjacent ramus of ischium • •Insertion •Medial surface of tibial shaft, just posterior to sartorius • •Action •Flexes the knee, adducts the thigh •helps to medially rotate the tibia on the femur • •Innervation •Anterior division of obturator nerve (L2, L3) Pectineus •Origin •Pecten pubis and pectineal surface of the pubis • •Insertion •Pectineal line of femur • •Action •Adducts the thigh and flexes the hip joint • •Innervation •Femoral nerve usually, although it may sometimes receive additional innervation from the obturator nerve as well (L2, L3, L4) Hip adduction – grade 5,4 •Position: patient lying on the tested side, lower limbs extended, the uninvolved one supported by PT in 30° abduction •Fixation: the uninvolved lower limb in abduction •Movement: adduction of the tested hip joint (by moving the tested lower limb closer to the untested) •Resistance: on the lower part of the thigh C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_079.jpg Hip adduction – grade 3 • Position: patient lying on the tested side, lower limbs extended, the uninvolved one supported by PT in 30° abduction Fixation: the uninvolved lower limb in abduction Movement: adduction of the tested hip joint (by moving the tested lower limb closer to the untested) C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_080.jpg Hip adduction – grade 2 C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_081.jpg Position: patient lying supine, lower limbs extended and in 30° abduction in hip joint Fixation: the pelvis on the tested side Movement: adduction of the tested hip joint – 10-15° (by moving the tested lower limb closer to the untested) Hip adduction – grade 1,0 •Position: patient lying supine, lower limbs extended and in 30° abduction in hip joint •Attempt to move: PT palpates the trace of contraction during patients attempt to adduct the hip (at the inner side of thigh) • C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_082.jpg Hip abduction •Gluteus •medius http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/gluteus-mediu s/atlasImage_large Tensor fasciae latae Gluteus minimus http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/gluteus-minim us/atlasImage_large http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/tensor-fascia -lata/atlasImage_large Gluteus medius •Origin •Dorsal ilium inferior to iliac crest • •Insertion •Lateral and superior surfaces of greater trochanter • •Action •Major abductor of thigh •anterior fibers help to rotate hip medially •posterior fibers help to rotate hip laterally • •Innervation •Superior gluteal nerve (L4, L5, S1) (L4, L5, S1) Tensor fasciae latae •Origin •Anterior superior iliac spine, outer lip of anterior iliac crest and fascia lata • •Insertion •Iliotibial band • •Action •Helps stabilize and steady the hip and knee joints by putting tension on the iliotibial band of fascia • •Innervation •Superior gluteal nerve (L4, L5, S1) (L4, L5, S1) Gluteus minimus •Origin •Dorsal ilium between inferior and anterior gluteal lines; also from edge of greater sciatic notch • •Insertion •Anterior surface of greater trochanter • •Action •Abducts and medially rotates the hip joint • •Innervation •Superior gluteal nerve (L4, L5, S1) (L4, L5, S1) Hip abduction – grade 5,4 •Position: patient lying on the untested side, the untested lower limb slightly flexed in knee and hip joint, the tested lower limb extended •Fixation: pelvis on the tested side •Movement: hip abduction in full range of motion •Resistance: on the lower part of the thigh C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_083.jpg Hip abduction – grade 3 C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_084.jpg Position: patient lying on the untested side, the untested lower limb slightly flexed in knee and hip joint, the tested lower limb extended Fixation: pelvis on the tested side Movement: hip abduction in full range of motion Hip abduction – grade 2 •Position: patient lying supine, lower limb extended (the untested one slightly abducted) •Fixation: pelvis on the tested side •Movement: hip abduction in full range of motion C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_087.jpg Hip abduction – grade 1,0 C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_085.jpg •Position: patient lying supine, lower limb extended •Attempt to move: PT palpates a trace of contraction during patients attempt to abduct a hip (over the trochanter major) Hip abduction – notes: •The fixation of the pelvis is necessary (no elevation of the pelvis should be allowed) • •No external rotation or flexion in the hip joint (substitution of iliopsoas and tensor fasciae latae) • •Proper range of motion and proper direction of movement should be kept • •No anteversion of the pelvis or hyperlordosis of the lumbar spine • Hip external rotation • http://www.med.uio.no/imb/english/research/projects/functional-anatomy/dype-setemuskler-elsevier-50 0.jpg http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/quadratus-fem oris/atlasImage_large Quadratus femoris •Origin •Lateral margin of obturator ring above ischial tuberosity • •Insertion •Quadrate tubercle and adjacent bone of intertrochanteric crest of proximal posterior femur • •Action •Rotates the hip laterally; also helps adduct the hip • •Innervation •Quadratus femoris branch of nerve to the quadratus femoris and inferior gemellus (L5, S1) (L5, S1) Piriformis •Origin •Anterior surface of lateral process of sacrum and gluteal surface of ilium at the margin of the greater sciatic notch • •Insertion •Superior border of greater trochanter • •Action •Lateral rotator of the hip joint •helps abduct the hip if it is flexed • •Innervation •Piriformis nerve (L5, S1, S2) (L5, S1, S2) Gemellus superior •Origin •Ischial spine • •Insertion •Medial surface of greater trochanter of femur, in common with obturator internus • •Action •Rotates the thigh laterally •helps abduct the flexed thigh • •Innervation •Nerve to the obturator internus and superior gemellus -- a branch of the sacral plexus (L5, S1) (L5, S1) Gemellus inferior •Origin •Posterior portions of ischial tuberosity and lateral obturator ring • •Insertion •Medial surface of greater trochanter of femur, in common with obturator internus • •Action •Rotates the thigh laterally •helps abduct the flexed thigh • •Innervation •Nerve to the obturator internus and inferior gemellus -- a branch of the sacral plexus (L5, S1) (L5, S1) Obturatorius externus •Origin •External surface of obturator membrane and anterior bony margins of obturator foramen • •Insertion •Posteromedial surface of greater trochanter of femur • •Action •Rotates the thigh laterally; also helps adduct thigh • •Innervation •Posterior division of obturator nerve innervates most of the adductor magnus; vertical or hamstring portion innervated by tibial nerve (L3, L4) http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/obturator-ext ernus/atlasImage_large Obturatorius internus •Origin •Internal surface of obturator membrane •posterior bony margins of obturator foramen • •Insertion •Medial surface of greater trochanter of femur, in common with superior and inferior gemelli • •Action •Rotates the thigh laterally •helps abduct the thigh when it is flexed • •Innervation •Nerve to the obturator internus and superior gemellus -- a branch of the sacral plexus (L5, S1) (L5, S1) http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/obturator-int ernus/atlasImage_large Gluteus maximus •Origin •Posterior aspect of dorsal ilium posterior to posterior gluteal line, posterior superior iliac crest, posterior inferior aspect of sacrum and coccyx, and sacrotuberous ligament • •Insertion •Primarily in fascia lata at the iliotibial band •also into the gluteal tuberosity on posterior femoral surface • •Action •Major extensor of hip joint, assists in laterally rotating the thigh •upper and middle third section of the muscle are abductors • •Innervation •Inferior gluteal nerve (L5, S1, S2) (L5, S1, S2) Hip external rotation – grade 5,4 •Position: patient lying supine, the shank of the tested lower limb hanging from the table, the untested lower limb flexed in hip and knee joint, foot on the table •Fixation: dorsal side of the lower part of the thigh •Movement: hip external rotation in full range of motion (40-50°) •Resistance: at the inner side of the lower shank C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_088.jpg Hip external rotation – grade 3 Position: patient lying supine, the shank of the tested lower limb hanging from the table, the untested lower limb flexed in hip and knee joint, foot on the table Fixation: dorsal side of the lower part of the thigh Movement: hip external rotation in full range of motion (40-50°) C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_089.jpg Hip external rotation – grade 2 Position: patient lying supine, lower limbs extended and slightly abducted, the tested one inner rotated Fixation: pelvis on the untested side Movement: hip external rotation in full range of motion (40-50°) C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_090.jpg Hip external rotation – grade 1,0 Position: patient lying supine, lower limbs extended Attempt to move: PT palpates a trace of contraction during patients attempt of hip external rotation (at the area of trochanter major) and observes the attempt to move the leg outward C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_091.jpg Hip external rotation – notes: •No adduction and flexion of the hip joint •No supination of the foot Hip internal rotation Tensor fasciae latae Gluteus minimus http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/gluteus-minim us/atlasImage_large http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/tensor-fascia -lata/atlasImage_large Hip internal rotation – grade 5,4 •Position: patient lying supine, the shank of the tested lower limb hanging from the table, the untested lower limb flexed in hip and knee joint, foot on the table •Fixation: dorsal side of the lower part of the thigh •Movement: hip internal rotation in full range of motion (aproximatelly 30°) •Resistance: at the outer side of the lower shank C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_092.jpg Hip internal rotation – grade 3 •Position: patient lying supine, the shank of the tested lower limb hanging from the table, the untested lower limb flexed in hip and knee joint, foot on the table •Fixation: dorsal side of the lower part of the thigh •Movement: hip internal rotation in full range of motion (30°) • C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_093.jpg Hip internal rotation – grade 2 Position: patient lying supine, lower limbs extended and slightly abducted, the tested one outer rotated Fixation: pelvis on the tested side Movement: hip internal rotation in full range of motion C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_094.jpg Hip internal rotation – grade 1,0 Position: patient lying supine, lower limbs extended Attempt to move: PT palpates a trace of contraction during patients attempt of hip internal rotation (at the area of trochanter major) and observes the attempt to move the leg inward C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_095.jpg Hip internal rotation •Fixation of the pelvis is necessary, proper position of the lower extremity •No adduction or supination of the foot Knee joint http://www.partsofthebody.net/wp-content/uploads/2014/06/anatomy-of-the-knee.png Knee joint movements • Image result for knee movements Knee joint muscles http://classroom.sdmesa.edu/eschmid/F08.23.L.150.jpg Knee flexion •Biceps femoris (short head) Biceps femoris (long head) Semitendinosus Semimembranosus http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/biceps-femori s-long-head/atlasImage_large http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/semitendinosu s/atlasImage_large http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/semimembranos us/atlasImage_large http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/biceps-femori s-short-head/atlasImage_large Biceps femoris - long head •Origin •Common tendon with semitendinosus from superior medial quadrant of the posterior portion of the ischial tuberosity • •Insertion •Primarily on fibular head •also on lateral collateral ligament and lateral tibial condyle • •Action •Flexes the knee, and also rotates the tibia laterally •long head also extends the hip joint • •Innervation •Tibial nerve (L5, S1, S2) Biceps femoris – short head •Origin •Lateral lip of linea aspera, lateral supracondylar ridge of femur, and lateral intermuscular septum of thigh • •Insertion •Primarily on fibular head; also on lateral collateral ligament and lateral tibial condyle • •Action •Flexes the knee, and also rotates the tibia laterally •long head also extends the hip joint • •Innervation •Common peroneal nerve (L5, S1, S2) Semitendinosus •Origin •From common tendon with long head of biceps femoris from superior medial quadrant of the posterior portion of the ischial tuberosity • •Insertion •Superior aspect of medial portion of tibial shaft • •Action •Extends the thigh and flexes the knee •rotates the tibia medially, especially when the knee is flexed • •Innervation •Tibial nerve (L5, S1, S2) Semimembranosus •Origin •Superior lateral quadrant of the ischial tuberosity • •Insertion •Posterior surface of the medial tibial condyle • •Action •Extends the thigh, flexes the knee •rotates the tibia medially, especially when the knee is flexed • •Innervation •Tibial nerve (L5, S1, S2) Knee flexion •Knee flexion with external rotation •(biceps femoris) C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_097.jpg C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_096.jpg Knee flexion with internal rotation (semitendinosus, semimembranosus) Knee flexion – grade 5,4 •Position: patient lying supine, abdomen underlaid with pillow, lower limb extended, feet away from the table •Fixation: the pelvis •Movement: knee flexion in full range of motion •Resistance: at the lower part of the shank (arched) C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_098.jpg Knee flexion – grade 3 •Position: patient lying supine, abdomen underlaid with pillow, lower limb extended, feet away from the table •Fixation: the pelvis •Movement: knee flexion in full range of motion C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_099.jpg Knee flexion – grade 2 C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_100.jpg •Position: patient lying on the tested side, untested lower limb extended and slightly abducted in the hip, extended in the knee •Fixation: PT supports the untested lower limb, fix the the pelvis on the untested side •Movement: knee flexion in full range of motion Knee flexion – grade 1,0 •Position: patient lying supine, abdomen underlaid with pillow, untested lower limb extended with foot away from the table, tested lower limb supported in slighly knee flexion •Attempt to move: PT palpates a trace o contraction during patients attempt to flex the knee joint (at the dorsal part of the thigh) • C:\Users\Verca\Desktop\fotky MMT noha\WP_20151008_101.jpg Knee flexion – notes: •Distinguish knee flexion with external and internal rotation if necessary •No movement of the pelvis (anteversion) •No movement of the hip joint (no rotation) Knee extension – quadriceps femoris •Rectus •femoris http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/rectus-femori s/atlasImage_large Vastus medialis Vastus lateralis Vastus intermedius http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/vastus-medial is/atlasImage_large Rectus femoris •Origin •Straight head from anterior inferior iliac spine; reflected head from groove just above acetabulum • •Insertion •Base of patella to form the more central portion of the quadriceps femoris tendon • •Action •Extends the knee • •Innervation •Muscular branches of femoral nerve (L2, L3, L4) Vastus medialis •Origin •Inferior portion of intertrochanteric line, spiral line, medial lip of linea aspera, superior part of medial supracondylar ridge of femur, and medial intermuscular septum • •Insertion •Medial base and border of patella; also forms the medial patellar retinaculum and medial side of quadriceps femoris tendon • •Action •Extends the knee • •Innervation •Muscular branches of femoral nerve (L2, L3, L4) Vastus lateralis •Origin •Superior portion of intertrochanteric line, anterior and inferior borders of greater trochanter, superior portion of lateral lip of linea aspera, and lateral portion of gluteal tuberosity of femur • •Insertion •Lateral base and border of patella; also forms the lateral patellar retinaculum and lateral side of quadriceps femoris tendon • •Action •Extends the knee • •Innervation •Muscular branches of femoral nerve (L2, L3, L4) Vastus intermedius •Origin •Superior 2/3 of anterior and lateral surfaces of femur; also from lateral intermuscular septum of thigh • •Insertion •Lateral border of patella; also forms the deep portion of the quadriceps tendon • •Action •Extends the knee • •Innervation •Muscular branches of femoral nerve (L2, L3, L4) Knee extension – grade 5,4 •Position: patient lying supine, shank of the tested lower limb hanging from the table, untested lower limb flexed in knee and hip joint, foot on the table •Fixation: the lower part of the dorsal side of thigh •Movement: knee extension from 90° flexion to full extension •Resistance: at the frontal part of the distal shank Knee extension – grade 3 •Position: patient lying supine, shank of the tested lower limb hanging from the table, untested lower limb flexed in knee and hip joint, foot on the table •Fixation: the lower part of the dorsal side of thigh •Movement: knee extension from 90° flexion to full extension Knee extension – grade 2 •Position: patient lying on the tested side, untested lower limb in knee extension, hip slightly abducted – PT supports the position, tested lower limb in 90° knee flexion, hip extension •Fixation: pelvis on the untested side •Movement: from 90° flexion to full extension of the knee joint Knee extension – grade 1,0 •Position: patient lying supine, untested lower limb in extension, tested lower limb slightly flexed in knee and hip joint (supported by PT) •Attempt to move: PT palpates a trace of contraction during patients attempt of knee extension (at the ligament patellae or quadriceps muscle area) Knee extension – notes: •No swing at the start of the movement •No rotation of the hip joint •No retroversion of the pelvis •Do the movement to full extension •Don´t fix the thigh from above (don´t touch quadriceps muscle) Thank you for your attention J • Výsledek obrázku pro leg workout funny