Lower Limb ( clinical relevance )

Clinical Relevance: Testing the Quadriceps Femoris

This is performed by positioning the patient supine, with the knee slightly flexed. The patient is
asked to extend the leg (at the knee) against resistance. If the femoral nerve is damaged, contraction
of the quadriceps femoris will be absent.

Clinical Relevance: Injury to the Adductor Muscles

Strain of the adductor muscles is the underlying cause of what is colloquially known as a ‘groin
strain‘. The proximal part of the muscle is most commonly affected, tearing near their bony
attachments in the pelvis.

Groin injuries usually occur in sports that require explosive movements or extreme
stretching. Treatment of any muscle strain should utilise the RICE protocol – rest, ice, compression
and elevation.

Damage to the Hamstrings

Muscle Strain

A hamstring strain refers to excessive stretch or tearing of the muscle fibres. They are often seen
athletes involved in running or kicking sports. Damage to the muscle fibres is likely to rupture the
surrounding blood vessels – producing a haematoma (a collection of blood). The haematoma is
contained by the overlying fascia lata.

Treatment of any muscle strain should utilise the RICE protocol – rest, ice, compression and
elevation.

Avulsion Fracture of the Ischial Tuberosity

An avulsion fracture occurs when a fragment of bone breaks away from the main body of bone.

In an avulsion fracture of the ischial tuberosity, the hamstring tendons ‘tear off’ a piece of the ischial
tuberosity. Such an injury usually occurs in sports that require rapid contraction and relaxation of
the muscles – such as sprinting, football and hurdling.

Clinical Relevance: Footdrop

Fig 1.2 – Footdrop, a result of common fibular, or deep fibular nerve damage
Lower Limb ( clinical relevance )

Footdrop is a clinical sign indicating paralysis of the muscles in the anterior compartment of the leg.
It is most commonly seen when the common fibular nerve (from which the deep fibular nerve
arises) is damaged.

In footdrop, the muscles in the anterior compartment are paralysed. The unopposed pull of the
plantarflexor muscles (found in the posterior leg) produces permanent plantarflexion. This can
interfere with walking – as the affected limb can drag along the ground. To circumvent this, the
patient can flick the foot outwards while walking – known as an ‘eversion flick‘.

Clinical Relevance: Locating the Common Fibular Nerve

The common fibular nerve can be a difficult structure to identify. However, it can be located using
the fibularis longus as an anatomical landmark.

There is a small space between the parts of the fibularis longus that originate from the head of the
fibula, and the neck of the fibula. The common fibular nerve passes through this gap, and is easily
identified.

After passing through the gap, the nerve terminates by bifurcating into two terminal branches; the
deep and superficial fibular nerve.