Exercise 13 Review Muscles of the Lower Limb Answers

Introduction

The hamstring muscle complex is comprised of 3 individual muscles and plays a disquisitional role in homo activities ranging from standing to explosive actions such equally sprinting and jumping. The following review article will summarize the structure and function of this muscle grouping and provide an introduction to common hamstring injuries and surgical considerations.

Structure and Role

The semitendinosus, semimembranosus, and biceps femoris muscles contain the hamstring muscle group. Beginning at the pelvis and running posteriorly along the length of the femur, the majority of muscles within the hamstring complex cross both the femoroacetabular and tibiofemoral joints. The brusque caput of the biceps femoris is an exception to this rule equally it originates from the lateral lip of the femoral linea aspera, distal to the femoroacetabular joint. For this reason, some argue that the short caput of the biceps femoris is not a true hamstring muscle. Unlike the short head of the biceps femoris, all other hamstring muscles originate from the ischial tuberosity. The proximal, long head of the biceps femoris and semitendinosus muscles are linked past an aponeurosis that extends approximately 7 cm from the ischial tuberosity. The distal hamstrings form the superolateral (biceps femoris) and superomedial (semimembranosus and semitendinosus) borders of the popliteal fossa. The gastrocnemius primarily forms the inferior border of the popliteal fossa.

The hamstring muscle group plays a prominent part in hip extension (posterior move of the femur) and knee flexion (posterior movement of the tibia and fibula).  Concerning the gait cycle, the hamstrings activate start at the final 25% of the swing phase generating extension forcefulness at the hip and resisting knee extension. The hamstring muscles also play an essential role as a dynamic stabilizer of the knee joint. Operating in tandem with the anterior cruciate ligament (ACL), the hamstrings resist anterior translation of the tibia during the heel strike phase of the gait bike.[one]

Embryology

A significant portion of lower extremity development occurs during weeks 4 to 8 of embryogenesis. Like all other skeletal muscle tissue, the hamstring muscles class from the embryonic mesoderm. Migrating from the somites during the early embryonic phase, mesodermal cells differentiate into myoblasts, which indistinguishable and coalesce, eventually forming functional musculus tissue.

Blood Supply and Lymphatics

The hamstring musculus complex receives vascular supply from the perforating branches of the deep femoral artery, too known as the profunda femoris artery. The profunda femoris is a branch of the femoral artery. The femoral avenue is demarcated from the external iliac artery by the inguinal ligament. In general, the deep veins of the thigh share the same proper noun as the major arteries which they follow. The femoral vein is responsible for a big degree of venous drainage of the thigh. It accompanies the femoral artery and receives boosted venous drainage from the profunda femoris vein. Similar to the femoral artery, the femoral vein transitions to go the external iliac vein at the level of the inguinal ligament. The lymphatic drainage of the thigh likewise mirrors the arterial supply and somewhen drains into the lumbar lymphatic trunks and cisterna chyli.

Fretfulness

The hamstring muscle complex is innervated by nerves that arise from the lumbar and sacral plexuses. These plexuses give rise to the sciatic nerve (L4-S3), which bifurcates into the tibial and mutual peroneal (fibular) nerves at the level of the tibiofemoral joint. The tibial nervus innervates the semimembranosus, semitendinosus, and long caput of the biceps femoris. The mutual peroneal branch of the sciatic nervus innervates the curt head of the biceps femoris.

Muscles

Biceps Femoris: Short Head

• Origin: Lateral lip of the linea aspera

• Insertion: The fibular head and lateral condyle of the tibia

• Function: Knee flexion and lateral rotation of the tibia

• Innervation: Fibular (common peroneal) nerve

• Vascular supply: Perforating branches of the deep femoral artery

Biceps Femoris: Long Head

• Origin: Ischial tuberosity

• Insertion: The fibular head and lateral condyle of the tibia

• Function: Human knee flexion, lateral rotation of the tibia, and hip extension

• Innervation: Tibial nerve

• Vascular supply: Perforating branches of the deep femoral avenue

Semitendinosus

• Origin: Lower, medial surface of the ischial tuberosity

• Insertion: Medial tibia (pes anserinus)

• Function: Knee flexion, hip extension, and medial rotation of the tibia (with human knee flexion)

• Innervation: Tibial nerve

• Vascular supply: Perforating branches of the deep femoral artery

Semimembranosus

• Origin: Ischial tuberosity

• Insertion: Medial tibial condyle

• Function: Knee flexion, hip extension, and medial rotation of the tibia (with articulatio genus flexion)

• Innervation: Tibial nerve

• Vascular supply: Perforating branches of the deep femoral artery

Physiologic Variants

Although they are uncommon, surgeons must remain aware of hamstring muscle anatomical variations. The hamstring muscle group, except for the curt head of the biceps femoris, typically originates from a conjoint muscle tendon arising from the ischial tuberosity. Interestingly, there are reports which reveal variants where the semitendinosus and the long head of the biceps femoris appear from distinct tendinous origins.[ane] Another study published in 2013 revealed findings of a 3rd caput of the biceps femoris and an anomalous muscle that inserted onto the semimembranosus.[2]

There is besides a study of a patient with bilateral absenteeism of the semimembranosus muscles. This finding was noticed incidentally on MRI after the patient presented with knee hurting afterward a fall.[3] Although the article did not indicate whether or not the patient had experienced symptoms related to this before his presentation, this finding may exist relevant in the context of ACL reconstruction every bit hamstring autografts are a common choice.

Common peroneal nervus entrapment neuropathy most commonly occurs at the level of the fibular caput and neck. A 2018 report revealed the findings of common peroneal neuropathy associated with variation of the short head of the biceps femoris. In this case, the location of the mutual peroneal nervus was inside a 4.4 cm tunnel between the gastrocnemius and curt head of the biceps femoris.[4]

Surgical Considerations

The vast majority of hamstring injuries are manageable nonoperatively; however, hamstring tendon avulsion ofttimes requires surgical intervention. Hamstring tendon avulsions are treated endoscopically with fixation of the torn segment of the hamstring tendon to the ischial tuberosity.[5] Surgical repair of chronic proximal hamstring rupture can have augmentation with an Achilles tendon autograft.[6]

Ischial apophyseal avulsion fractures are extremely rare. Studies written report that they account for between simply one.iv to four% of all hamstring injuries.[7] Avulsion fractures that are displaced less than ane cm are candidates for conservative management. Patients are advised to limit hamstring stretching, preventing the fractured segment of the ischial apophysis from condign further displaced.[8] Surgical fixation is necessary for patients who have ischial apophyseal avulsion fractures, which are displaced more than one cm, or who are experiencing symptomatic malunion. Early intervention is brash to decrease the risk of ischiofemoral impingement.[9]

The hamstring muscle is harvestable as an autograft in ACL reconstruction. The quadruple hamstring autograft involves the semitendinosus and gracilis muscles and is known to be one of the strongest grafts bachelor.[10] Compared to patellar tendon grafts, hamstring autografts offering a decreased hazard of donor site trauma, patellofemoral crepitation, kneeling pain, and loss of more than than 5 degrees of articulatio genus extension.[11] In contrast, studies demonstrate that hamstring autografts have an increased take a chance of laxity and functional hamstring weakness.[11] To date, no conclusive evidence exists, suggesting that one graft material produces superior long-term results. A study past Kocher et al. plant no association betwixt graft blazon and patient satisfaction in patients undergoing ACL reconstruction using hamstring and patellar grafts.[12]

Clinical Significance

Hamstring strains are common in both aristocracy and recreational athletes. In add-on to being highly prevalent, hamstring injuries are often boring healing and tend to recur. Estimates are that near one-third of those who suffer from a hamstring injury will reinjure themselves within i yr of returning to their sport.[13] Most hamstring strains occur in the context of high-risk activities such as sprinting, where rapid changes in speed or direction crusade excessive muscle lengthening. The biceps femoris is the nearly frequently injured of the hamstrings, followed past the semimembranosus and so the semitendinosus.[14][fifteen] Typically, hamstring injuries are characterized past hurting in the posterior thigh, which can be exacerbated by knee flexion and hip extension. In astringent injuries, patients may as well written report hearing a popping sound. During an evaluation of a patient with a possible hamstring injury, it is important that clinicians also consider other diagnostic possibilities such equally lumbosacral radiculopathy, adductor strain, or a femoral stress fracture.

Hamstring strain injuries classify as mild (Class I), moderate (Form II), or astringent (Course III) based on the severity of patient symptoms. Grade I injuries are characterized by minimal pain and functional impairment, with minimal disruption to the hamstring myofibrils present. Grade II injuries are partial thickness tears to the musculotendinous fibers. Patients showroom increased hurting with definite force loss. Grade Iii tears are present with severe pain, hematoma, significant strength loss, and a full-thickness tear to the hamstring musculus or tendon. Orthopedic consultation is the recommendation for Grade III tears and Grade 2/III tears, which touch on the distal aspect of the hamstring.

In the acute stage, the initial management of hamstring injuries is with protection, balance, ice, compression, and elevation to limit inflammation and swelling.[16] Range of motion should exist dictated past patient hurting tolerance, as excessive stretching of the hamstrings may lead to scar tissue formation.[17] The office of NSAIDs in hamstring injury is somewhat controversial, with some studies failing to show recovery benefits and others demonstrating possible adverse furnishings.[xviii][19] However, short courses (v to 7 days) of NSAIDs do not significantly hamper recovery and should be used primarily as analgesics. Alternative pharmacologic agents, such as platelet-rich plasma (PRP), have been explored for their employ in enhancing athlete recovery. Concerning PRP, in that location is no strong evidence to back up its utilise for muscle strain injury.[xx]

In patients who have healed to the bespeak where they tin begin therapeutic activities, exercise regimens that focus on eccentric contraction have been shown to shorten recovery time significantly.[21] These regimens can be altered based on the patient's stage of rehabilitation and can continue to subtract the rate of reinjury.[22] Although hamstring stretching is commonly advocated to decrease the probability of reinjury, hamstring flexibility training has not demonstrated a decrease in the incidence of hamstring re-injury. Studies have also emphasized the importance of neuromuscular control of the lumbopelvic region. A 2004 prospective randomized study plant that patients suffering from astute hamstring strain injury who were rehabilitated using a progressive agility and torso stabilization program showed lower rates of reinjury compared to those enrolled in a more standard progressive stretching and a strengthening programme.[23]

Review Questions

Figure

The paradigm shows the musculus areas that brand up the circuitous of the muscles of the posterior portion of the thigh: hamstring muscles. Contributed past Bruno Bordoni, PhD

References

1.

Koulouris G, Connell D. Hamstring muscle complex: an imaging review. Radiographics. 2005 May-Jun;25(3):571-86. [PubMed: 15888610]

ii.

Chakravarthi K. Unusual unilateral multiple muscular variations of back of thigh. Ann Med Health Sci Res. 2013 November;3(Suppl ane):S1-two. [PMC gratis commodity: PMC3853594] [PubMed: 24349835]

3.

Sussmann AR. Built bilateral absence of the semimembranosus muscles. Skeletal Radiol. 2019 October;48(ten):1651-1655. [PubMed: 30982941]

four.

Park JH, Park KR, Yang J, Park GH, Cho J. Unusual variant of distal biceps femoris muscle associated with common peroneal entrapment neuropathy: A cadaveric case report. Medicine (Baltimore). 2018 Sep;97(38):e12274. [PMC free article: PMC6160238] [PubMed: 30235672]

5.

Lempainen L, Banke IJ, Johansson 1000, Brucker PU, Sarimo J, Orava Due south, Imhoff AB. Clinical principles in the management of hamstring injuries. Human knee Surg Sports Traumatol Arthrosc. 2015 Aug;23(eight):2449-2456. [PubMed: 24556933]

6.

Folsom GJ, Larson CM. Surgical treatment of acute versus chronic complete proximal hamstring ruptures: results of a new allograft technique for chronic reconstructions. Am J Sports Med. 2008 Jan;36(1):104-nine. [PubMed: 18055919]

7.

Liu H, Zhang Y, Rang G, Li Q, Jiang Z, Xia J, Zhang M, Gu X, Zhao C. Avulsion Fractures of the Ischial Tuberosity: Progress of Injury, Mechanism, Clinical Manifestations, Imaging Examination, Diagnosis and Differential Diagnosis and Treatment. Med Sci Monit. 2018 December 27;24:9406-9412. [PMC costless article: PMC6322373] [PubMed: 30589058]

8.

Sherry M. Test and treatment of hamstring related injuries. Sports Health. 2012 Mar;four(2):107-14. [PMC complimentary article: PMC3435908] [PubMed: 23016076]

nine.

Gidwani Southward, Jagiello J, Bircher M. Avulsion fracture of the ischial tuberosity in adolescents--an easily missed diagnosis. BMJ. 2004 Jul x;329(7457):99-100. [PMC gratis article: PMC449822] [PubMed: 15242916]

10.

Frank RM, Hamamoto JT, Bernardoni Eastward, Cvetanovich G, Bach BR, Verma NN, Bush-league-Joseph CA. ACL Reconstruction Nuts: Quadruple (4-Strand) Hamstring Autograft Harvest. Arthrosc Tech. 2017 Aug;6(4):e1309-e1313. [PMC free article: PMC5622412] [PubMed: 29354434]

11.

Goldblatt JP, Fitzsimmons SE, Balk E, Richmond JC. Reconstruction of the inductive cruciate ligament: meta-analysis of patellar tendon versus hamstring tendon autograft. Arthroscopy. 2005 Jul;21(seven):791-803. [PubMed: 16012491]

12.

Kocher MS, Steadman JR, Briggs K, Zurakowski D, Sterett WI, Hawkins RJ. Determinants of patient satisfaction with outcome after anterior cruciate ligament reconstruction. J Bone Joint Surg Am. 2002 Sep;84(9):1560-72. [PubMed: 12208912]

13.

Heiderscheit BC, Sherry MA, Silder A, Chumanov ES, Thelen DG. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. J Orthop Sports Phys Ther. 2010 Feb;40(2):67-81. [PMC free article: PMC2867336] [PubMed: 20118524]

14.

Askling CM, Tengvar K, Saartok T, Thorstensson A. Acute first-time hamstring strains during high-speed running: a longitudinal report including clinical and magnetic resonance imaging findings. Am J Sports Med. 2007 February;35(2):197-206. [PubMed: 17170160]

15.

Opar DA, Williams MD, Shield AJ. Hamstring strain injuries: factors that pb to injury and re-injury. Sports Med. 2012 Mar 01;42(iii):209-26. [PubMed: 22239734]

16.

Brukner P. Hamstring injuries: prevention and treatment-an update. Br J Sports Med. 2015 October;49(19):1241-4. [PMC free commodity: PMC4602251] [PubMed: 26105015]

17.

Järvinen MJ, Lehto MU. The furnishings of early mobilisation and immobilisation on the healing process following muscle injuries. Sports Med. 1993 Feb;xv(2):78-89. [PubMed: 8446826]

18.

Reynolds JF, Noakes TD, Schwellnus MP, Windt A, Bowerbank P. Not-steroidal anti-inflammatory drugs neglect to raise healing of astute hamstring injuries treated with physiotherapy. S Afr Med J. 1995 Jun;85(6):517-22. [PubMed: 7652633]

nineteen.

Mishra DK, Fridén J, Schmitz MC, Lieber RL. Anti-inflammatory medication subsequently musculus injury. A handling resulting in short-term comeback but subsequent loss of musculus function. J Bone Joint Surg Am. 1995 Oct;77(x):1510-9. [PubMed: 7593059]

20.

Engebretsen L, Steffen 1000, Alsousou J, Anitua Due east, Bachl N, Devilee R, Everts P, Hamilton B, Huard J, Jenoure P, Kelberine F, Kon E, Maffulli Due north, Matheson M, Mei-Dan O, Menetrey J, Philippon M, Randelli P, Schamasch P, Schwellnus 1000, Vernec A, Verrall G. IOC consensus paper on the utilise of platelet-rich plasma in sports medicine. Br J Sports Med. 2010 Dec;44(15):1072-81. [PubMed: 21106774]

21.

Kraiem Z, Alkobi R, Sadeh O. Sensitization and desensitization of human thyroid cells in civilisation: furnishings of thyrotrophin and thyroid-stimulating immunoglobulin. J Endocrinol. 1988 Nov;119(2):341-9. [PubMed: 2462004]

22.

Brooks JH, Fuller CW, Kemp SP, Reddin DB. Incidence, risk, and prevention of hamstring musculus injuries in professional person rugby spousal relationship. Am J Sports Med. 2006 Aug;34(eight):1297-306. [PubMed: 16493170]

23.

Sherry MA, All-time TM. A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains. J Orthop Sports Phys Ther. 2004 Mar;34(three):116-25. [PubMed: 15089024]

culliganhishousy.blogspot.com

Source: https://www.ncbi.nlm.nih.gov/books/NBK546688/

Share this post