Hip flexors

Marsolais [38] reported improved motor function in patients with intramuscular stainless steel electrodes implanted in the quadriceps, hip flexors, extensors, and abductors. Though significant motor torque improvement was achieved in some of these patients, all of whom had some motor function preimplantation, patients required supervision for ambulation. 

Examination There was bilateral ptosis, rmld bifacial weakness (can t whistle a snarl-type of horizontal smile), diplopia, especially on lateral gaze to each side (attribntable to bilateral sixth-nerve weakness) and, as part of the clinical exam, definite difficulty swallowing water. He was short of breath and vital capacity was very low at 1.2 L. There was also moderate proximal weakness in the upper limbs, and hip flexors these worsened with briefly repetitive maximal effort. Sensory examination was normal. Tendon reflexes were slightly brisk throughout (as is usual in MG), and both plantar responses were flexor. 

Juvenile dermatomyositis (JDM) is perhaps the most uniform, in terms of clinical and histopathological features, of the whole PM/DM disease complex. Presentation may be before 5 years of age with peak incidence between 8 and 12 years. The disease may remit and recur until well into young adult life. The skin lesions include a facial rash in butterfly distribution across nose and cheeks. Erythematous skin changes are seen over extensor surfaces of joints, especially knees, knuckles and elbows. Muscle involvement is generally evident some time later and takes the form of weakness and stiffness, particularly affecting shoulder and pelvic musculature. Proximal muscles are often worse affected than distal muscles and extensors worse than flexors. In the absence of prompt and effective treatment contractures may occur at elbows, ankles, knees, and hips. Subcutaneous calcification and skin ulceration may be found calcification of deeper-lying connective tissue may be apparent on X-ray. 

Knee flexor 90 50-130 35-115 In general, decreases some disagreement with this, depending on hip angle... 

A number of muscles cross over more than one joint. The length of these muscles maybe inadequate to permit complete ROM of all joints involved. When a multijoint muscle simultaneously shortens at all joints it crosses, further effective tension development is prevented. This phenomena is called active insufficiency. For example, when the hamstrings are tested as knee flexors with the hip extended, less tension can be developed than when the hamstrings are tested with the hip flexed. Therefore, when testing the strength of multijoint muscles, the position of aU involved joints must be considered. 

The flexor muscles of the knee are located in the posterior compartment of the thigh. They are the hamstrings, the gracilis, the sartorius, the popliteus, and the gastrocnemius muscles. AU of these muscles are biarticular, with the exception of the popliteus and the short head of the biceps. Their action on knee flexion is related to the position of the hip. Rotation of the knee is also a function of these knee flexors. 

In the lower limbs the quadriceps femoris muscles are most severely affected and undergo progressive atrophy, particularly of the vastus medialis and lateralis, with relative sparing of the rectus femoris (Figure 9.2). As in the upper limbs the weakness is often more severe on the nondominant side. Weakness of the ankle dorsiflexors is also common but severe foot-drop occurs infrequently. Other muscle groups such as the hip extensors and abductors and ankle plantar flexors are usually only mildly affected. 

Fig. 12.3a-h. Anatomy of the anterior group (flexors) of muscles and tendons of the hip. Series of schematic drawings (a,c,e,g) and corresponding T1-weighted MR images (b,d,fdi) illustrate the relationship among the tensor fasciae latae (TfL)(JVL), iliopsoas (IPs), sartorius (Sa) and rectus femoris (RF) in transverse planes obtained from proximal to distal. Muscle bellies are represented in intermediate gray, tendons in black. In a,b, a white arrowhead indicates the rectus femoris tendon. Note that the sartorius muscle crosses the iliopsoas from lateral to medial as it proceeds downwards. Arrow, fasciae latae... 

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