Tensor fascia lata muscle

The patient was treated using facilitated positional release techniques for relief of the muscle hypertonicity as well as the restrictions and somatic dysfunctions found. Special attention was given to the treatment of the piriformis and tensor fascia lata muscles. A prescription was given for nonsteroidal antiinflammatory (NSAID) medication. 

Fig. 12.15a,b. Tensor fasciae latae muscle. Sagittal 12-5 MHz US images obtained in a healthy subject over the proximal (a) and distal (b) insertion of the tensor fasciae latae muscle (Tfl). a The proximal tendon (arrow) of the tensor fasciae latae muscle can be appreciated as it inserts into the anterior superior iliac spine (ASIS). In the same plane, the belly of the gluteus minimus (GMi) is seen deeply to the tensor fasciae latae muscle. In b, the distal myotendinous junction of the tensor fasciae latae muscle (Tfl) exhibits a typical pointed appearance as a result of the convergence of its muscle fibers into the fasciae latae (arrowheads). At this level, the muscle belly of the vastus lateralis (VL) is found between the tensor fasciae latae muscle and the femur (arrow). The photograph at the left side of the figure indicates probe positioning... 

Unilateral pseudohypertrophy of the tensor fasciae latae muscle is an uncommon clinical entity that may simulate a soft-tissue neoplasm. This condition is incidentally discovered in elderly women who present with an asymptomatic and unilateral lump in the hip area. A clinical history of hip arthoplasty and peripheral neuropathies is often associated (Ilaslan et al. 2003). US demonstrates a fusiform enlargement of the tensor fasciae latae muscle which assumes a hyperechoic appearance due to an increased amount of fatty tissue interspersed between the muscle fibers (Fig. 12.71). Ifthe examiner is not aware of this condition, the oval shape and hyperechoic appearance of the mass could simulate a soft-tissue lipoma. However, the typical striations of muscle echotexture should avoid any diagnostic confusion. Familiarity with this condition and the characteristic features of tensor fasciae latae hypertrophy on US may aid in making an accurate diagnosis and avoiding unnecessary biopsy or surgical intervention. 

The muscle tissue of the tensor fascia lata is palpated starting at the anterior superior iliac spine (ASIS) and descending downwards for approximately 4 to 6 inches. It will feel like a firm rope and be tender to the touch when hypertonic. 

The muscles and tendons of the anterior hip can be divided in two groups superficial (sartorius and tensor fasciae latae) and deep (rectus femoris, iliopsoas and pectineus). Superficial muscles can be easily delineated with high US frequencies, whereas deep muscles may require switching the transducer frequency down for an adequate examination. 

In the superficial group, the sartorius and tensor fasciae latae arise from the anterior and lateral aspect of anterior superior iliac spine respectively (Fig. 12.2). The sartorius, the longest muscle of the human body, crosses the midline overlying the deep... 

Fig. 12.2. Anatomy of the anterior muscles and tendons of the hip. Schematic drawing of an anterior view through the hip illustrates the relationships of the anterior muscles to each other. The superficial tensor fasciae latae (Tfl) and sartorius (Sfl) arise from the anterior superior iliac spine (straight arrow). On a deeper plane, the rectus femoris (Rf) originates from the anterior inferior iliac spine (arrowhead). Observe the iliacus and the psoas muscles which join distally to insert through a common tendon onto the lesser trochanter (curved arrow). Medially to the iliopsoas tendon, the pectineus muscle (Pe) can be seen arising from the anterior aspect of the superior ramus of the pubis (Pb)...

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... 

The anterior muscles detected at the articular level are, from lateral to medial the tensor fasciae latae, the rectus femoris, the sartorius, the iliopsoas and the pectineus. Over the joint space, the iliopsoas muscle is the first to be identified in a lateral position relative to the femoral neurovascular bundle. Its tendon lies in an eccentric position within the posterior part of the muscle belly and can be detected as a hyperechoic anisotropic fibrillar structure (Fig. 12.14). The tendon is in close relationship with the anterior hip capsule and the two structures can usually be distinguished... 

Overuse tendinopathies of the hip affect mostly the tendon of the tensor fasciae latae (Bass and Connel 2002) and the rectus femoris tendon. Patients complain of localized anterior hip pain vdiich comes on after or, in more severe disease, during sport activities. This condition typically involves sprinters and is secondary to a forceful extension of the hip. Physical examination reveals tenderness over the anterior superior and anterior inferior iliac spines. Contraction of the muscle against resistance can increase the local pain. Clinically, the diagnosis of tensor fasciae... 

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