Dynamic imaging of Rec fem

[Linh]

Hi Steve,

What technique/patient positioning do you employ to demonstrate separation of tendon tears/activation of quadriceps? Do you get the patient to hang their legs off the table and tell them to flex/extend their knees while they are still lying down?

I got 2 patients coming in for rec fem this week. Your lecture has been a great help. But I do think assessing the quality of scarring & follow up for healing is MR’s territory.

Best regards,
Linh

[Stephen Bird]

HI Linh,

I agree entirely that MRI should be used to follow progress / scarring etc of central tendon injuries as is more accurate.

As for a stress manoeuvre I have a few that you can try,

Asking them to cross their legs with the ankle of the leg you are scanning going on top of the other ankle works well to tighten the indirect tendon and it is this tendon that is 90% of the injuries we see.

You can also ask them to simply tighten their quadriceps group of muscles and most people can activate strongly. This is great for showing paradoxical movement.

Finally ask the patient to sit on the edge of the bed with hips and knees flexed 90 degrees and ask the patient to extend their knee against resistance provided by my leg. This works really well.
If you do the same test but ask them to raise their knee (flex the hip) against resistance this is a stress test for iliopsoas.

Steve

[Sandra St Cyr]

I love this – thanks Steve!

[Linh]

Thanks so much Steve! I doubt I have the strength to resist the patient’s knee and have my probe on the iliopsoas while pt is sitting. Same with bear hug subscap test, I got pulled towards the patient and lost my balance at times, quite embarrassing! But great tips, I will try these.

[Stephen Bird]

Toughen up a bit!!

Steve.

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