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Anatomy

Lower Limb

Question 66 of 180

You are performing a full neurological examination on a patient who presented with weakness of her left leg. The tendon of which of the following muscles is stretched during the patellar reflex:

Answer:

The quadriceps femoris tendon is continuous distally with the patella ligament which is attached to the tibial tuberosity distally.

The patella is a sesamoid bone embedded in the quadriceps femoris tendon which sits in the trochlear groove of the anterior femur. The patella acts to magnify the force exerted by the quadriceps femoris and to redirect the quadriceps force as it undergoes normal lateral tracking during flexion.

The medial and lateral patellar retinaculum are formed primarily from fibres of the vastus medialis muscle, and the vastus lateralis muscle and iliotibial tract respectively, and attach the patella margins to surrounding fascia.

The quadriceps femoris tendon is continuous distally with the patellar ligament which is attached to the tibial tuberosity distally.

By OpenStax College [CC BY 3.0 , via Wikimedia Commons

Patella. (Image by OpenStax College [CC BY 3.0 , via Wikimedia Commons)

Factors Preventing Lateral Patellar Draw

There are several structures that work together to keep the patella aligned and stabilised on the femur to prevent excessive lateral movement of the patella:

  • The lateral femoral condyle on the lateral aspect of the trochlear groove is normally slightly higher than the medial aspect, providing a buttress to the patella on the lateral side.
  • The vastus medialis muscle on the medial thigh acts to draw the patella in a medial direction. If the vastus medialis muscle is not strong enough, the patella is much more susceptible to dislocation.
  • The medial patellofemoral ligament, extending from the medial aspect of the patella to the medial femoral condyle, provides a significant force (about 60%) against lateral displacement.

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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