so everyone in this video we're going to dive into the key clinical anatomy of the quadriceps muscles we're going to show you all the anatomy as well as show you different conditions such as aell tendinopathy or osar schaus disease and how that matters in clinical practice if you're ready to learn let's dive in hey everyone CARiD here welcome back to clinical physio so let's dive into the quadriceps muscles and the first thing to say of course is that the name quad reeps tells us that there are four of these muscles the first of these is the biggest one rectus for morus so rectus for morus originates from two different places it has a straight head and a reflected head the straight head originates from the anterior inferior iliac spine of the pelvis and the reflected head just Round the Corner originates from the supraacetabular groove the groove just superior to the acetabulum of the pelvis from here the rectus vorus runs down the anterior thigh to insert into the superior patella via the quadriceps tendon that runs between the distal end of the rectus femoris and the patella the quadriceps tendon then turns into the patella tendon which inserts into the tibial tuberosity of the tibia you will see this theme of the quadriceps tendon and the t a tendon inserting into the tibial tuberosity throughout the anatomy so our next muscle of the four is vastus medialis located on the medial side of the anterior thigh now if we take off the rectus femoris muscle we'll be able to see this a little easier we can see that vastas medialis originates from the inter trochanteric line of the proximal femur which is this large swooping bony Landmark here on the anterior femur and it also originates from the linear Aspira running down here on the femur as well from here the vastus medialis runs down the medial side of the anterior thigh before like the rectus femoris muscle it inserts into the quadriceps tendon but this time on its medial Edge before the quadriceps tendon turns into the Pell tendon to insert into the tibial tuberosity then we have vastas lateralis located on the lateral side of the thigh this muscle originates from the greater tranta on the more lateral side of the proximal femur as well as the linear aspir on the posterior aspect of the femur as we said this muscle runs down the lateral thigh before attaching to the lateral aspect of the quadriceps tendon which then turns into the Pella tendon inserting into the tibial tuberosity and finally we have vastus intermedius located in the center of the quadriceps but deep or behind the rectus for morus muscle vastus intermedius originates from the anterior surface of the femoral shaft before it runs down the center of the anterior thigh and of course inserting into the quadriceps tendon which changes into the Bell tendon to insert into the tibial tuberosity of the tibia so now let's talk about the all important action of the quadriceps muscles and the action of these muscles is to extend the knee and in fact the quadriceps are the key muscle involved in this movement so if we now dive into the distal aspect of the quadriceps we can talk about the extensor mechanism the mechanism that allows for knee extension this is made up of the quadriceps tendon the patella and the patella tendon and all three of these different components together make up the extensor mechanism for an individual to be able to extend their knee all three of these different structures needs to be intact therefore if your patient has a rupture to the quadriceps tendon or a fracture of the patella or a rupture of the patella tendon they will not be able to complete a straight leg raise or knee extension this is why one of the most focal tests done in A&E after a patient has a knee trauma is to see whether or not they can complete a straight leg raise to check for the Integrity of these three structures and therefore the extension mechanism so next we're going to talk about the patella tendon in a little bit more detail for the condition of a patella tendonopathy this is also referred to as Jumper's knee because it most commonly occurs with a gradual onset due to repeated explosive movements of the quadriceps like when an individual is jumping and in fact it's most commonly seen in individuals who have jumping as a part of their sports or Hobbies such as basketball players such as long jumpers or high jumpers to give a few examples so when a patient has a Patell tendonopathy what we tend to find is that they present with pain in the center of the patella tendon so around the joint line of the knee anteriorly which is shown quite nicely here on the anatomy model where you can see the joint line on either side and therefore it's around this anterior section where we expect patients to have pain and so therefore you may well find that they have pain on palpation of the Patell tendon in that region this is quite nice to differentiate against when your patient might have patella femoral pain where we expect their pain to be a little bit higher around the patella or the tra of the femur itself so therefore knowing where patients get their pain here is really important now there are a couple of conditions that can present at the more distal patella tendon first of all an individual can have an insertional patella tendonopathy where they tend to have pain around the insertion of the patella tendon into the tibial tuberosity however one of the other really important conditions that will present with pain at the tibial tuberosity itself is osgard schlatter's disease more commonly referred to these days as just osgard Schlatter because the disease part of this condition is not a very good term so oscard schlatters occurs due to repeated traction from the Patell tendon onto the end plate or the growth plate bone at the tibial tuberosity this commonly occurs in teenagers where that bone around the tibial tuberosity is still growing therefore it's still a little bit immature and can be therefore more vulnerable to injury as a result so we find that individuals will come to see us with pain around the tibial tuberosity in particular because that's where the bone is being tractioned from the patella tendon where they might say to us that they've been noticing that when they're playing sports such as football or hockey or netball they're noticing this pain around the tibial tuberosity in particular with an overload sort of pattern we expect patients to present with quite marked swelling at the tibial tuberosity which can be really painful to palpate so certainly look out for that as well as a part of your differential diagnosis note the age is quite important here younger individuals of a Teenage year have more immature bone and therefore they are more likely to experience a pathology of the bone itself such as oscard schlatters however adults and older so for those between the ages of 20 and 40 whilst the bone has become more strong they are less likely to experience osgard schlatters because the bone is healthy but they may be more likely to experience a tendonopathy because the loads going through that tendon are much higher and as tendons get older they become a little bit more degenerate so that's a really important Point age matters younger individual think perhaps oscard schlatters particularly in your teenagers adults and slightly older you might be thinking about your Patell tendonopathy so next let's talk about nerve Supply and the nerve supply for the quadriceps muscles comes from the femoral nerve notice how the femoral nerve runs down the anterior thigh which therefore makes sense that the femoral nerve will innovate these muscles because the quadriceps are located on the anterior thigh now if we head up to the spine we can see that the femoral nerve originates from the nerve roots of L2 L3 and L4 this is really important when we think of pathology like a lumbar spine radiculopathy or a Lumbers spine nerve root compression here's a couple of reasons why first of all L3 for the knee we know that the myotome associated with the L3 level is knee extension right in the middle of those three and actually it therefore means and highlights to us that the L3 level carries a huge volume of the nerve supply for the femoral nerve because that knee extension controlled by the quadriceps is so closely associated with that spinal level we can also think about the patella tendon knee reflex when we're doing our reflex testing the Patell tendon reflex tests The Reflex at the spinal level L3 L4 once again when we look at the nerve supply for the femoral nerve it makes sense for why that is the case so everyone I really hope you've enjoyed this video if you have please support us by Smashing that like button and subscribe to the channel for all our best updates remember if you want more resources we have our brilliant Instagram account @ clinical physio loads of brilliant posts and reals for growing physiotherapists now if you want more on Anatomy make sure to check out clinical physio membership with the link to membership in the description below because on membership we have a whole series of anatomy tutorials with the anatomy boot camps we have the knee Anatomy boot camp the hip Anatomy boot camp the shoulder Anatomy boot camp the wrist and hand foot and ankle and more so make sure you check that out for all your Anatomy learning as well my name is CARiD thank you so much for joining us see you soon here on clinical physio