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Passing to the lower extremity, the thigh muscles are the largest and the most powerful in the body. In front a great, four-headed muscle, quadriceps extensor, unites into a single tendon in which the knee-cap is set, and serves to straighten the knee, or when rising from a sitting posture helps elevate the body.
Experiment 131. To illustrate reflex action by what is called knee-jerk. Sit on a chair, and cross the right leg over the left one. With the tips of the fingers or the back of a book, strike the right ligamentum patellæ. The right leg will be raised and thrown forward with a jerk, owing to the contraction of the quadriceps muscles.
Cartilaginous and partly ossified loose bodies may accumulate in the ilio-psoas bursa and distend it, both in a downward direction towards the hip-joint, with which it communicates, and upwards, projecting towards the abdomen. The bursa beneath the quadriceps extensor subcrural bursa usually communicates with the knee-joint and shares in its diseases.
The chief physiological antagonistics of the glutei are the quadriceps femoris and tensor fascia lata. While the leg is supporting weight the stifle joint is fixed in position mainly by the quadriceps femoris group of muscles which are attached to the patella. Tendinous fibres intersect this muscular mass and relieve muscular strain during weight bearing.
Since the femoral nerve supplies the quadriceps femoris muscles, it follows that when the psoic portion of this nerve becomes diseased, the stifle loses its support, and in a unilateral involvement when the subject attempts to walk on the affected member, the stifle sinks down for want of support and the leg collapses unless weight is caught up with the other leg.
The injured limb is rendered useless for progression, as it suddenly gives way whenever the knee is flexed. Treatment is conducted on the same lines as in transverse fracture of the patella; in the majority of cases the continuity of the quadriceps should be re-established by suture within five or six days of the accident. The limb should be put up with the knee flexed and the toes pointed.
By an operation of subcutaneous section at the hips, knees, and feet, with application of plaster-of-Paris and extension, this hopeless cripple walked with crutches in two months, and with an apparatus consisting of elastic straps over the quadriceps femoris, peroneals, and weakened muscles, the valgus-foot being supported beneath the sole.
Attacks of this kind may recur at irregular intervals, during a period of many years. On examining the joint, it is usually found to contain fluid, and there may be points of special tenderness corresponding to the ligaments that have been overstretched. In cases in which there has been recurrent attacks of locking, the ligaments become slack, the joint is wobbly, and the quadriceps is wasted.
It pouches upward under the quadriceps femoris for a distance of two or three inches, a pad of fat separating the capsule from the muscle. Below the patella it is separated from the patellar ligaments by a thick pad of fat, but inferiorly it is in contact with the femerotibial capsules. The joint cavity is the most extensive in the body.
As examples may be cited the rupture of the quadriceps extensor in attempting to regain the balance when falling backwards; of the gastrocnemius, plantaris, or tendo-calcaneus in jumping or dancing; of the adductors of the thigh in gripping a horse when it swerves "rider's sprain"; of the abdominal muscles in vomiting, and of the biceps in sudden movements of the arm.
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