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Adductor magnus
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Gluteus maximus
Rectus femoris
Tensor fascia lata
Vastus lateralis
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This patient who presents with hip flexor spasticity in the setting of cerebral palsy most likely has rectus femoris spasticity. The major flexors of the hip are the iliopsoas, the rectus femoris, and the sartorius muscles. The iliopsoas is the largest contributor to this motion and provides isolated hip flexion activity because it does not cross the knee. The sartorius muscle proceeds from the lateral pelvis to the medial knee and provides hip abduction and thigh lateral rotation in addition to its hip flexor function. Finally, the rectus femoris proceeds from the anterior pelvis to the anterior knee and provides knee extension in addition to hip flexion. In patients with cerebral palsy, the rectus femoris is often spastic during swing phase of gait and this "firing-out-of-phase" results in stiff knee gait dysfunction. Dreher et al. studied the technique of distal rectus femoris transfer in patients with cerebral palsy. The found that studies have shown improvement in peak knee flexion in swing phase and knee motion in swing phase after this procedure. They recommend that this surgery should be considered in patients with cerebral palsy and rectus femoris firing out of phase. Incorrect Answers: Answer 1: The adductor magnus originates from the ischium and inserts on the medial thigh and tibia. This muscle is responsible for hip adduction rather than hip flexion. Answer 2: The gluteus maximus originates from the ilium and inserts on the posterior thigh. This muscle is responsible for hip extension rather than hip flexion. Answer 4: The tensor fascia lata originates from the lateral thigh and inserts on the lateral knee. This muscle is responsible for hip abduction and knee stabilization rather than hip flexion. Answer 5: The vastus lateralis originates from the lateral thigh and inserts on the patella. This muscle is also part of the quadriceps femoris but provides isolated knee extension rather than combined hip flexion and knee extension. Bullet Summary: The rectus femoris is a hip flexor and knee extensor muscle that is often spastic in patients with cerebral palsy.
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